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368 Fractures of the Scapula

Fractures of the Scapula Client Education
Sheet
VetBooks.ir Initial Database

BASIC INFORMATION
• Mediolateral and ventrodorsal radiographic • Malalignment of fractured bone segments
• Degenerative joint disease with glenoid
Definition projections of proximal aspect of limb fractures
Scapular fractures involve the spine, body, neck, • CBC, serum biochemistry panel, and uri- • Infection
or glenoid regions of the bone. nalysis to assess anesthetic risk; see American • Implant failure
Society of Anesthesiologists classification
Epidemiology (p. 1196). Recommended Monitoring
SPECIES, AGE, SEX • Electrocardiogram (p. 1096) and thoracic • Lameness evaluation 1-3 months after injury
Dogs and cats, either sex and any age radiography for complications of thoracic and treatment
trauma • Radiography at 6-10 weeks to evaluate
RISK FACTORS fracture healing
Trauma to the proximal forelimb Advanced or Confirmatory Testing
Computerized tomography (CT) delineates PROGNOSIS & OUTCOME
Clinical Presentation occult lesions.
HISTORY, CHIEF COMPLAINT • Based on severity of injury
Forelimb trauma secondary to motor vehicle/ TREATMENT • Good to excellent for nonarticular lesions
firearm accidents, falls, bites, or other injury
Treatment Overview PEARLS & CONSIDERATIONS
PHYSICAL EXAM FINDINGS Treatment goals are fracture stabilization for
• Variable degrees of lameness bone healing and maintenance of glenoid (joint) Comments
• Swelling, bruising, open wounds around congruency. • Scapular fractures can be missed if lameness
scapula is mild or ambulation is not evaluated at
• Pain on palpation of shoulder joint Acute General Treatment hospital admission (e.g., patient is carried in).
• Minimally displaced, nonarticular fractures • Fractures are often identified during thoracic
Etiology and Pathophysiology can be stabilized for 1 month with external radiography of trauma patients.
• Uncommon fractures, representing 0.5%- bandage support such as a Velpeau sling or • Suprascapular nerve damage is characterized
2.5% of all fractures treated at referral spica splint (p. 1161). by atrophy of supraspinatus and infraspinatus
hospitals • Severely displaced spine or body fractures muscles.
• Can be associated with regional injury to are stabilized with orthopedic wire or bone • Scapular fractures tend to heal well because
cervicothoracic spine, thoracic structures plate/screws. of abundant periosseous vascularity and
(pulmonary contusions, pneumothorax), • Neck fractures are stabilized with small pins cancellous bone supply distally.
and brachial plexus or bone plate/screws.
• Extensive medial and lateral musculature • Glenoid fractures require alignment of joint Technician Tips
provides support and extraosseous vascularity surface and are stabilized with screws or Skin at the edges of Velpeau slings should be
to fractured bone segments. pins. watched carefully for rub sores.
• Fractures are classified based on location: • Avulsions of the acromion process or
body, spine, neck, and glenoid or stable/ supraglenoid tubercle require tension-band SUGGESTED READING
unstable extraarticular versus intraarticular wiring to counteract distraction by the Johnson AL: Scapular fractures. In Fossum TW,
lesions. deltoideus and biceps muscles, respectively. editor: Small animal surgery, ed 4, St. Louis, 2013,
Mosby, p 1122.
DIAGNOSIS Chronic Treatment AUTHOR: Joseph Harari, DVM, MS, DACVS
• Bandage support for 4-6 weeks for com-
Diagnostic Overview minuted lesions and tenuous fixations EDITOR: Kathleen Linn, DVM, MS, DACVS
Radiography is necessary for diagnosis. Sedation • Controlled ambulation and passive flexion/
or general anesthesia may be required to obtain extension exercises to maintain muscle
diagnostic images because positioning is key tone and joint motion for 6 weeks until
for highlighting certain fractures. radiography confirms bone healing
Differential Diagnosis Possible Complications
• Shoulder luxation • Suprascapular nerve damage with neck
• Dorsal displacement of the scapula fracture or surgical repair

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