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Scapula fracture: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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ICD-10 code
S42.1 Fracture of scapula.
Epidemiology of fracture of scapula
Fractures of the scapula constitute 0.3-1.5% of all bone lesions of the skeleton.
[1]
What causes a fracture of the scapula?
Fractures of the scapula in most cases occur with a direct mechanism of injury: a blow to the area of the scapula or a fall on it. With an indirect mechanism (a fall on the wrist or elbow joint of the withdrawn hand), the most common group is another damage: fractures of the articular cavity, shoulder blade, acromion and the coracoid process.
Anatomy of the scapula
The scapula is located from the II to VII rib on the posterior surface of the chest, it is a flat triangular bone with three edges (upper, medial and lateral), converging and forming three corners (upper, lateral and lower). The lateral corner is thickened and forms a neck of the scapula, passing into the articular cavity. Near the cavity from the upper edge a beak-shaped process departs. The anterior surface of the scapula is provided by the scapular muscle, the posterior part divides into two unequal pit sizes: the smaller one - the supraspinous, filled with the same muscle, and the large one - the subacute, filled with the subacute, small and large round muscles. The tip of the scapula, continuing in the lateral direction, ends in an acromion, hanging behind and above the articular cavity. From the awn and acromion begins the deltoid muscle, and from the coracoid process to the shoulder go the beak-brachial muscle, the short head of the biceps and the small pectoralis muscle. To the tubercles of the articular cavity above and below the cartilaginous zone, the long head of the biceps head and the long head of the three-headed muscles, respectively, are attached, respectively.
Starting from the transverse processes of C 1-4 with four prongs, it goes obliquely downward and the muscle that lifts the scapula is attached to the upper corner of the scapula. And two more muscles approach the medial edge of the scapula: a rhomboid, originating from the spinous processes C6-7 and Th3-4 and anterior dentate, starting with nine dents from the upper ribs (I to VIII or IX).
Such an abundance of muscles makes the shoulder blade very mobile. In addition, all of these muscles participate in the lead, reduction, external and internal rotation of the shoulder, and the trapezius and anterior cog muscles extend the shoulder beyond 90 °.
Symptoms of fracture of scapula
The nature of the symptoms of the fracture of the scapula depends on the localization of damage to the scapula. A permanent symptom is pain in the place of injury.
Diagnosis of fracture of scapula
In the history - a corresponding trauma with a characteristic mechanism of damage.
Examination and physical examination
Fractures of the body, awn and angles of the scapula are accompanied by pain, swelling due to hemorrhage - a symptom of the "triangular cushion". Palpable sometimes it is possible to reveal deformation, pathological mobility, crepitation. The limb functions suffer moderately.
Fracture of the articular cavity is manifested by pain, hemarthrosis, a sharp violation of the functions of the shoulder joint.
With a fracture of the neck of the scapula with a displacement of fragments, the shoulder joint slides forward and downward. Its outlines change. The acromion will unduly survive under the skin, and the coracoid process retreats posteriorly. Under the akromion, some kind of withering is formed. Movement in the shoulder joint is possible, but severely limited due to pain. When palpation is revealed, tenderness, sometimes crepitus in the zone of the neck of the scapula, especially if at the same time an attempt is made to passive movements. The injury site is available for examination from the anterior and posterior surfaces of the axilla.
Fractures of the acromion and the coracoid process characterize the swelling at the site of the injury, the presence of bruising (better seen on day 2-3), local tenderness and bone crunch, revealed by palpation of the processes. Movement in the shoulder joint is limited, as an attempt to perform them causes pain in the fracture sites.
Laboratory and instrumental research
The shoulder blade is covered with muscles, and its outer corner is covered with the tissues of the shoulder joint and is located in their depth. The pronounced swelling of the tissues due to edema and hemorrhage, repeating the shape of the scapula (symptom of the "triangular pillow"), in some cases makes it difficult to study and diagnose. To avoid possible errors with the slightest suspicion of a fracture of the scapula, it is necessary to perform radiography in two projections: the direct and lateral.
What do need to examine?
Treatment of fracture of scapula
Non-medicamentous and medicamentous treatment of fracture of scapula
Fractures of the scapula are treated mainly conservatively. For all kinds of fractures, anesthesia is performed by administering 1% of the procaine solution from 10 to 40 ml at the site of injury. Body fragments, awns and corners of the scapula are slightly displaced and do not need repositioning. Apply a dressing Dezo with a roller in the armpit for a period of 3-4 weeks.
With fractures of the neck of the scapula without displacement, a fracture of the acromion and the coracoid process with displacement, the limb is fixed with a diverting bus or a gypsum thoracobrachial bandage. The shoulder is withdrawn to 80-90 ° and diverted posteriorly from the axis of the forehead by 10-15 °. The period of immobilization is 4-6 weeks.
When the neck of the scapula is broken with the displacement, the reposition is performed with the aid of skeletal traction on the outgoing tire. Spin is carried through the elbow process. The position of the limb is the same as in fractures without displacement.
The stretch lasts 3-4 weeks, then it is replaced by a gypsum thoracobrachial bandage for another 3 weeks. The standing of fragments in the process of traction is controlled by clinical and radiological methods.
In the period of immobilization, a functional and physiotherapeutic treatment is carried out, after which a course of restorative therapy is prescribed.
Surgical treatment of shoulder fracture
To the surgical treatment of fractures of the neck, the shoulder blades are rarely used. Indications for open reposition are fractures with an unremoved significant displacement of fragments, especially angular ones, when they predict a gross violation of the functions of the shoulder joint.
The operation is performed under general anesthesia. The patient is placed on the stomach with the hand withdrawn. The incision is parallel to the outer edge of the scapula from the posterior edge of the deltoid muscle to the middle of the medial edge of the scapula. Exude and stupidly separate the subacute and small round muscles. The subacute muscle, along with the fascia, is crossed in the deltoid muscle. Raising the edges of the wound with hooks up and down, expose the neck of the scapula. The fragments are compared and fastened with metal plates. Slice the sown tissues. The skin is covered with catgut stitches and gypsum thoracobrachial bandage with lead and posterior deviation of the shoulder for a period of 6 weeks. The subsequent treatment is the same as with conservative methods.
Estimated period of incapacity for work
With fractures of the body, awn and the angles of the shoulder blade, the capacity for work is restored in 4-5 weeks.
With fractures of the neck of the scapula without displacement, a fracture of the acromion and the coracoid process with displacement to the patient, it is possible to start working in 6-8 weeks.
The ability to work with fractures of the neck of the scapula with displacement is restored in 8-10 weeks.
* In those cases where after surgery it is assumed the imposition of a deaf plaster bandage, the skin covers with catgut.