Scapular fractures and concomitant injuries

Objective: The association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized. Few studies have investigated this presumed association. In this study, we investigated the incidence of significant associated injuries with scapular fracture and their outcomes. Methods: A retrospective study was conducted from 2005 to 2009 in a level I trauma center in Thailand. All blunt trauma patients were identified. Patients' demographics, injury mechanism, associated injuries, Injury Severity Score (ISS), and survival outcomes were recorded. The management of associated injuries with scapular fracture was reviewed, and the risk factors for mortality were identified. Results: Among the 7 345 trauma patients admitted, scapular fractures occurred in 84 cases (1.1%). The mean age was (37.98 +/- 15.21) years. Motorcycle crash was the most frequent mechanism of injury, occurring in 51 cases (60.7%). Seventy-four patients (88.1%) suffering from scapular fractures had associated injuries: 5 (6.0%) had significant chest injuries, but none of them had blunt thoracic aortic injury. Two patients (2.4%) with scapular fractures died. Factors determining the likelihood of mortality were: (1) ISS>25 (LR=8.5, P<0.05); (2) significant associated chest injury (AIS>3, LR=5.3, P<0.05) and (3) significant associated abdominal injury(AIS>3, LR=5.3, P<0.05). Conclusion: A blunt scapular fracture may not accompany a blunt thoracic aortic injury but it is strongly related to other injuries like chest injury, extremity injury, head injury, etc. If a scapular fracture is found with a high ISS score, high chest or abdomen AIS score, the patient would have a high risk of mortality.