This retrospective series of 148 scapular fractures in 113 patients was the largest reported at the time, and the only one with structured follow-up of displaced subtypes. It documents the long-term disability caused by displaced scapular neck and spine fractures and proposes expanded indications for operative fixation. The authors also introduce a simple anatomic classification system and report outcomes of eight surgically treated cases using the posterior Judet approach.
The clinical reflex for scapular fractures should be: rule out associated injuries first, then classify the fracture by location to guide management. The 96% associated injury rate means a scapular fracture is a marker of high-energy trauma. Pulmonary injury, head injury, and ipsilateral clavicle fractures are common enough that a systematic search is mandatory, not optional.
Not all scapular fractures are equal. Body fractures do well nonoperatively even when displaced. Intraarticular glenoid fractures reliably cause significant stiffness and pain without intervention. Displaced neck fractures cause rotator cuff dysfunction through a mechanical mechanism: glenoid tilt converts compressive force to shear force, with a sharp increase beyond 40°-45°.
The surgical thresholds this paper proposes (more than 40° angulation or more than 1 cm medial glenoid displacement) give you a decision framework for neck fractures. When those criteria are met, the posterior Judet approach with plate fixation and early Codman's exercises is the operative construct — and in this series, it worked.
This retrospective series of 148 scapular fractures in 113 patients was the largest reported at the time, and the only one with structured follow-up of displaced subtypes. It documents the long-term disability caused by displaced scapular neck and spine fractures and proposes expanded indications for operative fixation. The authors also introduce a simple anatomic classification system and report outcomes of eight surgically treated cases using the posterior Judet approach.
The clinical reflex for scapular fractures should be: rule out associated injuries first, then classify the fracture by location to guide management. The 96% associated injury rate means a scapular fracture is a marker of high-energy trauma. Pulmonary injury, head injury, and ipsilateral clavicle fractures are common enough that a systematic search is mandatory, not optional.
Not all scapular fractures are equal. Body fractures do well nonoperatively even when displaced. Intraarticular glenoid fractures reliably cause significant stiffness and pain without intervention. Displaced neck fractures cause rotator cuff dysfunction through a mechanical mechanism: glenoid tilt converts compressive force to shear force, with a sharp increase beyond 40°-45°.
The surgical thresholds this paper proposes (more than 40° angulation or more than 1 cm medial glenoid displacement) give you a decision framework for neck fractures. When those criteria are met, the posterior Judet approach with plate fixation and early Codman's exercises is the operative construct — and in this series, it worked.