Scapula Fractures

A scapula fracture refers to a break in the shoulder blade, a flat triangular bone located in the upper back. While rare, making up less than 1% of all fractures, these fractures typically occur due to high-energy trauma such as car accidents, falls from height, or heavy impacts. Due to the scapula being well-protected by surrounding muscles, these fractures often involve other injuries, particularly rib fractures, lung trauma, or spinal injuries.

At Complete Orthopedics, our orthopedic specialists provide comprehensive evaluation and personalized treatment for scapula fractures, ranging from nonsurgical care to advanced surgical repair when needed.

This page explains the causes, symptoms, diagnosis, treatment options, and recovery process to help you understand your injury and treatment plan.

How Common It Is and Who Gets It

Scapula fractures are rare, accounting for less than 1% of all fractures and 3-5% of shoulder girdle fractures. The most common demographic affected is males aged 25-50. The fractures can occur in various parts of the scapula, with the body/spine being the most commonly fractured area (45-50%), followed by the glenoid (35%) and the acromion (8%).

Why It Happens

Scapula fractures are primarily caused by high-energy trauma, with motor vehicle collisions responsible for over 70% of cases. Indirect trauma, such as falls on an outstretched hand or glenohumeral dislocation, can also lead to fractures. Associated injuries are common, with 80-95% of patients having other injuries, such as rib fractures, hemothorax, pulmonary contusions, or head trauma.

How the Body Part Normally Works

The scapula is a large triangular bone that connects the humerus (upper arm bone) to the clavicle (collarbone). It plays a crucial role in shoulder movement, providing attachment points for 18 muscles, including those involved in stabilizing the shoulder and allowing it to rotate. The scapula’s glenoid serves as the socket for the humeral head, forming the glenohumeral joint, while other processes like the acromion and coracoid aid in joint function and muscle attachment.

What You Might Feel

Symptoms of a scapula fracture include severe shoulder pain, swelling, and bruising over the shoulder blade. Limited shoulder movement and tenderness upon palpation are common. Some patients may experience systemic symptoms like chest wall pain or shortness of breath, especially if associated injuries like rib fractures or lung trauma are present.

How Doctors Find the Problem

Diagnosis begins with a physical examination, noting pain, tenderness, and swelling. X-rays, particularly true AP, scapular Y, and axillary views, are essential to assess fracture type and displacement. CT scans are often used for detailed fracture analysis and planning surgical intervention. MRI may be utilized if ligamentous injuries are suspected in complex cases.

Classification

Scapula fractures can be classified based on location:

• Scapular body fractures: The central portion of the scapula.
• Glenoid fractures: Involving the shoulder joint socket.
• Acromion fractures: Involving the bony projection at the top of the scapula.
• Coracoid fractures: Near the tip of the scapula.

Each type can vary in severity, with some requiring surgery if displacement or instability occurs.

Other Problems That Can Feel Similar

Other conditions that can mimic the symptoms of a scapula fracture include rib fractures, shoulder dislocations, rotator cuff injuries, and nerve injuries. Accurate imaging and a thorough physical examination are essential to distinguish between these conditions.

Treatment Options

Non-Surgical Care
Most scapula fractures are treated conservatively. This includes immobilization with a sling for 2-3 weeks, followed by gradual rehabilitation to restore shoulder movement and strength. Non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to manage pain and swelling.

Surgical Care
Surgery is required for displaced fractures, fractures involving the glenoid, or those that compromise shoulder stability. Open reduction and internal fixation (ORIF) are commonly performed, using plates and screws to realign the bones. For glenoid fractures, the deltopectoral approach is typically used, while scapular body fractures may be treated via a posterior approach.

Recovery and What to Expect After Treatment

Recovery typically takes 6-8 weeks for bone healing. During this period, patients are advised to follow physical therapy protocols to regain full shoulder mobility and strength. Full activity, including sports and lifting, may resume after several months, depending on the severity of the injury.

Possible Risks or Side Effects

Complications include post-traumatic arthritis, especially if the glenoid joint surface is involved, and malunion, which may result from improper bone alignment during healing. Nerve injuries, particularly to the axillary nerve or suprascapular nerve, can occur during surgical intervention. Rarely, additional surgery may be required, such as a shoulder replacement if arthritis develops.

Long-Term Outlook

With proper treatment, the prognosis for scapula fractures is generally favorable, especially for non-displaced fractures. Most patients regain nearly full function of the shoulder. However, those with complex fractures, especially involving the glenoid or acromion, may experience complications like chronic pain or decreased range of motion.

Insurance & Cost

Scapula Fractures at Complete Orthopedics is covered by Medicare and most major insurance carriers (Aetna, Anthem BCBS, Cigna, Empire BCBS, UnitedHealthcare), as well as most workers’ compensation and no-fault insurance plans. Your out-of-pocket cost depends on your specific plan, deductible, and the medical necessity criteria that apply to your case.

Call our billing team at (631) 981-2663 before scheduling to verify your coverage and discuss expected out-of-pocket costs. For the full list of carriers we accept and patient billing protections, see our Insurance Information page.

Summary and Takeaway

Scapula fractures are rare but can result in severe shoulder pain and limited mobility. Most cases are treated non-surgically with a sling and physical therapy. Surgery is indicated for displaced fractures or those involving the glenoid. With proper management, patients typically recover with near-normal shoulder function.