Skip to main content
Top
Published in: Journal of Medical Case Reports 1/2024

Open Access 01-12-2024 | Scapular Fracture | Case report

Treatment options and outcomes for delayed scapular anatomical neck fractures: a case report and review of the literature

Authors: Farzad Amouzadeh Omrani, Mohammad Khak, Reza Tavakoli Darestani, Sina Afzal, Mojtaba Baroutkoub, Mahdi Aghaalikhani, Hasan Barati

Published in: Journal of Medical Case Reports | Issue 1/2024

Login to get access

Abstract

Introduction

Scapular anatomical neck fractures are among the most infrequent shoulder girdle fractures. Only seven radiologically confirmed cases of scapular anatomical neck fractures have been documented in the literature to date, of which only one case underwent delayed surgery.

Case presentation

A 34-year-old male Persian patient with morbid obesity was diagnosed with a scapula anatomical neck fracture after a motor vehicle collision. The radiographic assessment of the patient indicated an increase in the scapular glenopolar angle (73.9°). Due to concurrent chest and head injuries, surgical intervention was deferred until 6 weeks following the injury. The posterolateral limited Dupont–Evrard approach was used because of the patient’s extremely high body mass index. Two plates were utilized to achieve stable fixation of the glenoid neck fracture. Following a 1 year follow-up period, complete fracture union was successfully attained, resulting in a constant score of 79.

Conclusions

The most accurate radiographic indicators of these fractures are a superior fracture line located laterally to the coracoid process, a small inferior spike, and an elevated glenopolar angle. The only tendon attached to the glenoid is the long head of the triceps, making these fractures unstable; therefore, surgery is required in the majority of instances. The small size of the fractured component makes stabilization more difficult. Overall, anatomical scapular neck fractures are extremely uncommon and distinguished from other scapular fractures by their unique radiological and biomechanical characteristics. This case highlights the challenges encountered when managing scapular fractures in patients with morbid obesity. The delayed surgical intervention and the choice of surgical approach tailored to the patient’s specific anatomical and physiological considerations proved to be effective in achieving a favorable outcome.
Literature
1.
go back to reference Aldridge S, Gray M. Fractures of the scapula. Orthop Trauma. 2019;33(5):308–14.CrossRef Aldridge S, Gray M. Fractures of the scapula. Orthop Trauma. 2019;33(5):308–14.CrossRef
3.
go back to reference Bartoníček J, Frič V, Tuček M. Fractures of the anatomical neck of the scapula: two cases and review of the literature. Arch Orthop Trauma Surg. 2013;133:1115–9.CrossRefPubMed Bartoníček J, Frič V, Tuček M. Fractures of the anatomical neck of the scapula: two cases and review of the literature. Arch Orthop Trauma Surg. 2013;133:1115–9.CrossRefPubMed
4.
go back to reference Chen J, Zhang W, Pang G, Meng Q, Zhu Y, Deng X. Influence of coracoglenoid space on scapular neck fracture stability: biomechanical study. BMC Musculoskelet Disord. 2022;23(1):30.CrossRefPubMedPubMedCentral Chen J, Zhang W, Pang G, Meng Q, Zhu Y, Deng X. Influence of coracoglenoid space on scapular neck fracture stability: biomechanical study. BMC Musculoskelet Disord. 2022;23(1):30.CrossRefPubMedPubMedCentral
5.
go back to reference Bartoníček J, Tuček M, Frič V, Obruba P. Fractures of the scapular neck: diagnosis, classifications and treatment. Int Orthop. 2014;38:2163–73.CrossRefPubMed Bartoníček J, Tuček M, Frič V, Obruba P. Fractures of the scapular neck: diagnosis, classifications and treatment. Int Orthop. 2014;38:2163–73.CrossRefPubMed
6.
go back to reference Spadafore SM, Wolcott M, Selenke D. Scapula. In: Khodaee M, Waterbrook A, Gammons M, editors. Sports-related fractures, dislocations and trauma: advanced on-and off-field management. Berlin: Springer; 2020. p. 143–51.CrossRef Spadafore SM, Wolcott M, Selenke D. Scapula. In: Khodaee M, Waterbrook A, Gammons M, editors. Sports-related fractures, dislocations and trauma: advanced on-and off-field management. Berlin: Springer; 2020. p. 143–51.CrossRef
7.
go back to reference Hardegger F, Simpson LA, Weber B. The operative treatment of scapular fractures. J Bone Joint Surg Br Vol. 1984;66(5):725–31.CrossRef Hardegger F, Simpson LA, Weber B. The operative treatment of scapular fractures. J Bone Joint Surg Br Vol. 1984;66(5):725–31.CrossRef
8.
go back to reference Arts V, Louette L. Scapular neck fractures; an update of the concept of floating shoulder. Injury. 1999;30(2):146–8.CrossRefPubMed Arts V, Louette L. Scapular neck fractures; an update of the concept of floating shoulder. Injury. 1999;30(2):146–8.CrossRefPubMed
9.
go back to reference Ogawa K, Inokuchi W, Matsumura N. Delayed surgery for displaced fracture of the anatomic neck and spine of the scapula: a case report and literature review. JSES Open Access. 2018;2(3):169–73.CrossRefPubMedPubMedCentral Ogawa K, Inokuchi W, Matsumura N. Delayed surgery for displaced fracture of the anatomic neck and spine of the scapula: a case report and literature review. JSES Open Access. 2018;2(3):169–73.CrossRefPubMedPubMedCentral
10.
go back to reference Jeong GK, Zuckerman J. Scapula fractures. New York: Shoulder fractures Thieme; 2005. p. 199–222. Jeong GK, Zuckerman J. Scapula fractures. New York: Shoulder fractures Thieme; 2005. p. 199–222.
11.
go back to reference Dupont R, Evrard H. Sur une voie d’accès postérieure de l’omoplate. J Chir. 1932;39:528–34. Dupont R, Evrard H. Sur une voie d’accès postérieure de l’omoplate. J Chir. 1932;39:528–34.
12.
go back to reference Pires RE, Giordano V, de Souza FSM, Labronici PJ. Current challenges and controversies in the management of scapular fractures: a review. Patient Saf Surg. 2021;15(1):6.CrossRefPubMedPubMedCentral Pires RE, Giordano V, de Souza FSM, Labronici PJ. Current challenges and controversies in the management of scapular fractures: a review. Patient Saf Surg. 2021;15(1):6.CrossRefPubMedPubMedCentral
13.
go back to reference Constant C, Murley A. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–4.CrossRef Constant C, Murley A. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–4.CrossRef
14.
go back to reference Tanton M. Fractures du col chirurgical de l′ omoplate. J Chir Paris. 1913;11:701–10. Tanton M. Fractures du col chirurgical de l′ omoplate. J Chir Paris. 1913;11:701–10.
15.
go back to reference Ada JR, Miller ME. Scapular fractures: analysis of 113 cases. Clin Orthop Relat Res. 1991;269:174–80.CrossRef Ada JR, Miller ME. Scapular fractures: analysis of 113 cases. Clin Orthop Relat Res. 1991;269:174–80.CrossRef
16.
go back to reference Gagey O, Curey J, Mazas F. Les fractures récentes de l’omoplate: a propos de 43 cas. Revue de chirurgie orthopédique et réparatrice de l’appareil moteur. 1984;70(6):443–7.PubMed Gagey O, Curey J, Mazas F. Les fractures récentes de l’omoplate: a propos de 43 cas. Revue de chirurgie orthopédique et réparatrice de l’appareil moteur. 1984;70(6):443–7.PubMed
17.
go back to reference Euler E, Habermeyer P, Kohler W, Schweiberer L. Scapula fractures–classification and differential therapy. Der Orthopade. 1992;21(2):158–62.PubMed Euler E, Habermeyer P, Kohler W, Schweiberer L. Scapula fractures–classification and differential therapy. Der Orthopade. 1992;21(2):158–62.PubMed
18.
go back to reference Bahk MS, Kuhn JE, Galatz LM, Connor PM, Williams GR Jr. Acromioclavicular and sternoclavicular injuries and clavicular, glenoid, and scapular fractures. JBJS. 2009;91(10):2492–510. Bahk MS, Kuhn JE, Galatz LM, Connor PM, Williams GR Jr. Acromioclavicular and sternoclavicular injuries and clavicular, glenoid, and scapular fractures. JBJS. 2009;91(10):2492–510.
19.
go back to reference Tavakoli Darestani R, Manafi Rasi AR, Baroutkoub M, Afzal S, Ebadi SS, Barati H. Arthroscopic assessment of glenoid bone loss. Trauma Mon. 2022;27(6):636–42. Tavakoli Darestani R, Manafi Rasi AR, Baroutkoub M, Afzal S, Ebadi SS, Barati H. Arthroscopic assessment of glenoid bone loss. Trauma Mon. 2022;27(6):636–42.
20.
go back to reference Herrera D, Anavian J, Tarkin I, Armitage B, Schroder L, Cole P. Delayed operative management of fractures of the scapula. J Bone Joint Surg Br Vol. 2009;91(5):619–26.CrossRef Herrera D, Anavian J, Tarkin I, Armitage B, Schroder L, Cole P. Delayed operative management of fractures of the scapula. J Bone Joint Surg Br Vol. 2009;91(5):619–26.CrossRef
Metadata
Title
Treatment options and outcomes for delayed scapular anatomical neck fractures: a case report and review of the literature
Authors
Farzad Amouzadeh Omrani
Mohammad Khak
Reza Tavakoli Darestani
Sina Afzal
Mojtaba Baroutkoub
Mahdi Aghaalikhani
Hasan Barati
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2024
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-024-04424-3

Other articles of this Issue 1/2024

Journal of Medical Case Reports 1/2024 Go to the issue