Scapula Fractures

The scapula, or shoulder blade, is a flat, triangular bone in your upper back that connects the humerus (upper arm bone) with the clavicle (collarbone). Fractures of the scapula are rare, making up less than 1% of all broken bones. These injuries typically occur after high-energy trauma, such as a car accident, a fall from height, or being struck by a heavy object.

Because the scapula is surrounded by thick muscles and is well protected, it requires significant force to break. This is why many patients with scapula fractures also have other injuries, including rib fractures, lung trauma, or spinal injuries.

Types of Scapula Fractures

Scapula fractures can occur in different parts of the bone, including:

• Scapular body – the large, flat central portion
• Glenoid – the socket part of the shoulder joint
• Acromion or coracoid process – bony projections at the top and front of the scapula

Each fracture type may require different management depending on how displaced or involved the injury is.

When Is Surgery Needed?

Most scapula fractures heal well without surgery, especially if they are not significantly displaced. However, certain types of fractures may require surgical repair to restore shoulder function and avoid long-term problems.

Doctors may recommend surgery in the following situations:

• The bones are displaced more than 20 mm (about ¾ inch)
• There is a shortening of the bone by more than 25 mm
• The fracture causes the shoulder to angle abnormally (angulation >40°)
• There is a step-off in the joint surface of more than 4 mm
• The patient has a “floating shoulder” — a combination of clavicle and scapula fractures making the shoulder unstable

The Surgical Procedure: Open Reduction and Internal Fixation (ORIF)

Surgery to repair a scapula fracture typically involves open reduction and internal fixation (ORIF). This means the bones are carefully repositioned into their normal alignment and then held in place using plates and screws.

The Judet approach is often used to access the broken scapula. This involves moving aside the infraspinatus muscle while carefully protecting the nerves and blood vessels that pass through the area.

In some cases, especially if both the scapula and clavicle are broken, both may be repaired during the same operation. This helps restore the stability of the shoulder girdle.

What to Expect After Surgery

Recovery Timeline

• Bone healing typically occurs within 8–10 weeks.
• Patients begin physical therapy shortly after surgery to regain motion and strength.
• Return to full activity can take several months, depending on the severity of the injury and patient progress.

Functional Outcomes

According to follow-up studies:

• Most patients regain excellent shoulder function, with scores that are nearly identical to their uninjured arm.
• Patients reported being able to return to regular activities, including lifting, reaching, and sports.

Possible Complications

While surgical treatment is generally safe and effective, some potential complications include:

• Infraspinatus muscle weakness or shrinkage (hypotrophy) – due to the surgical approach, though this rarely affects function
• Infection, though very rare when proper technique is used
• Post-traumatic arthritis, especially if the joint surface is involved
• Need for further surgery, such as shoulder replacement (arthroplasty), if arthritis or poor healing develops

In a large-scale study, around 12.6% of patients who had surgery for scapula fractures later required a shoulder replacement, particularly when the joint (glenoid) was involved.

Scapula Fractures and Associated Injuries

It is important to understand that scapula fractures often come with other injuries, especially when caused by high-energy trauma. In fact:

• Nearly 50% of patients had additional injuries
• Common associated conditions include:
  • Rib fractures
  • Lung injuries (e.g., pneumothorax or lung contusions)
  • Spinal fractures
  • Shoulder dislocations

This highlights the importance of a thorough evaluation and comprehensive care plan.

Is Surgery Right for You?

Not every scapula fracture needs surgery. The decision is based on:

• The location and severity of the fracture
• Whether the bones are displaced
• Your activity level, age, and health status
• Whether you have other injuries

If your fracture involves the shoulder joint or causes significant deformity or instability, surgery may offer the best chance for a strong, stable, and pain-free shoulder.

Summary

• Scapula fractures are rare and often associated with other traumatic injuries.
• Non-surgical treatment is successful in many cases, especially for stable or minimally displaced fractures.
• Surgical treatment using ORIF offers excellent outcomes for select patients with displaced or complex fractures.
• Most patients who undergo surgery regain near-normal function and experience low complication rates.
• A careful evaluation by an orthopedic surgeon is essential to determine the best treatment plan for your injury.

 

Do you have more questions?

Q. What is a scapula fracture?
A. A scapula fracture is a break in the shoulder blade, which is the flat, triangular bone located in the upper back.

Q. What causes scapula fractures?
A. Scapula fractures are typically caused by high-energy trauma such as car accidents or falls from a height.

Q. What are the symptoms of a scapula fracture?
A. Symptoms include severe shoulder pain, swelling, bruising, limited shoulder movement, and tenderness over the shoulder blade.

Q. How is a scapula fracture diagnosed?
A. Diagnosis is made through a physical exam and confirmed with imaging tests such as X-rays or CT scans.

Q. Are scapula fractures common?
A. No, scapula fractures are relatively rare due to the protection provided by surrounding muscles and the chest.

Q. What types of scapula fractures are there?
A. Fractures can occur in different parts of the scapula, including the body, neck, or glenoid (socket of the shoulder joint).

Q. How are scapula fractures treated?
A. Most scapula fractures are treated without surgery using immobilization, pain management, and physical therapy.

Q. When is surgery needed for scapula fractures?
A. Surgery is needed if the fracture is displaced, involves the shoulder socket, or affects shoulder stability and function.

Q. What does non-surgical treatment for scapula fractures involve?
A. It includes wearing a sling, resting, applying ice, pain medication, and gradually starting shoulder exercises.

Q. What are the goals of treatment for scapula fractures?
A. The goals are to relieve pain, allow the bone to heal properly, and restore normal shoulder movement and strength.

Q. How long does it take to recover from a scapula fracture?
A. Recovery time varies but generally takes several weeks to months depending on fracture severity and treatment.

Q. What complications can occur with scapula fractures?
A. Complications can include chronic pain, decreased shoulder motion, nerve injury, or improper bone healing.

Q. Can physical therapy help after a scapula fracture?
A. Yes, physical therapy is essential to regain shoulder motion, strength, and function after immobilization or surgery.

Q. What should patients avoid during recovery from a scapula fracture?
A. Patients should avoid heavy lifting, overhead activities, or movements that cause pain until cleared by their doctor.

Q. How can scapula fractures be prevented?
A. Prevention involves using seat belts, wearing protective gear during sports, and taking safety measures to prevent falls and accidents.

Q. Is imaging always necessary to evaluate a scapula fracture?
A. Yes, imaging like X-rays or CT scans is necessary to assess fracture location, severity, and guide treatment decisions.

Q. What is the prognosis for scapula fractures?
A. Most patients recover well with proper treatment, regaining good shoulder function and minimal long-term issues.

Q. Are there special considerations for scapula fractures in athletes?
A. Yes, return to sport requires full recovery of strength and shoulder function, often guided by sports medicine specialists.