ARRS 2022 Abstracts

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E1058. Scapular Fracture Classifications: What Orthopedic Surgeons Want to Know
Authors
  1. Beiyi Shen; Stony Brook Medicine
  2. Alvaro Bravo-Martinez; Stony Brook Medicine
  3. Max Hao; Stony Brook Medicine
  4. Jessa Tunacao; Stony Brook Medicine
  5. Elaine Gould; Stony Brook Medicine
  6. Akihiko Oishi; Stony Brook Medicine
  7. Daichi Hayashi; Stony Brook Medicine
Background
The scapula functions at the shoulder girdle as a base of motion and stability in association with the superior shoulder suspensory complex and the scapulothoracic, glenohumeral, and acromioclavicular joints. Scapular fractures are uncommon and typically caused by high energy trauma. Up to 43% of scapular fractures in trauma patients are not recognized on the initial chest radiograph because they are often overlooked, not included in the study, or superimposed by other structures or artifacts. Imaging plays a key role in determining the type of scapular fractures and help orthopedic surgeons plan surgical intervention.

Educational Goals / Teaching Points
This presentation aims to (1) describe anatomy and biomechanical function of the scapula, epidemiology, injury mechanism, and imaging classifications of scapular fractures; (2) recognize critical injuries associated with scapular fractures; (3) and understand what orthopedic surgeons want to know when they determine surgical vs. nonsurgical management of scapular fractures.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We will describe anatomy and biomechanics of the scapula, glenohumeral joint, and acromioclavicular joint, and epidemiology and injury mechanism of scapular fracture. Then, imaging evaluation of scapular fracture is discussed and illustrated in detail. X-ray imaging includes anteroposterior, Grashey, axillary, and lateral scapular (Y) views. This radiographic series allows diagnosis of scapular and ipsilateral clavicle fractures, as well as acromioclavicular and glenohumeral joint injuries. Grashey and axillary views are particularly useful for detection of intraarticular scapular fractures. CT allows detailed characterization of bone, joint, muscle, or ligament injury at the shoulder girdle and enables more reliable and accurate detection and staging of scapular injuries; this is especially true for coracoid process, glenoid, and scapular neck fractures. Several scapular fracture classifications are explained including (a) extra-articular (coracoid fracture - type 1 and 2; acromial fracture - type 1 to 3; scapular neck fracture (extra-articular glenoid neck fracture) - type 1 and 2; and scapular body fracture); Ideberg classification of intra-articular glenoid fracture (type 1–6); and [c] scapulothoracic dissociation. Differential diagnoses (os acromiale, accessory ossicles) and associated injuries (clavicle, rib, sternum, and spine fracture, pneumothorax, pulmonary contusion, brachial plexus injury) are also discussed. Last, clinical management and indications for surgery are described.

Conclusion
Imaging diagnosis can be made with radiographs but CT is helpful for fracture characterization and surgical planning. Treatment is generally nonoperative in a sling. Surgical management is indicated for intra-articular fractures, displaced scapular neck fractures, open fractures, and those associated with glenohumeral instability. Knowledge of scapular fracture classifications help guide orthopedic surgeons to select an appropriate surgical and nonsurgical management strategy.