UMEM Educational Pearls

Title: What's the Diagnosis? Written by Dr. Katherine Baugher

Posted: 6/12/2011 by Haney Mallemat, MD (Emailed: 6/13/2011) (Updated: 6/13/2011)
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Question

13 y.o. with shoulder trauma (during basketball game). Arm held in adduction and exquisite scapular tenderness. Diagnosis?

Answer

Answer: Scapular Fracture

Scapular Fracture

Uncommon (1% of all fractures)
Extensive force required; high probability of associated injuries (pneumothorax, shoulder dislocation).
5 types: body/spine, acromion, neck, glenoid, and coracoid
Arm held in adduction and pain with shoulder movement; may mimic rotator cuff tear.
Obtain X-rays (AP shoulder and lateral scapula) or CT (if displaced).
Conservative management for non-displaced fractures; Orthopedic reduction for displaced fractures.
Complications include post-traumatic arthritis or bursitis.
NSAIDs are first-line analgesics.

References

Rosen P, Barkin R. Emergency Medicine: Concepts and Clinical Practice. Mosby Year Book; 2010:573-574.

Zlowodzki M, Bhandari M, Zelle BA, Kregor PJ, Cole PA. Treatment of scapula fractures: systematic review of 520 fractures in 22 case series. J Orthop Trauma. Mar 2006;20(3):230-3.