Intra-thoracic displacement of scapular lateral margin: a case report and literature review

Cases of scapular fractures with fragments displacing into the thoracic cavity via intercostal spaces are exceedingly rare in clinical practice. According to the literature, there have been no prior reports of distal lateral margin fractures of the scapula that displace into the thoracic cavity.

We reported a case of a patient who presented with right shoulder pain and limited mobility after a fall. Examination revealed fractures of the medial and lateral margins of the right scapula, with the distal end of the lateral margin having detached from the inferior angle of the scapula and penetrating the thoracic cavity through the second intercostal space. Therefore, there existed the possibility of a pleural breach. We opted to perform an operation of open reduction and internal fixation via the Judet approach, during which it was confirmed that the fracture fragments were in contact but didn't perforate the pleura, thereby avoiding complications such as pneumothorax. The use of plates on both the medial and lateral columns, together with the sturdy scapular spine, formed a triangular structure that stabilized the fracture. At the six-month postoperative follow-up, the patient demonstrated favorable clinical outcomes.

Surgical approaches are increasingly becoming minimally invasive. In this complex case of scapular fracture, we chose a sufficiently exposed large incision surgical approach to provide a clear view of the fracture fragment that was directed toward the pleura. The non-thoracotomy approach, avoiding the complication of pneumothorax and ensuring rigid fracture fixation, represented an alternative form of "minimally invasive" surgery.