Scapula fracture fixation is an operation to realign and stabilise a displaced fracture of the shoulder blade. Most scapula fractures are treated non-operatively, but significantly displaced fractures — particularly those involving the glenoid neck or intra-articular glenoid — may require surgery.
An incision is made on the back of the shoulder (posterior approach, typically modified Judet). The fracture is exposed by working between or through the infraspinatus and teres minor muscles. The fragments are reduced and fixed with plates and screws. For intra-articular glenoid fractures, an anterior or combined approach may be needed. The operation takes one and a half to three hours.
Surgery is considered for significantly displaced glenoid neck fractures (medialization greater than 15–20 mm or angulation greater than 30–40 degrees), intra-articular glenoid fractures with a step or gap, and scapula fractures associated with a floating shoulder (combined clavicle and scapula neck fracture).
Most scapula fractures (over 90%) heal well with a sling and physiotherapy. The scapula is surrounded by thick muscles that provide a natural splint.
CT scan with 3D reconstruction for planning. Assessment of associated injuries — scapula fractures typically result from high-energy trauma and are often associated with rib fractures, pulmonary contusion, and brachial plexus injuries.
Restoration of scapular anatomy, particularly the glenoid articular surface and the relationship between the glenoid and the humeral head. Improved shoulder mechanics and reduced risk of post-traumatic arthritis.
Common after scapula surgery. Physiotherapy is essential.
Numbness or weakness in the shoulder.
More than expected due to the muscular approach.
Weakness of external rotation. Usually recovers.
Wound or deep infection.
Plates may be palpable through thin muscle.
Rare in the scapula due to excellent blood supply.
General anaesthesia. Positioned lateral or prone.
Sling for two to four weeks. Gentle exercises from week one. Active movement from four to six weeks. Strengthening from eight weeks. Full recovery four to six months.
X-rays at two weeks, six weeks, and three months.
The scapula is enclosed in thick muscle that acts as a natural splint. Most fractures heal well with a sling and exercises. Surgery is only needed when displacement significantly affects the shoulder joint mechanics.