Open Reduction and Internal Fixation as Management of a Complex Scapular Fracture in a Polytraumatized Child: Case Report
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Published:
Dec 27, 2025
Keywords:
Scapula, pediatrics, bone fractures, open reduction, surgical management
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Abstract
Scapular fractures in children are rare and typically result from high-energy trauma. Conservative treatment is usually the preferred approach, and surgical intervention is uncommon. In adults, surgery has demonstrated better short-term functional outcomes, but its benefits in the pediatric population remain unclear. Determining which pediatric patients may benefit from osteosynthesis is challenging due to the lack of available evidence. However, the presence of complications and certain imaging measurements may help guide management. The objective of this report is to describe the case of a child who underwent surgical treatment for a complex scapular fracture and to highlight the usefulness of the glenopolar angle as a criterion for decision-making in these patients. Alterations in the glenopolar angle and other radiographic parameters may be useful in identifying patients who could benefit from surgical management, as well as in predicting complications and postoperative outcomes. Nevertheless, further studies are needed to validate these findings over the long term and to better establish their diagnostic and prognostic value.
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How to Cite
Mesa Rincón, D., Gamarra Patrón, A., Ochoa Ariza, M. F., & Gómez, S. R. (2025). Open Reduction and Internal Fixation as Management of a Complex Scapular Fracture in a Polytraumatized Child: Case Report. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(6), 578-585. https://doi.org/10.15417/issn.1852-7434.2025.90.6.2074
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Case Presentations
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References
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5. Tatro JM, Schroder LK, Molitor BA, Parker ED, Cole PA. Injury mechanism, epidemiology, and Hospital trends of scapula fractures: A 10-year retrospective study of the National Trauma Data Bank. Injury 2019;50(2):376-81. https://doi.org/10.1016/j.injury.2019.01.017
6. Dimitroulias A, Molinero KG, Krenk DE, Muffly MT, Altman DT, Altman GT. Outcomes of nonoperatively treated displaced scapular body fractures. Clin Orthop Relat Res 2011;469(5):1459-65. https://doi.org/10.1007/s11999-010-1670-4
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9. Jones CB, Cornelius JP, Sietsema DL, Ringler JR, Endres TJ. Modified Judet approach and minifragment fixation of scapular body and glenoid neck fractures. J Orthop Trauma 2009;23(8):558-64. https://doi.org/10.1097/BOT.0b013e3181a18216
10. Gauger EM, Cole PA. Surgical technique: a minimally invasive approach to scapula neck and body fractures. Clin Orthop Relat Res 2011;469(12):3390-9. https://doi.org/10.1007/s11999-011-1970-3
11. Cole PA, Dubin JR, Freeman G. Operative techniques in the management of scapular fractures. Orthop Clin North Am 2013;44(3):331-viii. https://doi.org/10.1016/j.ocl.2013.04.001
12. Tuček M, Naňka O, Malík J, Bartoníček J. The scapular glenopolar angle: standard values and side differences.
Skeletal Radiol 2014;43(11):1583-7. https://doi.org/10.1007/s00256-014-1977-4
13. Tuncel Cini N, Guner Sak N, Babacan S, Ari I. Investigation of morphological and biomechanical properties of the scapula for shoulder joint. Medeni Med J 2023;38(3):159-66. https://doi.org/10.4274/MMJ.galenos.2023.15483
14. Reynolds AW, Schimoler PJ, Miller MC, Kharlamov A, Hughes AJ, Altman GT. Stability, deformity, and fixation of the floating shoulder: a cadaveric biomechanical study. J Shoulder Elbow Surg 2023;32(3):519-25. https://doi.org/10.1016/j.jse.2022.09.021
15. Yadav V, Khare GN, Singh S, Kumaraswamy V, Sharma N, Rai AK, et al. A prospective study comparing conservative with operative treatment in patients with a ‘floating shoulder’ including assessment of the prognostic value of the glenopolar angle. Bone Joint J 2013;95-B(6):815-9. https://doi.org/10.1302/0301-620X.95B6.31060
16. Michelitsch C, Kabelitz N, Frima H, Kabelitz M, Beks R, Stillhard PF, et al. Osteosynthesis of scapular fractures: a retrospective cohort study. Arch Orthop Trauma Surg 2022;142(12):3845-52. https://doi.org/10.1007/s00402-021-04283-3
17. Dobelle E, Robert S, Gaujac N, Laumonerie P, Mansat P, Bonnevialle N. Scapular fractures osteosynthesis via Judet’s posterior approach: clinical and radiographic results. Int Orthop 2023;47(6):1557-64. https://doi.org/10.1007/s00264-023-05754-5
18. Vidović D, Benčić I, Ćuti T, Bakota B, Bekić M, Dobrić I, et al. Surgical treatment of scapular fractures: Results and complications. Injury 2021;52(Suppl 5):S38-S43. https://doi.org/10.1016/j.injury.2020.09.031
19. Wijdicks CA, Anavian J, Hill BW, Armitage BM, Vang S, Cole PA. The assessment of scapular radiographs: analysis of anteroposterior radiographs of the shoulder and the effect of rotational offset on the glenopolar angle. Bone Joint J 2013;95-B(8):1114-20. https://doi.org/10.1302/0301-620X.95B8.30631
20. Morey VM, Chua KHZ, Ng ZD, Tan HMB, Kumar VP. Management of the floating shoulder: Does the glenopolar angle influence outcomes? A systematic review. Orthop Traumatol Surg Res 2018;104(1):53-8.
https://doi.org/10.1016/j.otsr.2017.11.004
2. Schultz BJ, Davis EP, Chang G, Ward NH, Berkes M, Choo AM. Open reduction and internal fixation of pediatric scapula fractures: A report of 2 cases. JBJS Case Connector 2022;12(1). https://doi.org/10.2106/jbjs.cc.21.00725
3. Naňka O, Bartoníček J, Havránek P. Diagnosis and treatment of scapular fractures in children and adolescents: A critical analysis review. JBJS Rev 2022;10(2). https://doi.org/10.2106/jbjs.rvw.21.00132
4. Fonacier FS, Chan HK, Ugalde I. Pediatric scapular fractures and associated injuries following blunt chest trauma. Am J Emerg Med 2022;52:196-9. https://doi.org/10.1016/j.ajem.2021.12.014
5. Tatro JM, Schroder LK, Molitor BA, Parker ED, Cole PA. Injury mechanism, epidemiology, and Hospital trends of scapula fractures: A 10-year retrospective study of the National Trauma Data Bank. Injury 2019;50(2):376-81. https://doi.org/10.1016/j.injury.2019.01.017
6. Dimitroulias A, Molinero KG, Krenk DE, Muffly MT, Altman DT, Altman GT. Outcomes of nonoperatively treated displaced scapular body fractures. Clin Orthop Relat Res 2011;469(5):1459-65. https://doi.org/10.1007/s11999-010-1670-4
7. Rajfer RA, Salopek T, Mosier BA, Miller MC, Altman GT. Long-term functional outcomes of nonoperatively treated highly displaced scapular body and neck fractures. Orthopedics 2020;43(3):e177-e181. https://doi.org/10.3928/01477447-20200314-05
8. Gosens T, Speigner B, Minekus J. Fracture of the scapular body: Functional outcome after conservative treatment. J Shoulder Elbow Surg 2009;18(3):443-8. https://doi.org/10.1016/j.jse.2009.01.030
9. Jones CB, Cornelius JP, Sietsema DL, Ringler JR, Endres TJ. Modified Judet approach and minifragment fixation of scapular body and glenoid neck fractures. J Orthop Trauma 2009;23(8):558-64. https://doi.org/10.1097/BOT.0b013e3181a18216
10. Gauger EM, Cole PA. Surgical technique: a minimally invasive approach to scapula neck and body fractures. Clin Orthop Relat Res 2011;469(12):3390-9. https://doi.org/10.1007/s11999-011-1970-3
11. Cole PA, Dubin JR, Freeman G. Operative techniques in the management of scapular fractures. Orthop Clin North Am 2013;44(3):331-viii. https://doi.org/10.1016/j.ocl.2013.04.001
12. Tuček M, Naňka O, Malík J, Bartoníček J. The scapular glenopolar angle: standard values and side differences.
Skeletal Radiol 2014;43(11):1583-7. https://doi.org/10.1007/s00256-014-1977-4
13. Tuncel Cini N, Guner Sak N, Babacan S, Ari I. Investigation of morphological and biomechanical properties of the scapula for shoulder joint. Medeni Med J 2023;38(3):159-66. https://doi.org/10.4274/MMJ.galenos.2023.15483
14. Reynolds AW, Schimoler PJ, Miller MC, Kharlamov A, Hughes AJ, Altman GT. Stability, deformity, and fixation of the floating shoulder: a cadaveric biomechanical study. J Shoulder Elbow Surg 2023;32(3):519-25. https://doi.org/10.1016/j.jse.2022.09.021
15. Yadav V, Khare GN, Singh S, Kumaraswamy V, Sharma N, Rai AK, et al. A prospective study comparing conservative with operative treatment in patients with a ‘floating shoulder’ including assessment of the prognostic value of the glenopolar angle. Bone Joint J 2013;95-B(6):815-9. https://doi.org/10.1302/0301-620X.95B6.31060
16. Michelitsch C, Kabelitz N, Frima H, Kabelitz M, Beks R, Stillhard PF, et al. Osteosynthesis of scapular fractures: a retrospective cohort study. Arch Orthop Trauma Surg 2022;142(12):3845-52. https://doi.org/10.1007/s00402-021-04283-3
17. Dobelle E, Robert S, Gaujac N, Laumonerie P, Mansat P, Bonnevialle N. Scapular fractures osteosynthesis via Judet’s posterior approach: clinical and radiographic results. Int Orthop 2023;47(6):1557-64. https://doi.org/10.1007/s00264-023-05754-5
18. Vidović D, Benčić I, Ćuti T, Bakota B, Bekić M, Dobrić I, et al. Surgical treatment of scapular fractures: Results and complications. Injury 2021;52(Suppl 5):S38-S43. https://doi.org/10.1016/j.injury.2020.09.031
19. Wijdicks CA, Anavian J, Hill BW, Armitage BM, Vang S, Cole PA. The assessment of scapular radiographs: analysis of anteroposterior radiographs of the shoulder and the effect of rotational offset on the glenopolar angle. Bone Joint J 2013;95-B(8):1114-20. https://doi.org/10.1302/0301-620X.95B8.30631
20. Morey VM, Chua KHZ, Ng ZD, Tan HMB, Kumar VP. Management of the floating shoulder: Does the glenopolar angle influence outcomes? A systematic review. Orthop Traumatol Surg Res 2018;104(1):53-8.
https://doi.org/10.1016/j.otsr.2017.11.004