The forgotten scapula fracture: Challenges in delayed presentation

Scapula fracture is an uncommon high-velocity injury often missed in a polytrauma setting. Most are managed conservatively. Operative management is indicated in select situations, though there are no guidelines currently available to help make such a decision. Surgery is challenging due to the rarity of scapular fractures, their complex anatomy, the need for specialized implants and the technical skill required for such fixation. In the case of neglected scapular fractures, these issues are further exacerbated by the patient's delayed presentation. A thorough knowledge of anatomy is required to restore the essential strut stability of the scapula during minimally invasive surgery. This is essential for early mobilization of the shoulder girdle and good functional outcome. A narrative review of the various types of scapular fracture and their classification system is provided below with clinical cases and operative pearls. It also summarizes the diagnostic challenges, indications for delayed surgical intervention, technical considerations, current evidence, emerging technologies including three-dimensional planning, and practical recommendations for managing neglected scapular fractures.