A 65 yo M presents to the ED after falling 10 feet off a ladder. He is complaining of R shoulder pain, but denies head trauma, LOC or other injury. An xray of the R shoulder is done. What's the diagnosis? (see below for answer)

Answer: Scapular Fracture (superior border)

• Rare, represent 1% of overall fractures
• Associated w/ high energy trauma
• 90% of paitents w/ scapular fractures have other associated traumatic injuries
• Thoracic injury (rib fractures, thoracic spine fractures), pulmonary injury (pneumothorax, lung contusion), head injury, brachial plexus injury
• Findings: flattened shoulder, ecchymosis, limited ROM, shoulder held in adduction
• Majority of fracutres involving glenoid require operative management
• Otherwise minimally displaced scapular body fractures are managed non-operatively
• Immobilization w/ sling, ortho follow up
• This patient had subsequent CTs (head, cspine, chest/abdomen/pelvis) which were negative for other injuries

References:

Lapner PC, Uhthoff HK, Papp S. “Scapula Fractures”. Orthop Clin North Am. 2008 Oct;39(4):459-74, vi. doi: 10.1016/j.ocl.2008.06.004.

Zlowodzki, Michael, , et al. "Treatment of Scapula Fractures: Systematic Review of 520 Fractures in 22 Case Series". Journal of Orthopaedic Trauma, vol. 20, no. 3, March 2006, pp. 230-233.