Trauma · Shoulder

Scapula ORIF

Plate-and-screw fixation of displaced scapular neck, body, or glenoid fractures to restore shoulder mechanics.

Overview

Shoulder joint anatomy showing the humeral head, glenoid socket, and rotator cuff muscles (supraspinatus and infraspinatus).
Shoulder anatomy. The shoulder is a shallow ball-and-socket joint. The top of the upper-arm bone (humerus) sits against a small dish on the shoulder blade (glenoid), and four rotator-cuff tendons wrap around the ball to hold it centered during every arm motion.
Wikimedia Commons · CC BY-SA 4.0

The scapula (shoulder blade) is a flat bone surrounded by muscle that forms the back of the shoulder joint. Because the scapula is well-protected by soft tissue, most fractures are minimally displaced and heal without surgery.

Surgical fixation is reserved for significantly displaced or angulated fractures, glenoid fractures that disrupt the joint surface, and injuries that alter shoulder mechanics. A small subset of scapular body and neck fractures benefits from surgery based on shortening, angulation, and combined upper-extremity injury patterns.

Why it's done

Scapula ORIF is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:

  1. Displaced glenoid fracture

    Joint-surface step-off leads to shoulder instability and arthritis.

  2. Displaced or angulated scapular neck or body fracture

    Significant mal-rotation affects the scapulohumeral rhythm.

  3. Floating shoulder

    Combined scapular neck and clavicle fracture warrants fixation.

  4. Open fracture

    Urgent debridement and stabilization.

How it works

Posterior (Judet-type) approach is used for scapular body and neck fractures. Plate fixation is applied along the lateral border and spine of the scapula, contoured to match the bone's complex curves.

Displaced glenoid fractures are approached either posteriorly or anteriorly depending on the fragment location. Screws or small plates restore the joint surface.

Recovery

The arm is protected in a sling with early passive and active-assisted shoulder motion. Active motion progresses at six weeks, and strengthening at three months. Full recovery typically takes three to six months. Scapular winging and persistent shoulder pain are known complications. Hardware is left unless symptomatic.

Contact

For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or request an appointment online.

Further Reading

External patient-education references and related OSI pages for additional background: