Scapula Fracture - Causes, Symptoms, and Treatment

Introduction:

A complex network of encircling muscles surrounds the triangular-shaped bone known as the shoulder blade (scapula). Less than one percent of all fractured bones are scapula fractures, and many of these can be repaired without surgery.

Scapula fractures can result from vigorous, blunt trauma injuries encountered in a road traffic accident or falling from tremendous heights. Other severe injuries commonly accompany scapular fractures, such as fractured bones in the shoulder, collarbone, and ribs and damage to the head, lungs, or spinal cord.

The scapula may have one or more fractures.

• Scapular body (50% to 60% of patients).

• Scapular neck (25% of patients).

• Glenoid.

• Acromion.

• Coracoid.

What Are the Causes?

• Road traffic accidents due to a bike or vehicle collision or mishap.

• Direct trauma to the shoulder by falls.

• Falling with an outstretched arm.

• Blunt trauma to the shoulder by hitting with a baseball bat or hammer.

• Falling from greater heights.

• Contact sports involving teams.

• Direct scapula blow.

What Are the Symptoms of Scapula Fractures?

The most typical signs and symptoms of a scapula fracture include the following:

• Extreme pain when the patient moves the arm.

• Swelling around the back of the shoulder.

• Scrapes around the affected area.

How Is the Patient Evaluated for Scapula Fractures?

The doctor will assess the shoulder's location and posture to decide on the best course of action. The doctor will check for other injuries because scapula fractures frequently coexist with other trauma. The damage to soft tissues will also be treated (abrasions, open wounds, and muscular trauma).

If the patient has other severe injuries, the doctor might not be able to perform a thorough physical examination. To ascertain the degree of scapula damage, the doctor may also request imaging examinations of the shoulder and chest. The doctor can also suggest a computed tomography (CT) scan that gives a more comprehensive image. X-rays produce precise images of solid objects like bones.

What Are the Treatment Modalities for Scapula Fractures?

The majority of scapula fractures do not require surgery. Treatment options include ice, painkillers, and immobilization with a sling or shoulder immobilizer. For the first two weeks, the sling is usually worn for comfort, and then the shoulder's range of motion gradually increases. Also, surgery will be considered in severe cases.

How Is Non-surgical Treatment Done for Scapula Fractures?

• For most scapula fractures, non-surgical treatment with a straightforward sling is effective.

• While the bone heals, the shoulder is stabilized by the sling.

• To reduce the possibility of shoulder and elbow stiffness, the doctor could advise the patient to move the shoulder within the first week following the injury.

• As the discomfort subsides, the sling is removed.

• Exercises for passive stretching should be performed until full shoulder motion is restored. It takes anywhere between six months to a year to complete.

What Are the Surgical Treatments for Scapula Fractures?

Surgery may be required for some forms of scapular fractures:

1. Glenoid articular surface fractures where the bone has migrated out of position (displaced).

2. Scapula neck fractures that are severely angulated.

3. Acromion processes fractures that cause the arm bone to rub up against them which is also known as impingement syndrome.

The bone pieces are first realigned (reduced) during this procedure, and they are then secured together by fastening metal plates to the outside of the bone with specialized screws.

What Are the Preoperative Steps Leading To Scapula Fracture Surgery?

• The procedure is explained to the patient.

• Any queries or doubts about the procedure may be addressed.

• Informed consent permits the procedure.

• Recording a complete medical history.

• A complete physical exam is done to ensure good health before undergoing the procedure.

• Blood tests or other diagnostic tests depend upon pre-existing medical conditions.

• Exposure to any medicines, latex, tape and anesthetic agents (local and general) are evaluated.

• Detailed preoperative drug history is taken.

• History of bleeding disorders.

• Any anticoagulant medicines that affect blood clotting must be stopped.

• Pregnancy.

• An eight-hour fast before the procedure, generally after midnight, is advised.

• A sedative before the procedure may be given to help relax the patient.

• The sedative may make the patient drowsy, and assistance might be needed.

• A physical therapist before surgery may discuss rehabilitation.

• Specific preparations may be advised based on the medical condition or pre-existing disease.

How Is Pain Management Done Postoperatively?

• After an injury or surgery, pain is a normal part of recovery.

• The patient may recover more quickly if the doctor and nurses attempt to lessen the pain.

• Following surgery or an injury, prescription medications are frequently given to treat short-term pain.

• Opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics are just a few of the medications that can be used to control pain.

• To enhance pain relief and reduce the need for opioids, the doctor may combine these drugs.

• Be advised that while opioids can help with pain relief after injury or surgery, they are narcotics and can lead to addiction.

• In the United States, opioid use and overdose have elevated to a serious public health concern.

• It is crucial to utilize opioids solely in accordance with the current rules and norms in effect.

What Are the Postoperative Risks of a Scapula Fracture Repair Surgery?

Any surgical procedure contains certain risks or complications. Scapular fracture surgeries are no exception to this and may present postoperative complications, as enumerated below;

• Bleeding of the surgical site.

• Infection to the wound.

• Blood clots in the legs may disseminate to the lungs, causing death.

• Joint pain and weakness may not subside even after surgery.

• In some cases, a full-range motion may not be achieved in the shoulder joint.

• Nerves in the area of surgery may be injured, which results in weakness or numbness.

• Damage to blood vessels may occur at the surgical site.

• Other risks depending on specific medical conditions, may occur.

Conclusion:

Most scapula fractures result from direct impact. The most frequent signs and symptoms are pain, swelling, and bruising. Only approximately ten percent of scapula fractures necessitate surgery, and these fractures repair well and quickly with outstanding function. The scapular region's functional movements can be largely regained through rehabilitation. After an accident, physical therapy or rehabilitation is crucial for three to four months. After that, however, it gradually improves the patient's living condition.