Review of Article
Jerome McIntosh,* MBBS, Pouya Akhbari,† MBBS, MSc, FRCS (Tr & Orth) Eng,
Amar Malhas,‡ MBBS, FRCS (Tr & Orth) Eng, and
Lennard Funk,†§ MBBCh, MSc, FRCS (Tr & Orth) Eng
Scapula fractures are infrequent, representing 1% of all fractures. They are often secondary to high-energy trauma and have significant associated injuries. Over 50% of scapula fractures occur as a result of road traffic collisions, with almost 20% involving a pedestrian being struck by a car. A simple fall accounts for only 12% of scapula fractures in the population.
While most of the fractures can be successfully managed nonoperatively and a superior shoulder suspensory mechanism injury, may require surgical intervention. Almost 90% of scapula fractures are attributed to high energy mechanisms. These are well reported in the literature, with associated injuries. Anterior glenoid rim fractures associated with dislocation have also been reported. However, scapula fractures attributed to sports injuries are not well reported in the literature.
Approximately 0.5% of all sports-related fractures are scapula fractures. No studies were identified that focused on scapula fractures in rugby or European football (soccer). Elite rugby players are a unique population in that they are often subjected to high-energy collisions.6 Each player can expect to routinely receive 1.95 to 2.13 times their bodyweight during tackles and collisions, with the mean weight of a front row player approaching 99.79 Kg.
The forces involved become substantial. Predictably, these common events during any match lead to a high rate of injury and time off play. Specifically, shoulder injuries are thought to occur every 17,000 player-hours of a match, although only 1% of those result in a fracture.
Scapula fractures in elite rugby players are rarer, representing only 8% of significant shoulder injuries requiring specialist orthopaedic management. Given its significance, there is little in the literature specifically addressing this injury.
During the 8-year study review period, the senior author saw 829 shoulder injuries in competitive rugby players and 103 shoulder injuries in competitive soccer players. Eleven patients with scapula fractures were identified (Table 1). Of these, 9 patients were professional rugby players (4 rugby league and 5 rugby union); 1 patient was a professional soccer player; and 1 patient was an amateur soccer player.
The results of this study demonstrated that scapula fractures in rugby or soccer players are associated with a prolonged recovery time of 4 to 5 months. There is little in the literature focusing on scapula injuries in professional rugby players other than its incidence.
The rate of suprascapular nerve injury in rugby players was 22% in the study. The literature also reports high rates of ongoing pain after scapula neck and body injuries treated nonoperatively, with rates of exertional weakness approaching 40% to 60% of cases.
To conclude, Scapula fractures acquired in sports are a serious injury with a prolonged recovery period, and they can have career-ending effects. There is a high association of these fracture patterns with suprascapular nerve injuries, which must be examined during clinical assessment. These high-energy injuries are rarely described in athletes and classically relate to major trauma, highlighting the forces associated with rugby and other contact sports.
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