Fracture of the Scapula with Intrathoracic Penetration. A Case Report*

Abstract

Fracture of the scapula is a rare injury in adolescents. The most common etiology is a motor-vehicle accident or another type of high-velocity blunt trauma. There is a high prevalence of associated injuries, many of which may be life-threatening. Operative treatment has been recommended only in the case of a displaced fracture of the glenoid neck or step-off within the glenohumeral joint. We report an additional operative indication: a fracture of the body of the scapula with penetration of the thoracic cavity by a fracture fragment. Our search of the literature did not reveal any previous report of this injury. A thirteen-year-old boy was struck by a dump truck while riding a bicycle. He lost consciousness and was hypotensive at the scene of the accident. A pneumothorax was diagnosed on arrival to the hospital. After endotracheal intubation and placement of a chest tube, the patient was transferred to the University of Missouri Hospitals and Clinics for definitive care. Physical examination revealed bilateral subcutaneous emphysema palpated over the anterior chest wall, multiple abrasions, and contusions about the thorax and the left upper extremity. A large hematoma was noted in the area of the symphysis pubis. Blood was noted at the external meatus. Orthopaedic examination revealed swelling and contusion about the posterior part of the left shoulder with no palpable osseous instability. There was a smooth range of motion, without crepitus, to 90 degrees of abduction. A full passive range of motion of the shoulder was not attempted, but the elbow and the wrist had a full, smooth passive range of motion and the vascular status of the extremity was intact. As the patient had been pharmacologically paralyzed at the referring hospital, a full motor and sensory examination was not initially possible at our institution. The records from the initial examination did …