Assessment of functional outcome of operative management of scapular fractures through Arabic version DASH score

Scapular fractures are rare, accounting less than1% all fractures. 3-5%all fractures of shoulder girdle, however very serious because 80-90% due to high energy trauma such as Motor car accidents or Fall from height. It can be associated with life-threatening injuries such as thoraco-scapular dissociation and vascular injury as subclavian and axillary vessels and brachial plexus injuries.So morbidity and mortality reports are relatively high.It can be diagnosed by X ray and computed tomography scan (CT scan) that play important role to discover scapular fractures and associated injuries ,and to guide clinical decision such as approaches and other surgical interventions.Most of scapular fractures are managed conservatively by Immbolization in sling .literature stated that conservative management of scapular body fractures and scapular neck fractures displaced less than 10 mm have satisfactory outcome and operative management suitable for displaced glenoid fossa fractures and scapular neck fractures more than 10 mm and associated with better functional outcome.Others stated that conservative management with highly displaced scapular body and neck fractures are associated with satisfactory long -term functional outcome with minor loss of motion and strength.

So standard treatment of scapular fracture is still controversial and there is no clear guidelines about management of scapular fractures.

In Investigators hypothesis, Operative management of scapular fractures is better choice due to better functional outcome, early rehabilitation ,high union rate and less complications. Investigators will try to answer this question ''What is the effect of operative management of scapular fractures on functional outcome?''

Inclusion Criteria:

• 1.All patient presented with scapular fractures more than 18 years old involving body, neck and glenoid 2.Intraarticular glenoid fractures with step-off >4 mm 3.>20% of the joint is involved and Fragment large enough to be hold by lag screw.

Exclusion Criteria:

1- Low demanded patients:Age >65 yrs . 2.Scapular fractures of acromion and coracoid process and Osteoporotic fractures .

3.Scapular fractures associated with brain injuries cervical spine injuries and brachial plexus injuries.

Any patients who meets the inclusion criteria and agrees to be involved in our study will do:

1. Preoperative assessment:

   1. Examination : Neurological and Vascular examination

   2. Imaging:

      • Plain X- ray (True AP - Scapula Y view ) and Plain X-ray (True AP )of contralateral side Measurement of Glenopolar angle (GPA)
      • CT scan

2. Intra-operative assessment:

   a. Selection of approach. b.Postion C.Type of osteosynthesis d. Blood loss e. Radiation exposure.