Fracture Scapula

With knowledge of common accidental fractures, the finding of a fracture at an unusual site will suggest an unusual mechanism of injury. In the absence of a history of an unusual mechanism, abuse should be considered. Unusual sites of fractures in infants and toddlers include phalanges (Fig. 11.9), meta-carpals, metatarsals, pelvis and scapula (Fig. 11.10). Pelvic fractures have been described in association with sexual abuse (Johnson et al. 2004). 

The scapula develops multiple ossification centres which can be confused for fractures. Only the body s ossification centre is present at birth. In the first year a centre appears in the distal coracoid. A second centre appears at the base of the coracoid (the subcoracoid centre) around 10 years and forms a third of the... 

Fractures of the scapula are rare and are typically the result of high energy trauma. Immediate concern is therefore with regard to associated rib fractures, pulmonary or cardiac contusion and mediastinal injury. The presence of tenderness and swelling around the shoulder indicates the possibility of a scapular fracture, which can be evaluated by CT. Indirect trauma leads to avulsion injuries (Goss 1996). 

Treatment is usually by immobilisation with a sling and early mobilisation as comfort allows. Fractures of the body of the scapula are rarely displaced,... 

Fig. 24.11. Dissection of the axillary artery associated with a fracture of the body of the scapula. The simultaneous evaluation of osseous and vascular structures within the affected area is especially helpful in trauma (VRT image)...

Fractures of the sternum, scapulae, or clavicles are also possible, but generally they require a more forcefiil trauma for them to occur in adults. The clavicle is the most commonly fractured bone in children, however. 

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