Scapula Fractures

A scapula fracture refers to a break in the shoulder blade, a flat triangular bone located in the upper back. While rare, making up less than 1% of all fractures, these fractures typically occur due to high-energy trauma such as car accidents, falls from height, or heavy impacts. Due to the scapula being well-protected by surrounding muscles, these fractures often involve other injuries, particularly rib fractures, lung trauma, or spinal injuries.

How Common It Is and Who Gets It? (Epidemiology)

Scapula fractures are rare, accounting for less than 1% of all fractures and 3-5% of shoulder girdle fractures. The most common demographic affected is males aged 25-50. The fractures can occur in various parts of the scapula, with the body/spine being the most commonly fractured area (45-50%), followed by the glenoid (35%) and the acromion (8%).

Why It Happens – Causes (Etiology and Pathophysiology)

Scapula fractures are primarily caused by high-energy trauma, with motor vehicle collisions responsible for over 70% of cases. Indirect trauma, such as falls on an outstretched hand or glenohumeral dislocation, can also lead to fractures. Associated injuries are common, with 80-95% of patients having other injuries, such as rib fractures, hemothorax, pulmonary contusions, or head trauma.

How the Body Part Normally Works? (Relevant Anatomy)

The scapula is a large triangular bone that connects the humerus (upper arm bone) to the clavicle (collarbone). It plays a crucial role in shoulder movement, providing attachment points for 18 muscles, including those involved in stabilizing the shoulder and allowing it to rotate. The scapula’s glenoid serves as the socket for the humeral head, forming the glenohumeral joint, while other processes like the acromion and coracoid aid in joint function and muscle attachment.

What You Might Feel – Symptoms (Clinical Presentation)

Symptoms of a scapula fracture include severe shoulder pain, swelling, and bruising over the shoulder blade. Limited shoulder movement and tenderness upon palpation are common. Some patients may experience systemic symptoms like chest wall pain or shortness of breath, especially if associated injuries like rib fractures or lung trauma are present.

How Doctors Find the Problem? (Diagnosis and Imaging)

Diagnosis begins with a physical examination, noting pain, tenderness, and swelling. X-rays, particularly true AP, scapular Y, and axillary views, are essential to assess fracture type and displacement. CT scans are often used for detailed fracture analysis and planning surgical intervention. MRI may be utilized if ligamentous injuries are suspected in complex cases.

Classification

Scapula fractures can be classified based on location:

• Scapular body fractures: The central portion of the scapula.
• Glenoid fractures: Involving the shoulder joint socket.
• Acromion fractures: Involving the bony projection at the top of the scapula.
• Coracoid fractures: Near the tip of the scapula.

Each type can vary in severity, with some requiring surgery if displacement or instability occurs.

Other Problems That Can Feel Similar (Differential Diagnosis)

Other conditions that can mimic the symptoms of a scapula fracture include rib fractures, shoulder dislocations, rotator cuff injuries, and nerve injuries. Accurate imaging and a thorough physical examination are essential to distinguish between these conditions.

Treatment Options

Non-Surgical Care
Most scapula fractures are treated conservatively. This includes immobilization with a sling for 2-3 weeks, followed by gradual rehabilitation to restore shoulder movement and strength. Non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to manage pain and swelling.

Surgical Care
Surgery is required for displaced fractures, fractures involving the glenoid, or those that compromise shoulder stability. Open reduction and internal fixation (ORIF) are commonly performed, using plates and screws to realign the bones. For glenoid fractures, the deltopectoral approach is typically used, while scapular body fractures may be treated via a posterior approach.

Recovery and What to Expect After Treatment

Recovery typically takes 6-8 weeks for bone healing. During this period, patients are advised to follow physical therapy protocols to regain full shoulder mobility and strength. Full activity, including sports and lifting, may resume after several months, depending on the severity of the injury.

Possible Risks or Side Effects (Complications)

Complications include post-traumatic arthritis, especially if the glenoid joint surface is involved, and malunion, which may result from improper bone alignment during healing. Nerve injuries, particularly to the axillary nerve or suprascapular nerve, can occur during surgical intervention. Rarely, additional surgery may be required, such as a shoulder replacement if arthritis develops.

Long-Term Outlook (Prognosis)

With proper treatment, the prognosis for scapula fractures is generally favorable, especially for non-displaced fractures. Most patients regain nearly full function of the shoulder. However, those with complex fractures, especially involving the glenoid or acromion, may experience complications like chronic pain or decreased range of motion.

Out-of-Pocket Cost

Medicare

CPT Code 23130 – Judet Approach Shoulder Surgery (Open Scapulothoracic Bursectomy): $148.40

Medicare Part B typically covers 80% of the approved cost for this procedure once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield generally cover the remaining 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans work in coordination with Medicare to fill the coverage gap and reduce financial responsibility.

If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans typically cover any remaining coinsurance or small deductibles, which generally range between $100 and $300, depending on your plan and provider network.

Workers’ Compensation

If your Judet approach shoulder surgery is needed due to a work-related injury, Workers’ Compensation will cover all associated medical expenses, including surgery, postoperative care, and rehabilitation. You will not have any out-of-pocket expenses, as the employer’s insurance carrier directly covers all approved treatments.

No-Fault Insurance

If your shoulder injury requiring the Judet approach surgery is related to an automobile accident, No-Fault Insurance will typically cover the full cost of treatment, including surgery and follow-up care. The only potential out-of-pocket cost may be a small deductible or co-payment depending on your policy.

Example

David Smith required Judet approach shoulder surgery (CPT 23130) to address his scapulothoracic bursitis. His estimated Medicare out-of-pocket cost was $148.40. Since David had supplemental insurance through Blue Cross Blue Shield, his remaining balance was fully covered, leaving him with no out-of-pocket expenses for the surgery.

Frequently Asked Questions (FAQ)

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.

Summary and Takeaway

Scapula fractures are rare but can result in severe shoulder pain and limited mobility. Most cases are treated non-surgically with a sling and physical therapy. Surgery is indicated for displaced fractures or those involving the glenoid. With proper management, patients typically recover with near-normal shoulder function.

Clinical Insight & Recent Findings

A recent study reviewed the outcomes of surgical versus conservative management of scapula fractures, particularly focusing on those treated at a level 1 trauma center.

The study found that scapula fractures, though rare, are often caused by high-energy trauma, such as road traffic accidents, and are frequently associated with polytrauma. The results revealed no statistically significant difference in quality of life between surgical and non-surgical treatment groups.

However, the surgical group did show better outcomes in certain complex fracture cases, especially for intra-articular fractures. The study highlighted that conservative management could be highly effective in many cases, but surgical intervention remains crucial for more severe fractures. (“Study on scapula fractures – see PubMed.“)

Who Performs This Treatment? (Specialists and Team Involved)

Orthopedic surgeons, particularly those specializing in shoulder injuries, are the primary specialists involved in treating scapula fractures. Physical therapists also play a crucial role in rehabilitation.

When to See a Specialist?

You should see a specialist if you experience persistent shoulder pain after a traumatic event, or if you have difficulty moving your shoulder due to pain or injury.

When to Go to the Emergency Room?

Seek emergency care if you have significant trauma to the shoulder, especially if accompanied by chest pain, difficulty breathing, or symptoms of nerve injury.

What Recovery Really Looks Like?

Recovery varies based on the severity of the fracture. Non-surgical cases typically recover in 6-8 weeks, while surgical cases may take several months to regain full function.

What Happens If You Ignore It?

If left untreated, scapula fractures can result in chronic pain, decreased shoulder movement, or long-term shoulder instability.

How to Prevent It?

Prevention involves wearing seatbelts in vehicles, using protective gear during sports, and taking precautions to avoid falls.

Nutrition and Bone or Joint Health

A diet rich in calcium and vitamin D helps support bone health, while regular exercise maintains joint function and muscle strength.

Activity and Lifestyle Modifications

During recovery, avoid lifting heavy objects, overhead activities, or any movements that trigger pain. Follow rehabilitation protocols as recommended by your doctor.