Articular and extra-articular scapula fracture

Scapular fracture is varied but rare, and studies have only low levels of evidence. Surgical indications are increasingly numerous, but non-operative treatment with early rehabilitation is the gold-standard in the majority of cases, showing good results. Surgery is indicated according to the patient's functional demand, on certain anatomic criteria evaluated on CT: glenopolar angle <20 °, >10 mm frontal displacement (medialization) and sagittal angulation >40 ° for fractures of the scapular neck and body, and >4 mm joint displacement, involvement of more than 30% of the joint surface and persistent subluxation for glenoid fractures. Surgery provides good functional results but is technically difficult, with high rates of complications. Acromion fracture, and particularly stress fracture following reverse total arthroplasty, is difficult to treat and incurs frequent sequelae of pain and non-union. Conservative treatment is recommended only in non-displaced lateral fracture (Levy 1). In more medial fracture, osteosynthesis with one or two plates should be considered. Prosthetic revision is indicated in fewer than 10% of cases, for instability or glenoid loosening. The superior shoulder suspensory complex must be analyzed in the bone (scapular neck and clavicle) and ligaments (acromioclavicular and coracoclavicular). The extent of neck fracture displacement dictates surgical management, either (most frequently) by fixation of the clavicle alone or by double clavicular and scapular fixation.