Concomitant Intra-Articular Glenohumeral Lesions in Fractures of the Scapula Body

Abstract

Background: Scapula body fractures are rare injuries with an incidence of 1% of all fractures accounting for 3% to 5% of all upper extremity fractures. Fractures of the scapula commonly result from high-energetic trauma and fall from great height. While several studies focused on concomitant injuries of chest and head as well as the cervical spine, up to now in the common literature, no study exists analyzing the prevalence of concomitant intra-articular glenohumeral injury following extra-articular scapular fracture. Objectives: The aim of this study was to analyze the prevalence of concomitant intra-articular glenohumeral injuries in acute fractures of the scapula by performing magnetic resonance imaging (MRI) of the shoulder joint. Study Design and Methods: This prospective cohort study was performed at our academic Level I trauma center from November 2014 to October 2016. According to our clinical algorithm, all patients suffering from an acute scapula body fracture primarily underwent computed tomography (CT) for assigning the fracture according to the Orthopedic Trauma Association (OTA)-classification and therapy planning. In addition, 3 T MRI-scans of all patients were performed within seven days after trauma. Results: Twenty-one (16 male/5 female, mean age 53 years (25–83 y) patients with scapula body fractures (OTA 14.A3.2 80.1%, OTA 14.A3.1 4.8%, OTA14.B3.1 4.8%, OTA14.C3 9.5%) were enrolled. MRI revealed 11 acute intra-articular injuries in 8 of 21 patients (38%). In all 21 patients, hematoma of the rotator cuff and periarticular muscles was present. Three patients (14.3%) presented a partial bursa sided tear of the supraspinatus tendon, whereas in 5 (23.8%), a partial articular sided supraspinatus tendon tear and in 2 (9.5%) patients, a subtotal tear was observed. One patient (4.8%) showed a complete transmural supraspinatus tendon tear. Conclusions: Traumatic concomitant glenohumeral injuries in scapula body fractures seem to be more frequent than generally expected. Subsequent surgical treatment of these formerly missed but therapy-relevant injuries may increase functional outcome and reduce the postoperative complication rate following scapula body fractures.

The relationship between the presence of scapula fracture and mortality and morbidity in cases with blunt thoracic trauma

“…There are studies in the literature that show significantly varied results in this regard. [1,6,[16][17][18] Interestingly, the only finding in our study that did not overlap with the literature was the absence of brachial plexus and vascular injury in any of our cases. [7,13,16] Our region is a geographically scattered rural settlement.…”

“…In the previous studies, rib fractures were also found to be associated with SF. [6,13,14] To the best of our knowledge, no similar study was found that revealed a statistically significant correlation between the increased number of rib fractures and SF. We think that these significantly higher rates of rib fractures are due to the difference in both the trauma mechanism and the average age.…”

“…The sternal fracture was detected in 13 (15.1%) of our cases with SF, and no statistically significant relationship was found between SF and sternal fracture (p=0.261). In the study of Zyskowski et al, [6] the rate of sternum fracture in patients with SF was found to be 4.8%.…”

“…In many sources, additional injuries accompanying SF have been studied collectively as pneumothorax, pulmonary contusion, closed head trauma, and spleen/liver lacerations. [1,4,7,15] In the study of Zyskowski et al, [6] which included 21 cases, thoracic and extrathoracic injuries accompanying SF were classified, and the rate of lung contusion associated with SF was found to be 19%, and pneumothorax cases were 14.28%. In the study of Veysi et al, [16] it was reported that 28% of the cases had a pneumothorax, and 15.2% had lung contusion.…”

“…At the same time, intra-abdominal organ injuries, brain injuries, and pelvic fractures may accompany SF. [6] Mortality rates reaching approximately 15% have been reported in traumas accompanied bySFs. [4,7] Therefore, the patient with SF should be evaluated as a multi-trauma patient.…”