Fractures of the scapula, or shoulder blade, and acromion are relatively uncommon and typically the result of high-energy trauma. Because of the significant force required to fracture these well-protected bones, they are often associated with other injuries and require careful specialist assessment.
What is Scapular and Acromion Fractures?
The scapula is the flat, triangular bone at the back of the shoulder that serves as the attachment point for numerous shoulder and arm muscles. Scapular fractures account for less than 1 percent of all fractures and typically occur following road traffic accidents, falls from height, or direct heavy blows. The acromion is the bony projection at the top of the scapula that forms the roof of the shoulder joint. Isolated acromion fractures can also occur from direct trauma.
Types of Scapular and Acromion Fractures
Causes
Scapular fractures require significant force to occur, as the scapula is well protected by surrounding musculature. Road traffic accidents, particularly motorcycle collisions and car crashes, are the most common cause. Falls from significant height, industrial accidents, and sports collisions involving direct high-velocity impact to the shoulder or back can also produce scapular fractures. Because of the force required, scapular fractures are frequently accompanied by other injuries including rib fractures, pneumothorax, clavicle fractures, and brachial plexus injuries, which should be actively assessed.
- Severe pain localised to the posterior shoulder and scapular region, worsening significantly with any arm movement
- Swelling and bruising over the back of the shoulder and shoulder blade, which may take 24 to 48 hours to fully develop
- A visible deformity or step in cases of significantly displaced fractures
- Inability to move the arm due to pain, with the arm typically held close to the body in a protective position
- Weakness, numbness or tingling in the arm or hand, which may indicate associated brachial plexus or axillary nerve injury
- Shortness of breath or chest pain if associated pneumothorax or rib fractures are present, which must be assessed urgently
Diagnosis
Plain X-rays of the shoulder in multiple planes are the initial imaging investigation and will identify the majority of scapular fractures. Fractures involving the glenoid are best evaluated with CT scan with three-dimensional reconstruction, which is the gold standard for surgical planning. MRI is used when there is clinical suspicion of associated brachial plexus injury or rotator cuff tear. Associated vascular injury is evaluated with CT angiography when pulse deficits or expanding haematoma are detected.
Treatment
Non-Surgical Management
The vast majority of scapular fractures, over 90 percent, are treated non-surgically. Immobilisation in a sling for 3 to 4 weeks, followed by physiotherapy, is the standard approach for fractures that are stable and not significantly displaced.
Surgical Fixation (displaced fractures)
Displaced glenoid neck fractures, fractures involving the glenoid joint surface, or acromion fractures that are impinging on the subacromial space are treated surgically. Dr. Kushalappa performs open reduction and internal fixation to restore the anatomy and prevent secondary complications such as shoulder impingement or post-traumatic arthritis.
Why Choose Dr. Kushalappa Subbiah in Bangalore?
Dr. Kushalappa Subbiah completed a Fellowship in Shoulder Surgery at the Sydney Shoulder Research Institute, where he trained in advanced arthroscopic shoulder procedures including labral repair and reconstruction. He holds the International Olympic Committee (IOC) Diploma in Sports Medicine, and has direct clinical experience managing shoulder injuries in Indian athletes across cricket, swimming, tennis, and contact sports. He is appointed as a Consultant Shoulder Surgeon at NH Hospital, Bangalore.