Post-traumatic bilateral scapular and thoracic vertebral body fractures - a case report

The simultaneous fracture of both scapulae with coexisting fracture of the thoracic vertebral body is observed extremely rarely and is fully dependent on the mechanism that caused them.

The 59-year-old patient was admitted to the trauma and orthopedic department because of back pain and the inability to move independently. A few hours earlier he suffered bludgeoning trauma from a thick branch falling from a tree. During the physical examination significant limitation the range of motion in shoulder joints with was found. <15 ° flexion and <30 ° abduction, with limited external rotation in the right shoulder joint, and <15 ° flexion and <15 ° abduction, with significant external rotation deficiency. Normal range of motion in both hands was preserved. No sensory deficits or paresis were observed. Radiographic examination revealed the presence of a multifragmentary fracture of both scapulae and a fracture of the Th9 vertebral body, which was confirmed by computed tomography of the chest. The patient was qualified for conservative treatment of scapular fractures and was fitted with an abduction splint for the left shoulder. The Th9 vertebral body required surgical approach. The patient underwent transpedicular stabilization of the Th7,8,9,10 vertebrae with precontoured rods for the kyphotic deformation of the spine. After the procedure, the patient was provided with Javette's brace strengthening the spine correction and discharged for further outpatient observation.

Fracture of the scapula is one of the most demanding fractures to diagnose in the classic radiological examination. CT scans with 3D reconstruction can be considered to be the "gold standard". Surgical procedures is indicated for patients with severe comminution of fracture fragments and neurological symptoms. Minor fracture displacements can be conservatively treated. Coexisting Th9 vertebra fracture in this case required surgery by posterior transpedicular stabilization.