What is your diagnosis?

Nondisplaced scapular neck and spine fracture (labeled in Image 2).

Image 2.  Case courtesy of Dr Ian Bickle, Radiopaedia.org, rID: 74640. Annotations by author

What other injuries are often associated with this diagnosis?

The scapula is relatively mobile and surrounded by large muscles that can absorb a significant amount of force. Therefore, in the presence of a scapular fracture, suspect other traumatic injuries such as the following [1,2].

1. Upper torso: rib fractures, clavicular fractures, sternal fractures

2. Cardiopulmonary: myocardial contusion, aortic dissection, pulmonary contusion, pneumothorax

3. Spinal: thoracic spine > cervical spine > lumbar spine

How can you better characterize this fracture?

Shoulder trauma x-ray series

1. True anteroposterior view

2. Superior-inferior axillary view (looking inferiorly at the shoulder with the arm abducted) (image 3)

Image 3. Case courtesy of Assoc Prof Frank Gaillard, Radiopaedia.org, rID: 7505. Annotations by author

3. Scapular Y view (Image 4)

Image 4. Case courtesy of Andrew Murphy, Radiopaedia.org, rID: 48080. Annotations by author

• Pearl: CT can be used to further characterize the fracture if there is concern for intra-articular extension, significant displacement, or high suspicion for concurrent injuries

Image 5. Case courtesy of Dr David Cuete, Radiopaedia.org, rID: 28072

What is your management and disposition from the ED?

This patient can be placed in a sling and follow up with orthopedics and/or sports medicine in 1-2 weeks. Most isolated scapular fractures are minimally displaced and require a sling for 2 weeks, followed by early shoulder mobility.

• Pearl: Indications for operative management include the following [2]

• Open fractures or neurovascular compromise

• Glenoid: displaced intra-articular fracture

• Scapular neck: fracture with significant angulation

• Scapular spine: comminuted fracture

• Acromion: fracture with subacromial space impingement

• Coracoid process: fracture with > 1cm displacement or third-degree acromioclavicular separation