A 90-Year-Old Male with Shoulder Pain After a Fall

Diagnosis

This patient was diagnosed with a comminuted intraarticular fracture of the scapula. Scapular fractures are uncommon, accounting for only 3%–5% of shoulder girdle fractures. Intraarticular fractures constitute 10%–30% of all scapular fractures.

Learnings/What to Look for

• This injury is associated with high-energy trauma. Scapular fractures are frequently associated with other acute injuries, including rib fracture (53%), lung injury (47%), head injury (39%), spinal fracture (29%), and clavicle fracture (25%)
• Intraarticular fractures of the glenoid account for the vast majority of open reduction and internal fixation procedures performed for management of scapular fractures

Pearls for Urgent Care Management and Considerations for Transfer

• Most scapula fractures can be managed with closed treatment
• Closed techniques are more suitable if there is significant displacement
• Surgery is often delayed if other, higher-acuity injuries are present

Acknowledgment: Images and case provided by Experity Teleradiology (www.experityhealth.com/teleradiology).