Fractures of the scapula.

The scapula connects the arm with the chest wall and is therefore of great importance for a free range of shoulder of motion. For a long-term scapular fractures had been treated predominantly conservative. However, clinical studies of the past decades revealed that some fracture patterns deserve operative treatment to prevent unfavorable functional outcome and chronic state of pain. Scapular fractures are predominantly acquired during high-energy trauma and these patients' presents with a mean of 3.9 associated injuries in the emergency department. Injuries to the head, chest and ipsilateral upper extremity are most common. As some of these injuries are possibly life threatening they are treated first. Scapular fractures are only very seldom surgical emergencies. Therefore they are treated during the phase of reconvalescence in polytraumatized patients. Decision-making should be based on a thoroughgoing diagnostics, including conventional x-rays and a CT-scan, epically in cases of glenoid neck or cavity fractures. All fracture patterns should be identified to there full extend and put into the context of the scapular suspensory complex. The OTA lately presented a new and comprehensive system for classification of the scapular fractures. It is divided in two levels. Level one for the general orthopedic or trauma surgeon and Level two for the advanced upper Extremity or Shoulder surgeon. This classification scheme allows an easy access to understanding of the severity and prognostics of scapular fractures. As a general guideline surgery is indicated if a double disruption of the Scapula suspensory system, a relevant malposition or dysintegrity of the glenoid (articular surface) or a displacement of the lateral column is present.