Abstract
Surgical treatment of displaced intra- and extra-articular fractures of the scapula becomes a topical issue. Exact determination of the type of the fracture and its displacement represents necessary prerequisite for its indication.
This requires the two Neer views as well as 3D CT reconstruction from the posterior, lateral, anterior and medial views with subtraction of the humeral head and the clavicle. The aim of surgical treatment depends on the type of fracture.
In displaced intra-articular fractures it is the restoration of the congruency and stability of the joint. In displaced extra-articular fractures of processes, particularly of the coracoid, acromion and spine, the aim is to achieve healing in anatomical position, since healing in displacement may compromise the rotator cuff.
In displaced extra-articular fractures of the scapular body and neck the objective of treatment is to restore the anatomical position of the glenoid to the lateral border of the scapular body (the gleno-polar angle), i.e. to reconstruct the length and integrity of the lateral border. To achieve the normal range of motion of the scapula the restoration of congruency between its anterior surface and the chest wall is also important or, where necessary, it also requires removal of fragments penetrated into the chest wall.
Indicated currently for surgical treatment are extra-articular fractures of the scapular body and neck that meet the following criteria: 100% translation of fragments of the lateral border, 25-degree displacement of the glenoid to the lateral border of the scapula, medial displacement of the glenoid to the lateral border exceeding 1cm, and a fragment of the scapula penetrated into the chest wall. Surgical treatment of fractures of the scapular body and neck requires adequate mastering of the posterior Judet approach.