71.7 Fractures of the scapula

The scapula can break in several ways. Direct blows occasionally break it into several pieces. Its coracoid process can fracture, either with no displacement, or with downward displacement. Its neck can fracture, so that its glenoid articulation breaks off and is displaced. This is the most common scapula injury, and provided it does not involve the joint surface, it needs only symptomatic treatment. The acromion may fracture with only a crack, or with severe communition and displacement.

These fractures cause much pain and bleeding and are difficult to diagnose without sophisticated X–rays. A patient’s clavicle, his ribs, or his spine may be broken at the same time.

The scapula is splinted on both sides by muscle, so treatment is easy. Give him a sling and encourage him to move his shoulder, elbow, and fingers actively and early.

Figure 71.4: AN ANTERIOR DISLOCATION OF THE SHOULDER. Note the characteristic profile of the patient’s shoulder.

Figure 71.5: THE X–RAY APPEARANCES of an anterior dislocation of the shoulder. Always take an AP and an oblique view before you try to reduce what might seem to be an ordinary dislocation. If you take an oblique view routinely, you will not miss a rare posterior dislocation. A quarter of all acute dislocations are associated with a fracture, most commonly a fracture of the greater tuberosity.