Open Reduction Internal Fixation of a Scapula Fracture
The patient is a 32 year old male with a BMI of 51.2 who sustained a highly displaced intra articular scapular fracture approximately 3 weeks ago as a result of a motorcycle accident. Radiographs and CT demonstrate an overriding, comminuted, displaced, and angulated scapular fracture, which involves much of the scapular body, neck, and mid to inferior aspect of the glenoid with intra-articular extension with no dislocation present.
A Judet approach to the posterior scapula is used in which an incision is created over the scapular spine and extended inferiorly over the medial border the scapula. Once the fascia is incised, the deltoid and trapezius muscles are elevated with a cuff of tissue left on either side for later repair. The infraspinatus muscle belly is elevated from medially to laterally. Special care is taken to avoid injury to the suprascapular nerve The fracture is reduced, and a custom contoured 10-hole 2.7 mm plate is placed with 3 screws above and 3 screws below the fracture site.
Fluoroscopy is used throughout the procedure in order to assess hardware placement and ensure there is no intra-articular screw penetration. The shoulder is taken through a range motion to ensure the stability of the joint and fixation.
The wound is thoroughly irrigated and closed in layers. Interrupted 0 vicryl suture is used for the infraspinatus and deltotrapezial muscle fascia, followed by interrupted 2-0 vicryl sutures in the subcutaneous tissues, and the skin is closed with staples. Sterile bandages and a sling are then applied.