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History of diagnostics and treatment of scapular fractures in children and adolescents and its clinical importance

  • Trauma Surgery
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Abstract

Almost 70 scapular fractures in children and adolescents, up to the age of 17 years, have been described in detail in the literature since 1839. The diagnosis of these injuries was based on autopsy, radiographs, CT and MRI examinations. The most frequent findings were fractures/epiphyseolyses of the coracoid, followed by fractures of the infraspinous part of the body and avulsion of the inferior angle of the scapular body. Less common were fractures of the acromion. Intra-articular fractures of the glenoid, or separation of an intact glenoid along the line of the anatomical or surgical necks, were reported only sporadically. Scapulothoracic dissociation was also recorded in several cases. The majority of fractures were treated non-operatively; operative treatment was used in glenoid fractures, certain fractures of the coracoid and fractures of the scapular body with intrathoracic penetration. Except for scapulothoracic dissociation, outcomes of treatment of these injuries were very good.

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References

  1. Blount WP (1955) Fractures in children. Williams and Wilkins, Baltimore

    Google Scholar 

  2. Weber BG, Brunner Ch, Freuler F (1978) Die Frakturbehandlung bei Kindern und Jugendlichen. Springer, Berlin

    Book  Google Scholar 

  3. Ogden JA (2000) Skeletal injury in the child, 3rd edn. Springer, New York

    Google Scholar 

  4. Goldstein RY, Chu A, Otsuka NY (2014) Scapular fractures in the adolescent patient: Diagnosis, management, and complications. In: Zuckerman JD (ed) Disorders of the shoulder, vol 3, 3rd edn. Wolters Kluwer-Lippincott, Williams and Wilkins, Philadelphia, pp 290–299

    Google Scholar 

  5. Fabricant PD, Flynn JM (2017) Fractures, dislocations, and acquired problems of the shoulder in children. In: Rockwood CA, Matsen FA, Wirth MA, Lippit SB, Fehringer EV, Sperling JW (eds) The Shoulder, 5th edn. Elsevier, Philadelphia, pp 515–542

    Google Scholar 

  6. Bartoníček J, Cronier P (2010) History of the treatment of scapular fractures. Arch Orthop Trauma Surg 130:83–92. https://doi.org/10.1007/s00402-009-0884-y

    Article  PubMed  Google Scholar 

  7. South JF (1839) Case of fracture of the coracoid process of the scapula with partial dislocation of the humerus forwards and fracture of the acromion process of the clavicle. Med Chir Trans 22:100–109. https://doi.org/10.1177/095952873902200108

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Callaway T (1849) A dissertation upon dislocations and fractures of the clavicle and shoulder-joint. Highley, London. https://doi.org/10.1007/s11999-011-2098-1

    Article  Google Scholar 

  9. Gurtl E (1864) Handbuch der Lehre von den Knochenbrüchen. Zweiter Teil, Hamm, Grote, p 521

    Google Scholar 

  10. Poland J (1887) Osteomyelitis of the scapula; separation of its coracoid epiphysis; pyemia (Card specimen). Pathol Soc Transac London 38:261–262

    Google Scholar 

  11. Bennett EH (1888) Separation of the coracoid epiphysis of the scapula. Trans Royal Acad Med Ireland 6:408–410. https://doi.org/10.1007/BF03171167

    Article  Google Scholar 

  12. Bennett EH (1888) Separation of the coracoid epiphysis of the scapula. Dublin J Med Science 86:97–99

    Article  Google Scholar 

  13. Lucas RC (1890) A case of fracture of the coracoid process uncomplicated with other injury with a study of the lesion. Guy’s Hosp Report 47:45–57

    Google Scholar 

  14. Poland J (1898) Traumatic separation of the epiphyses. Smith and Elder, London, pp 144–162

    Google Scholar 

  15. Stimson LA (1917) Fractures and dislocations. Lea & Febiger, New York, p 235

    Google Scholar 

  16. Braine (1919) Décollement épiphysaire de l’extrémité supérieure de l’_humérus avec fractures de l’omoplate: 1° fracture de la fosse sous-épineuse; 2° fracture de la coracoide à sa base chez un enfant de 13 ans. Bull Mémoir Sociét Anat, Paris, pp 386–390

    Google Scholar 

  17. Richmond CE (1880) Two cases of fracture of the scapula. Br Med J 1(1010):692–693. https://doi.org/10.1136/bmj.1.1010.692-a

    Article  Google Scholar 

  18. Bramwell P (1887) Fracture of the neck of the left scapula. Br Med J 1(1384):70. https://doi.org/10.1136/bmj.2.1384.70

    Article  Google Scholar 

  19. Wagner RC (1893) Fracture of both scapulae in an infant. University Med Magazine (University of Pensylvania) 6:470–471

    Google Scholar 

  20. Sissons WH (1860) Compound fracture of the scapula—recovery. Med Times Gazette 2:357

    Google Scholar 

  21. Rambaud A, Renault Ch (1864) Origine et développement des os. Librairie de F. Chamerot, Paris, pp 192–197

    Google Scholar 

  22. Hamilton F (1871) Practical treatise on fractures and dislocations. 4th edit. Henry C Lea, Phildelphia, pp 202–212

  23. McAlister A (1897) Notes on the acromion. J Anat Phys 27:245–251

    Google Scholar 

  24. Tanton J (1915) Fractures en général—fractures des membres—membre supérieur. JB Baillière, Paris, pp 785–819

    Google Scholar 

  25. Coues WP (1935) Fractures of the coracoid process of the scapula. New Engl J Med 212:727–728

    Article  Google Scholar 

  26. Lorthioir P (1927) Fractures du corps de l’omoplate. Archiv Franco-Belges Chir 30:888–889

    Google Scholar 

  27. Findlay R (1931) Fractures of the scapula. Ann Surg 93:1001–1008. https://doi.org/10.1097/00000658-193105000-00005

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Reggio AW (1938) Fracture of the shoulder girdle. In: Wilson PD (ed) Experience in the management of fractures and dislocations, based on an analysis of 4390 cases. Lippincott, Philadelphia, pp 370–374

    Google Scholar 

  29. Protass JJ, Stampfii FV, Osmer JC (1975) Coracoid process fracture diagnosis in acromioclavicular separation. Radiology 116:61–64

    Article  CAS  PubMed  Google Scholar 

  30. Pilling L, Steinert V, Hörmann D (1980) Skapulafrakturen in Kindeslater. Zentralbl Chir 105:1302–1304

    CAS  PubMed  Google Scholar 

  31. Ogden JA, Phillips SB (1983) Radiology of postnatal skeletal development VII. The Scapula Skeletal Radiol 9:157–169

    Article  CAS  PubMed  Google Scholar 

  32. Starke W (1988) Isolierte Frakturen des Schulterblattes in Kindes- und Jugendalter. Aktuelle Traumatol 18:73–75

    CAS  PubMed  Google Scholar 

  33. An HS, Vonderbrink JP, Ebraheim NA, Shiple F, Jackson WT (1988) Open scapulothoracic dissociation with intact neurovascular status in a child. J Orthop Trauma 2:36–38. https://doi.org/10.1097/00005131-198802000-00009

    Article  CAS  PubMed  Google Scholar 

  34. Ng GPK, Cole WG (1994) Three-dimensional CT reconstruction of the scapula in the management of a child with a displaced intra-articular fracture of the glenoid. Injury 25:679–680. https://doi.org/10.1016/0020-1383(94)90014-0

    Article  CAS  PubMed  Google Scholar 

  35. Lee S, Meinhard B, Schultz E (1997) Open reduction and internal fixation of glenoid fossa fracture in a child: a case report and review of the literature. J Orthop Trauma 11:452–454. https://doi.org/10.1097/00005131-199708000-00016

    Article  CAS  PubMed  Google Scholar 

  36. Warner JJP, Port J (1994) Stress fracture of the acromion. J Shoulder Elbow Surg 3:262–265

    Article  CAS  PubMed  Google Scholar 

  37. Kalideen JM, Satyapal KS (1994) Fractures of the acromion in tetanus neonatorum. Clin Radiol 49:563–565. https://doi.org/10.1016/s0009-9260(05)82938-1

    Article  CAS  PubMed  Google Scholar 

  38. Currarino G, Prescott P (1994) Fractures of the acromion in young children and a description of a variant in acromial ossification which may mimic a fracture. Pediatr Radiol 24:251–255. https://doi.org/10.1007/BF02015447

    Article  CAS  PubMed  Google Scholar 

  39. Blue JM, Anglen JO, Helikson MA (1997) Fracture of the scapula with intrathoracic penetration. J Bone Joint Surg Am 79-A:1076–1078. https://doi.org/10.2106/00004623-199707000-00016

    Article  Google Scholar 

  40. Moon BS, Price CT, Campbell JB (1998) Upper extremity and rib stress fractures in a child. Skeletal Radiol 27:403–405. https://doi.org/10.1007/s002560050408

    Article  CAS  PubMed  Google Scholar 

  41. Toro FG, Vaisman A, Villalón IE, Calvo R (2010) Fracture dislocation of the glenoid fossa with open physis: a case report. J Pediatr Othop 30:336–338

    Article  Google Scholar 

  42. Nakama K, Gotoh M, Mitsui Y, Okawa T, Higuchi F, Nagata K (2011) Epiphyseal fracture of the coracoid process occurring at the conjoined tendon origin. Case Rep Orthop 2011:329745. https://doi.org/10.1155/2011/329745

    Article  PubMed  PubMed Central  Google Scholar 

  43. Alaia EF, Zehava Sadka Rosenberg ZS, Rossi I, Zember J, Roedl JB, Pinkney L, Steinbach LS (2017) Growth plate injury at the base of the coracoid: MRI features. Skeletal Radiol 46:1507–1512. https://doi.org/10.1097/00000658-193105000-00005

    Article  PubMed  Google Scholar 

  44. Shannon SF, Hernandez NM, Sems SA, Larson AN, Milbrandt TA (2019) High-energy pediatric scapula fractures and their associated injuries. J Pediatr Orthop 39:377–381

    Article  PubMed  Google Scholar 

  45. Shin SJ, Wang SH, Kim JR (2016) Lung injury caused by greenstick fracture of the scapular body in a 6-year-old boy. Skeletal Radiol 45:555–558

    Article  PubMed  Google Scholar 

  46. Park HY, Jang HJ, Sur YJ (2017) Scapular body fracture and concomitant inferior angle apophyseal separation with intrathoracic displacement: a case report. J Pediatric Orthop B 26:429–432

    Article  Google Scholar 

  47. Park K-J, Kim Y-M, Kim D-S, Choi E-S, Shin H-C, Jeong J-J (2015) Avulsion fracture of the acromial physis in a 14-year-old boy; a case report. Arch Orthop Trauma Surg 135:223–235

    Article  PubMed  Google Scholar 

  48. Zettas JP, Muchnic PD (1976) Fractures of the coracoid process base in acute acromioclavicular separation. Orthop Rew 5:77–79

    Google Scholar 

  49. Montgomery SP, Loyd RD (1977) Avulsion fracture of the coracoid epiphysis with acromioclavicular separation. Report of two cases in adolescents and review of the literature. J Bone Joint Surg Am 59-A:963–965

    Article  Google Scholar 

  50. Zilberman RR (1981) Fracture of the coracoid process of the scapula. Injury 13:203–206

    Article  CAS  PubMed  Google Scholar 

  51. Bernard TN, Brunet ME, Haddad RJ (1983) Fractured coracoid process in acromioclavicular dislocations. Report of four cases and review of the literature. Clin Orthop Relat Res 175:227–232

    Article  Google Scholar 

  52. Taga I, Yoneda M, Ono K (1986) Epiphyseal separation of the coracoid process associated with acromioclavicular sprain. A case report and review of the literature. Clin Orthop Rel Res 207:138–141

    Article  Google Scholar 

  53. Martin-Herrero T, Rodríguez-Merchán C, Munuera-Martínez L (1990) Fractures of the coracoid process: presentation of seven cases and review of the literature. J Trauma 30:1597–1599

    Article  CAS  PubMed  Google Scholar 

  54. Bauer G, Fleuschmann W, Dussler E (1995) Displaced scapula fractures: indication and long-term results of open reduction and internal fixation. Arch Orthop Trauma Surg 114:215–219

    Article  CAS  PubMed  Google Scholar 

  55. Combalía A, Arandes JM, Alemany X, Ramón R (1995) Acromioclavicular dislocation with epiphyseal separation of the coracoid process: report of a case and review of the literature. J Trauma 38:812–815. https://doi.org/10.1097/00005373-199505000-00024

    Article  PubMed  Google Scholar 

  56. Cottalorda J, Allard D, Dutour N, Chavrier Y (1996) Fracture of the coracoid process in an adolescent. Injury 27:436–437. https://doi.org/10.1016/0020-1383(96)00041-1

    Article  CAS  PubMed  Google Scholar 

  57. Holst AK, Christiansen JV (1998) Epiphyseal separation of the coracoid process without acromioclavicular dislocation. Skeletal Radiol 27:461–462. https://doi.org/10.1007/s002560050419

    Article  CAS  PubMed  Google Scholar 

  58. DiPaola M, Marchetto P (2009) Coracoid process fracture with acromioclavicular joint separation in an American football player: a case report and literature review. Am J Orthop 38:37–40

    PubMed  Google Scholar 

  59. Leijnen M, Steenvoorde P, Da Costa A, Adhin S (2009) Isolated apophyseal avulsion of the coracoid process: case report and review of literature. Acta Orthop Belg 75:263–264

    Google Scholar 

  60. Jettoo P, de Kiewiet G, England S (2010) Base of coracoid process fracture with acromioclavicular dislocation in a child. J Orthop Surg Res 5:77. https://doi.org/10.1186/1749-799X-5-77

    Article  PubMed  PubMed Central  Google Scholar 

  61. Pedersen V, Prall WC, Ockert B, Haasters F (2014) Non-operative treatment of a fracture to the coracoid process with acromioclavicular dislocation in adolescent. Orthop Rew 6:5499

    Google Scholar 

  62. Archik S, Nanda SN, Tripathi S, Choudhari A, Rajadhyaksha H (2016) An isolated displaced fracture of the coracoid process treated with open reduction and internal fixation—a case report and review of literature. J Orthop Case Rep 6:37–39. https://doi.org/10.13107/jocr.2250-0685.372

    Article  PubMed  PubMed Central  Google Scholar 

  63. Knapik DM, Patel SH, Wetzel RJ, Voos J (2018) Prevalence and management of coracoid fracture sustained during sporting activities and time to return sport. Am J Sports Med 46:753–758. https://doi.org/10.1177/0363546517718513

    Article  PubMed  Google Scholar 

  64. Kuhl PJ, Bley T, Veldhoen S (2019) Die isolierte traumatische Avulsionsfraktur der Apophyse des Processus coracoideus als Differenzialdiagnose des Claviculahochstands beim Adoleszenten. Fortschr Röntgenstr 191:946–947. https://doi.org/10.1055/a-0884-3058

    Article  Google Scholar 

  65. Wollstein J, Tegtbur U, Meller R, Hanke AA, Berndt T, Krettek C, Weber-Spickschen TS (2019) Isolierte Fraktur des Processus coracoideus bei einem 14-jährigen Wasserballnationalspieler. Unfallchirurg 122:79–82. https://doi.org/10.1007/s00113-018-0547-y

    Article  PubMed  Google Scholar 

  66. Hart RA, Diamandakis V, El-Khoury G, Buckwalter JA (1995) A stress fracture of the scapular body in child. Iowa Orthop J 15:228–232

    CAS  PubMed  PubMed Central  Google Scholar 

  67. Bowen TR, Miller F (2006) Greenstick fracture of the scapula: a cause of scapular winging. J Orthop Trauma 20:147–149. https://doi.org/10.1097/01.bot.0000174707.10980.f4

    Article  PubMed  Google Scholar 

  68. Curtis C, Sharma V, Micheli L (2007) Delayed union of a scapular fracture—an unusual cause of persistent shoulder pain. Med Sci Sports Exerc 39:2095–2098. https://doi.org/10.1249/mss.0b013e318156e8ec

    Article  PubMed  Google Scholar 

  69. Tryfonidis M, Reynolds J, Ostlere S, Matthews S (2008) Greenstick fracture of the scapular blade; an unusual case of winging of the scapula. Injury Extra 39:130–133

    Article  Google Scholar 

  70. Caesar BC, Qureshi AA, Hay SM (2009) Locked and angulated fracture of the scapula blade in a 15-year-old rugby player: a closed manipulation technique for reduction. Eur J Orthop Surg Traumatol 19:93–95

    Article  Google Scholar 

  71. Burda R, Cibur P, Kitka M (2010) Subperiostal direct scapular fracture in a child. Rozhl Chir 89:146–147

    CAS  PubMed  Google Scholar 

  72. Kim MJJ, Rinsky LA, MacKenzie JD (2011) Scapular stress fracture initially masquerading as tumor or infection. Radiol Case Reports 6:510. https://doi.org/10.2484/rcr.v6i4.510

    Article  Google Scholar 

  73. Heyse-Moore Heyse-Moore GH, Stoker DJ (1982) Avulsion fractures of the scapula. Skeletal Radiol 9:27–32

    Article  PubMed  Google Scholar 

  74. Brindle TJ, Coen M (1998) Scapular avulsion fracture of high school wrestler. J Orthop Sports Phys Ther 27:444–447. https://doi.org/10.2519/jospt.1998.27.6.444

    Article  CAS  PubMed  Google Scholar 

  75. Kaminsky SB, Pierce D (2002) Nonunion of a scapula body fracture in a high school football player. Am J Orthop 31:456–457

    PubMed  Google Scholar 

  76. Szopinski KT, Adamczyk G, Drwiega M (2012) Traumatic detachment of the inferior angle of the scapula in a 5-year-old boy—a sonographic diagnosis. Skeletal Radiol 41:615–618

    Article  PubMed  Google Scholar 

  77. Miller C, Grainger A, Phillips R, Sabouni MV, Kraft JK (2018) Bowing fracture of the inferior angle of the scapula; a difficult diagnosis. Pediatr Radiol 48:146–149. https://doi.org/10.1007/s00247-017-3945-3

    Article  PubMed  Google Scholar 

  78. Jacoby J, Nicholls AJ, Clarke NMP, Fairhurst J (2011) Bilateral acromial fractures in a neonate with epileptic encephalopathy. Pediatr Radiol 41:788–789. https://doi.org/10.1007/s00247-010-1918-x

    Article  PubMed  Google Scholar 

  79. Morris CS, Lloyd T (1990) Case report 642. Skeletal Radiol 19:607–608. https://doi.org/10.1007/BF0024128

    Article  CAS  PubMed  Google Scholar 

  80. Oni OOA, Hoskinson J, McPherson S (1992) Closed traumatic scapulothoracic dissociation. Injury 23:138–139

    Article  CAS  PubMed  Google Scholar 

  81. Lange RH, Noel SH (1993) Traumatic lateral scapular displacement: an expanded spectrum of associated neurovascular injury. J Orthop Trauma 7:361–366

    Article  CAS  PubMed  Google Scholar 

  82. Zelle BA, Pape HC, Gerich TG et al (2004) Functional outcome following scapulothoracic dissociation. J Bone Joint Surg Am 86-A:2–7

    Article  Google Scholar 

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Acknowledgements

The authors wish to thank Prof. Chris Colton MB BS FRCS and Ludmila Bébarová PhD for their assistance in the editing the manuscript.

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  1. Institute of Anatomy, 1st Faculty of Medicine, Charles University, U Nemocnice 3, 128 00, Prague, Czech Republic

    Jan Bartoníček & Ondřej Naňka

  2. Department of Orthopedics, 1st Faculty of Medicine, Charles University and the Central Military Hospital, Prague, Czech Republic

    Jan Bartoníček

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Bartoníček, J., Naňka, O. History of diagnostics and treatment of scapular fractures in children and adolescents and its clinical importance. Arch Orthop Trauma Surg 142, 1067–1074 (2022). https://doi.org/10.1007/s00402-021-03800-8

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