Therapie von Glenoid- und Skapulafrakturen

Fractures of the scapula are caused by direct or indirect trauma and can be isolated or associated with multiple injuries. Most such fractures can be diagnosed in plain X-rays of the shoulder in the a-p plane. In the case of more complex injuries computer tomography is a great help in deciding whether or not surgery is indicated. As the shoulder blade is surrounded by powerful muscles, which give adequate stability in the case of bone fracture, conservative treatment of scapular fractures is usually possible. If dislocated fracture of the joint or shoulder instability with fracture of the clavicle is present or the movement in the thoracoscapular joint is impaired surgical stabilization is necessary. Anterior access is used mainly in the case of rim fractures. When a dorsal or combined access route to the shoulder is used the particular anatomical conditions in this region must be borne in mind to avoid iatrogenic vascular and/or neural injuries. The triangular bony structure of the shoulder blade with its almost paper-thin centre allows the fixation of devices for osteosynthesis only at the edges and in the glenoid region (Kirschner wires, fragment screws, plates). A wide variety of classification systems take account of anatomical and functional aspects and those suggesting what treatment is indicated. Carrier bags and the Gilchrist and Desault bandage are both suitable for the initial immobilization. Physiotherapy is started when posttraumatic or postoperative pain fades away.