[Scapular fracture related to polytrauma severity in patients with serious brachial plexus palsy]

Brachial plexus palsy is often accompanied by other injuries. Scapular fracture is thought to be a marker of polytrauma severity. The aim of this study was to evaluate associated injuries in patients with serious brachial plexus involvement and to determine whether there is a relationship between scapular fracture and severity of polytrauma in such patients.

We retrospectively evaluated 84 surgical patients who underwent brachial plexus reconstruction at our department between 2008 and 2011. In all of them, data on scapular fracture and major associated injuries were recorded.

Of the 84 patients, 22 (26.2%) had a scapular fracture. Of 61 patients with upper plexus palsy only 10 (16.4%) suffered a scapular fracture while of 23 patients with more severe plexus lesions 12 (52.2%, p<0.001) had fractured scapula. The ISS score in the patients with fractured scapula was significantly higher (51.8, SD=11, range=18-75, p<0.001). The patients with scapular fractures also had a significantly higher number of rib, clavicle, upper and lower limb fractures, and injuries to the thoracic organs and the head.

Both scapular fracture and serious brachial plexus injury are usually associated with other severe injuries. They occur due to high-energy trauma. Generally, patients who sustain scapular fractures and upper limb impairment in motorcycle and car crashes are at high risk of other associated injuries and more severe polytrauma.