[Radiographic evaluation of scapula fractures]

The authors use both radiographic and CT examination for diagnosing fractures of the scapula. The standard trauma series consists of chest radiograph, ap radiograph of injured shoulder girdle, ap and lateral radiographs of the scapula (Neer I and II views). According to our experience, the axillary view is not very helpful. Chest radiograph allows for assessment of the thoracic wall, lungs and of both of the shoulder girdles, particularly the position of both scapulas with regard to the spine (thoracoscapular dissociation). The radiograph of the shoulder girdle should cover the entire scapula, the clavicle, acromioclavicular and sternoclavicular joints, and the proximal humerus. Where a scapula fracture is found, Neer I and II views are used. Neer I view is used to evaluate the joint line of the glenohumeral joint, medial displacement of the glenoid and to determine the value of the glenopolar angle. Neer II view, also called Y-view, allows assessing translation, angulation and overlapping of fragments of the lateral borders of the scapular body. CT scans are helpful for evaluation of the glenoid fossa and, where necessary, of the processes of the scapula. They, however, do not allow for correct determining of the fracture types, those of the scapular body in particular. Three-dimensional CT reconstruction is the only method that is able to determine the personality of the scapula fracture. In these reconstructions it is necessary to image the scapula from the anterior, posterior, medial and lateral aspects. Evaluation of the glenoid fossa and of the adjacent parts of the lateral border of the scapula requires subtraction of the proximal humerus and the clavicle. The authors verified the contribution of this radiodiagnostic method on a group of 25 patients with a fracture of the scapula, operated on between 2005 and 2008.