Presentation
Right shoulder pain following a motor vehicle accident.Background of polytrauma.
Patient Data
There are multiple fractures of the scapular body. There are associated right 3rd and 4th rib fractures and a non-displaced fracture of the distal clavicle.
There is an incidental normal variant - pseudotumor deltoideus.
CT imaging confirms multiple right scapular body fractures accounting for the linear densities on the frontal X-ray view. There is a subtle distal right clavicle fracture, right 3rd and 4th rib fractures, and left 3rd to 8th rib fractures, with multifocal lung contusions.
Additionally, there were comminuted fractures of the right acetabulum and right anterior column on CT imaging.
The patient also suffered a left ankle fracture dislocation.
(Limited CT imaging has been uploaded).
Case Discussion
Scapular fractures are uncommon and often portend serious mechanisms of polytrauma in high-energy or high-velocity injuries. There are usually multiple associated fractures or injuries. In this instance, there are rib fractures and a distal clavicular fracture.
In instances of polytrauma and immobilization, tangential or lateral views are difficult to obtain. In this instance, the linear densities of the scapula blade on the frontal view can easily be misinterpreted and consequently, the scapula body fractures are missed especially in the absence of the lateral view.
CT imaging of the scapula and/or delayed plain film imaging can be considered once the patient has been stabilized or life-threatening injuries have been diagnosed and managed.
Incidental pseudotumor deltoideus is an example of a "don't touch" lesion.
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