[The surgical treatment of scapular fractures]

Scapular fractures are predominantly managed non-operatively. However, a subset of patients develops persistent pain, weakness, and functional impairment due to malunion, non-union, rotator cuff dysfunction, or scapulothoracic dyskinesia. Early identification of patients at risk for ongoing symptoms is essential, as timely surgical intervention may improve outcomes. Owing to the lack of randomized controlled trials comparing operative and non-operative management, surgical indications remain controversial. This article reviews the biomechanics of the scapula, mechanisms of injury, fracture types, and current operative indications. Two clinical cases are presented to illustrate decision-making in operative versus non-operative treatment. While selected patients benefit from surgical fixation with good long-term functional outcomes, evidence indicates that both treatment strategies can achieve high union rates when appropriately individualized.