Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2014 Apr;49(2):165-171. Korean.
    Published online Apr 29, 2014.
    https://doi.org/10.4055/jkoa.2014.49.2.165
    Copyright © 2014 by The Korean Orthopaedic Association
    Case Report

    Treatment of Scapula Fractures of the Inferior Angle Causing Pseudowinging Scapula

    Kyoung-Dae Min, M.D., Seok-Ha Hwang, M.D.,* Jun-Bum Kim, M.D., Sang-Hyuck Cho, M.D. and Byung-Ill Lee, M.D.
      • Department of Orthopedic Surgery, Soonchunhyang University College of Medicine, Seoul, Korea.
      • *Department of Orthopepic Surgery, Sungae Hospital, Seoul, Korea.
    • Correspondence to: Seok-Ha Hwang, M.D. Department of Orthopedic Surgery, Sungae Hospital, 22 Yeouidaebang-ro 53-gil, Yeongdeungpo-gu, Seoul 150-960, Korea. TEL: +82-2-840-7233, FAX: +82-2-840-7755, Email: hwangseokha@naver.com
    Received November 25, 2013; Revised December 11, 2013; Accepted January 08, 2014.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Nonoperative treatment of scapular body fractures has shown good clinical results. Although scapula fractures of the inferior angle, particularly with oblique lines from the medial proximal to lateral distally, are very rare, we believe that such a fracture pattern would be regarded as an avulsion fracture of the serratus anterior muscle requiring surgery. We have experienced three cases demonstrating pseudowinging of the scapula due to displacement of the inferior angle fracture of the scapula. Surgical repair or plating showed satisfactory clinical results. Through these cases, we describe the cause of winging scapula and the problems resulting from an avulsion fracture of the serratus anterior muscle with a review of the relevant literature and explain the reason that an operation is needed for this fracture pattern.

    Keywords
    scapula; serratus anterior muscle; winging scapula; avulsion fracture

    Figures

    Figure 1
    (A) On physical examination, a 41-year-old driver who suffered a traffic accident; image shows right winging of the scapula at posttraumatic one year. (B) Scapula lateral view shows the bony fragment, which is separated from the inferior border of the scapula and displaced by the serratus anterior muscle. (C) Image of 3-dimensional-computed tomography can check for a blunted fracture margin, suggesting nonunion. (D) Intraoperative image shows the surgical technique used to reduce and hold the fracture with a double plate and surgical repair. (E) At postoperative six weeks, lateral radiograph of the right scapula shows a well reducted state of the bony fragment. (F) At postoperative three months, there is no winging of the scapula on elevation of the arm and no crepitus on abduction.

    Figure 2
    (A, B) Scapula lateral view and image of 3-dimensional-computed tomography show the inferior border fracture of the scapula and anterolateral displacement of the bony fragment. (C, D) At postoperative three months, lateral radiograph and image of 3-dimensional-computed tomography of the left scapula confirm good alignment of the inferior angle of the scapula.

    Figure 3
    (A) On initial examination, a 55-year-old man who fell from a height of 2 m; photography shows dominant winging of the right scapula in leaning with his arms on the wall. (B) Scapula lateral view shows anterolateral displacement of the bony fragment with the inferior border fracture of the scapula. (C) At postoperative three months, image of 3-dimensional-computed tomography of the right scapula confirms acceptable alignment of the inferior angle of the scapula.

    Tables

    Table 1
    Summary of Literature Reporting on Fracture of the Inferior Angle of the Scapula

    References

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    MeSH Terms
    Scapula*
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