FRACTURES OF THE SCAPULA
Mechanisms of injury:-
The body of the scapula is fractured by a crushing
force, which usually also fractures ribs and may dislocate
the sternoclavicular joint.
-neck of the scapula
may be fractured by a blow or by a fall on the shoulder;
the attached long head of triceps may drag the
glenoid downwards and laterally
-The coracoid
process may fracture across its base or be avulsed at
the tip. Fracture of the acromion is due to direct
force. Fracture of the glenoid fossa usually suggests a
medially directed force (impaction of the joint) but
may occur with dislocation of the shoulder7
-Clinical features
-arm is held immobile
-bruising over the scapula or the chest wall
-X-Ray:- a comminuted fracture of the body of the
scapula, or a fractured scapular neck with the outer
fragment pulled downwards by the weight of the arm.
Classification
-the scapula are divided anatomically into
scapular body, glenoid neck, glenoid fossa, acromion
and coracoid processes.
Treatment,:-
Body fractures Surgery is not necessary- The patient
wears a sling for comfort, and from the start practises
active exercises to the shoulder, elbow and fingers.
-the head is centred on
the major portion of the glenoid and the shoulder is
stable a non-operative approach is adopted
-Fractures of the acromion Undisplaced fractures are
treated non-operatively.
-Type III acromial
fractures, in which the subacromial space is reduced,
require operative intervention
-Fractures of the coracoid process-proximal to the
ligaments are usually associated with acromioclavicular
separations and may need operative treatment.
-Combined fractures-there is an associated
fracture of the clavicle or disruption of the acromioclavicular
ligament the glenoid mass may become
markedly displaced giving rise to a "floating shoulder"
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