Varied Reduction and Fixation Modalities for Scapula Fractures: A Case Series

Scapula fractures usually comprise polytrauma and seldom are operated on, resulting in a dearth of literature and clinical experience. The aim of this case series is to illustrate diverse patterns of scapula fracture, varied reduction and fixation modalities practiced in different case scenarios.

This is a retrospective descriptive case series, conducted at a teaching tertiary care center over a period of 1 year. Fifteen patients (14 males and 1 female) of scapula fractures following high-energy trauma, with an average age of 32.5 years, were selected based on the inclusion and exclusion criteria. They were operated by a single experienced trauma surgeon for internal fixation with a combination of different implant combination and placement. Variedly classified scapula fractures requiring a specific approach, reduction, and fixation with case-tailored implant positioning are illustrated in detail. Augmentation techniques such as long sub-glenoid screw, dual lateral border construct, concurrent acromion and coracoid fixation using saber incision, corresponding intra-articular and extra-articular fracture, lateral border reduction necessitating medial release using reverse Judet approach were applied and found to be effective in restoration of bony anatomy. This was evident by the restoration of radiographic (Cole's) parameters assessed postoperatively and at 6-month follow-up. Furthermore, augmentation of traditional fixation allows early range of motion and hence, a satisfactory functional outcome as apparent by the Constant-Murley Score assessment at 6-month follow-up.

Scapular fractures have a varied type, which makes accurate classification and visualization of fracture planes absolutely indispensable. Each pattern requires special consideration for choosing the appropriate surgical approach to achieve adequate reduction and final fixation using specific placement of different implants.