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Scapular Fractures in the Pan-scan Era
Cortlyn Brown1, Karim Elmobdy2, Ali S Raja3
1Department of Emergency Medicine, The University of California San Francisco, San Francisco, CA.
Summary
Increased use of chest CT scans in trauma evaluations reveals many minor scapular fractures. These fractures, often diagnosed via CT alone, are associated with higher admission rates and injury severity scores but not increased mortality.
Area of Science:
- Trauma imaging and diagnosis
- Orthopedic injury assessment
- Radiological interpretation in emergency medicine
Background:
- Traditional teaching associates scapular fractures with severe injuries and high morbidity.
- Increased utilization of chest computed tomography (CT) and pan-scan protocols may lead to the diagnosis of clinically insignificant scapular fractures.
- This challenges previous assumptions regarding the severity of scapular fractures.
Purpose of the Study:
- To determine the proportion of scapular fractures detected solely by chest CT (SOCTO) versus those seen on both chest X-ray (CXR) and CT.
- To identify the frequency of isolated scapular fractures (without other thoracic injuries).
- To compare admission rates, mortality, hospital length of stay, and injury severity scores (ISS) across different patient groups.
Main Methods:
- Analysis of prospectively enrolled patients from the NEXUS Chest CT study across nine Level I trauma centers.
- Inclusion criteria: age > 14 years, blunt trauma within 6 hours of ED presentation, and chest imaging during evaluation.
- Comparison of four groups: scapular fracture, non-scapular fracture, scapular fracture SOCTO, and isolated scapular fracture.
Main Results:
- Scapular fractures were found in 2.7% of patients with both CXR and chest CT; 60.3% were SOCTO, and 19.0% were isolated.
- Common associated thoracic injuries included rib fractures, pulmonary contusion, pneumothorax, and thoracic spine fractures.
- Scapular fracture patients had higher admission rates (86.8% vs. 47.4%), higher ISS (21 vs. 5), and longer hospital stays (9.2 vs. 5.6 days) than non-scapular fracture patients, but similar mortality rates.
Conclusions:
- Under current blunt trauma imaging protocols, most scapular fractures are detected by chest CT alone and are often associated with other thoracic injuries.
- Patients with scapular fractures (SOCTO or isolated) exhibit increased admission rates and ISS compared to those without scapular fractures.
- Despite these differences, hospital mortality remains similar across groups, suggesting a potential re-evaluation of traditional teachings.
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