| Disease Discussion | Scapular fractures constitute approximately 1% of all fractures and 5-7% of those about the shoulder. Scapular fractures may involve the glenoid fossa and articular surface, neck, body, spinous process, acromion process, and coracoid process. They are found most frequently in the scaplar body, followed by the neck and other regions of the bone. Fractures of the rim of the gleonoid cavity occur approximately in 20% of traumatic glenohumeral joint dislocations. Either the anterior or posterior glenoid rim may be affected. Larger portions of the glenoid fossa may be fractured when the humeral head is driven against the glenoid cavity by a direct force. Fractures of the coracoid process relate to a direct injury from a dislocation humeral head, a direct force on the tip of the coracoid itself, or an avulsion owing to traction on the coracoclavicular ligament, the short head of the biceps, or the coracobrachialis. Isolated fractures of the coracoid process occur as a result of an avulsion injury or in trapshooters related to repetitive stress from the impact of the recoiling rifle. AP radiographs may not demonstrate the coracoid process adequately and must be supplemented with a lateral scapular view or axillary projection or both. Neurologic injuries may be a sequela of scapular fracture, particularly one that involves the acromion process or leads to avulsion of the coracoid process. Vascular compromise is rare following scapular injuries. Fractures of neighboring bones, including the ribs and clavicle, acromioclavicular joint dislocation, pulmonary involvement, skull fractures, and cerebral contusion may accompany scapular injuries. |
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