Diagnosis of scapular injuries
The clinical picture largely depends on the localization of the injury and the presence of associated complications (e.g., rib fractures with the development of pneumo- or hemothorax). Local manifestations include edema, abrasions, and pain; however, due to the powerful muscular framework, differentiating a fracture from a severe contusion can be challenging.
- Body and angles: usually fracture without significant fragment displacement.
- Glenoid fossa: movements in the shoulder cause acute pain, blood accumulates in the joint cavity (hemarthrosis).
- Acromion: deformation is visually noticeable, and soreness increases when attempting to tense the deltoid muscle.
- Scapular neck: the articular surface shifts inferiorly and anteriorly, the coracoid process is depressed, and the acromion begins to protrude. The most important criterion distinguishing this injury from an anterior shoulder dislocation is the absence of springy resistance when attempting movement in the joint.
Due to mild or masked symptoms, radiography in two projections remains the mandatory diagnostic standard, which is clarified using computed tomography (CT) if necessary.
Principles of conservative treatment
At the pre-hospital stage, when an accurate diagnosis is difficult to make without imaging, the patient is given general analgesics and the arm is immobilized with a sling or a Desault bandage. Subsequent tactics in a trauma hospital depend on the nature of the injury:
- Without displacement (body and angles): a local anesthetic is injected into the fracture area. The arm is placed on an abduction splint (abduction in the shoulder joint up to 90°, flexion in the elbow up to 30°), which ensures relaxation of the shoulder girdle muscles. If the fragments are reliably splinted by the muscle mass, treatment in a sling is permitted for a period of 3–4 weeks.
- With displacement (scapular neck): manual reposition and skeletal traction via the olecranon are required. The limb is placed on a CITO abduction splint (shoulder abduction 90°, posterior displacement 10°, elbow flexed to 90°). The weight mass ranges from 1.5 to 4 kg, and the fixation period is up to 4 weeks.
In all cases, therapeutic exercises (physical therapy) for the hand, wrist, and elbow joints are started from the first days of treatment.
Historical path: from bone-setters to CITO
Methods of bone fragment reposition were already described in detail by Avicenna. During the Renaissance, Ambroise Paré revolutionized limb surgery: he abandoned stump cauterization by introducing vessel ligation, justified the necessity of amputations within healthy tissues, and created the first prostheses.
In Russia, the treatment of injuries began with monastic healers and folk bone-setters (such as Pervushka Petrov in the 17th century). Systematic training started with the opening of medical schools under Peter the Great. In 1806, E. O. Mukhin published the work "First Principles of Bone-Setting Science", combining anatomical knowledge and medical experience.
Traumatology and orthopedics finally formed as a separate surgical specialty in 1932. A huge contribution to the development of the discipline was made by:
- G. I. Turner — achieved the opening of Russia's first department of orthopedics (1900).
- A. L. Polenov — initiator of the creation of the first First-Aid Stations (1917).
- N. N. Priorov — founder of the institute, which in 1940 became the Central Institute of Traumatology and Orthopedics (CITO).
The high level of the Soviet school made it possible to return 72% of the wounded to service during the Great Patriotic War, and the post-war period was marked by the introduction of new methods of osteosynthesis and bone defect plasty.
For the differential diagnosis of a scapular neck fracture and an anterior shoulder dislocation, remember the "spring": during a dislocation, the arm exerts springy resistance, whereas in a scapular neck fracture, the articular surface is displaced, but resistance is absent.
Class and exam questions
How to transport a patient with a suspected scapular fracture?
At the pre-hospital stage, immobilization of the arm with a sling or a Desault bandage is necessary, as well as pain relief with general analgesics.
In what position is the arm fixed during the treatment of a scapular body fracture?
The limb is placed on an abduction splint: the shoulder is abducted to 90°, and the elbow joint is flexed to 30°. This ensures optimal relaxation of the shoulder girdle muscles.
When did traumatology become an independent medical discipline in our country?
The official decision to separate traumatology and orthopedics into an independent branch of surgery was made in 1932 at the XXII All-Union Congress of Surgeons.
What else to study on this topic
- Method of skeletal traction via the olecranon
- Differential diagnosis of shoulder joint injuries
- Contribution of N. N. Priorov and G. I. Turner to the development of national orthopedics
- Experience in treating gunshot wounds of the extremities during the Great Patriotic War
- Development of prosthetics and orthopedic devices (G. A. Albrecht school)
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