Scapula fracture with intrathoracic displacement of fracture following a mechanical fall: Discussion and outcome of an unusual presentation

Abstract

Scapula fractures are uncommon, usually associated with polytrauma from high-energy trauma. Intrathoracic displacement of fracture fragments is a rare complication. There is no clear consensus on operative management of scapula fractures since good functional outcomes are reported for non-operative treatment. All five previously reported cases involving intrathoracic displacement resulted from high-impact trauma and were treated operatively. In contrast, we describe the first reported case of a non-operatively treated scapula fracture with intrathoracic displacement, from lower-energy trauma. An 83-year-old female fell down nine stairs, sustaining a right displaced scapular body fracture, extending into the right third intercostal space, with associated second, third and fifth right rib fractures. The patient underwent non-operative management with sling immobilisation, pain management, supervised physiotherapy and monitoring of respiratory physiology. Seven months post-injury, the patient required no analgesia, was managing activities of daily living and had demonstratable improvement in upper limb outcome scores. This is the sixth reported case of intrathoracic displacement of a scapula fracture, and the first resulting from lower-energy trauma successfully managed with multi-disciplinary non-operative treatment.