Case report of an unusual extra-articular scapular malunion: Rare indication for surgery.

Introduction: Scapular fractures are relatively rare injuries usually associated with high-energy trauma and multiple concomitant injuries. Most of scapular fractures do not require surgical intervention.

Patient And Clinical History: A 42-year-old male sustained an extra-articular scapular body fracture along with multiple rib fractures with flail segments and right pneumothorax treated with intercostal drain. The scapula fracture was treated non-operatively initially, which resulted in very poor outcome. Operative intervention was planned following scans which showed a bony spike from the ventral surface impinging on the chest wall.

Surgical Technique: Bony spur was approached from dorsal side using a three-dimensional anatomical model as a guide for accurate localization.

Results: The patient's symptoms including shoulder stiffness and pain on deep inspiration settled down completely following removal of the spur.

Discussion: This case presents a new indication for surgical intervention in scapular body fracture which has not been published before. All the relevant measurements related to the fracture namely gleno-polar angle, lateral border offset and angulation were within published limits of indications for conservative treatment. Despite this, it resulted in poor outcome necessitating surgical intervention.