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Emerg Med J. 2007 May; 24(5): 370.
PMCID: PMC2658500

An unusual fracture of the scapular body

Fractures of the scapula are infrequent; they constitute 3–5% of all shoulder girdle injuries and 1% of all fractures. Fractures of the scapular body/spine make up 50% of scapular fractures.1

A 36‐year‐old man fell off a horse and sustained a direct injury to the shoulder. On examination, the patient had a prominence over the inferior angle of the scapula with restricted range of movement of the shoulder, especially protraction and retraction of shoulder. Radiographs revealed an unusual fracture of the body of the scapula with an apex anterior angulation of 40° on the scapular Y view.

figure em47050.f1
Figure 1 x Ray showing an angulated fracture of the body of scapula.

Scapulothoracic movement is complex and has six movements: elevation, depression, upward rotation, downward rotation, protraction and retraction and they are an important part of the movements of the shoulder girdle. Alhough most scapular body fractures are treated conservatively, fracture malunion can have adverse mechanical and functional effects on shoulder movement.1 Scapular snapping syndrome is one of the problems that could arise from malunion.

Accident and emergency staff need to be aware of these complications and the importance of ordering scapular Y views. These fractures would merit an early orthopaedic referral.


Competing interests: None declared.


1. Goss T P, Rockwood CA J r, Matsen F A, Wirth M A, Lippitt S B. Fractures of the scapula. In: eds. The shoulder, 3rd edn. Philadelphia: Saunders, 2004. 413–454.454

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