M u s c u l o s k e l e t a l I m a g i n g • R ev i ew

Ropp and Davis

Scapular Fractures

Musculoskeletal Imaging
Review
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FOCUS ON:

Scapular Fractures: What

Radiologists Need to Know
Alan M. Ropp1 OBJECTIVE. The purpose of this article are to review scapular anatomy and function,
Derik L. Davis describe imaging features of traumatic scapular injury, and discuss the role of diagnostic im-
aging in clinical decision making after shoulder trauma.
Ropp AM, Davis DL CONCLUSION. Knowledge of scapular anatomy, function, injury patterns, imaging ap-
pearance, and clinical management is important for the radiologist to the care of patients who
present with acute shoulder trauma.

Keywords: CT, fracture, radiography, scapula, shoulder,
trauma
DOI:10.2214/AJR.15.14446
Received January 18, 2015; accepted after revision
February 22, 2015.
1
Both authors: Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland School of
Medicine, 22 S Greene St, Baltimore, MD 21201. Address
correspondence to D. L. Davis (ddavis7@umm.edu).
This article is available for credit.
AJR 2015; 205:491–501
0361–803X/15/2053–491
© American Roentgen Ray Society
S
capular fractures are uncommon,
accounting for only 3–5% of
shoulder girdle fractures and few-
er than 1% of all fractures [1].
High-energy trauma is the most common
cause, and scapular fractures are frequently as-
sociated with other acute injuries, including rib
fracture (53%), lung injury (47%), head injury
(39%), spinal fracture (29%), and clavicle frac-
ture (25%) [2]. The initial diagnosis of scapular
fracture is often delayed or ignored, because
clinical care in the acute setting is focused on
patient resuscitation after one or more life-
threatening injuries [3–5].
Imaging plays the key role in identifying
and classifying scapular fractures and thus
guides clinical decision making. This article
will review the use of diagnostic imaging for
evaluating traumatic scapular fracture and
describe imaging findings associated with
operative management indications.
Anatomy
The scapula is a flat triangular bone with
several distinct regions (Fig. 1). The glenoid
fossa forms the articular surface of the scap-
ula and connects to the scapular body via the
neck of the scapula. The scapula serves as an
attachment site for 17 muscles, which facil-
itate movement and form a functional soft-
tissue envelope for the shoulder girdle [6].
These muscles are subdivided into scapulo-
thoracic and scapulohumeral groups (Appen-
dix 1). The rotator cuff muscles are a sub-
component of the scapulohumeral group.
Normal Biomechanics
Background
The scapula functions at the shoulder girdle
as a base of motion and stability in association
with the superior shoulder suspensory complex
and the scapulothoracic, glenohumeral, and ac-
romioclavicular joints. These articulations pro-
vide a functional link between the thorax and
the upper extremity [7]. The superior shoulder
suspensory complex comprises a bone and liga-
mentous ring formed by the scapula, distal clav-
icle, acromioclavicular joint, and coracoclavicu-
lar ligament. Scapular contributions include the
glenoid, coracoid, and acromion process [8].
The superior shoulder suspensory complex, in
concert with the scapulothoracic muscles, acts
to suspend the upper extremity from the thorax.
The scapula, through its relationship with the
superior shoulder suspensory complex, is hung
from the clavicle by the acromioclavicular joint
and coracoclavicular ligament [9].
Scapular motion and stability rely on the
sensorimotor system to coordinate the static
and dynamic stabilizers of the shoulder gir-
dle [10]. Coordination of scapulothoracic and
scapulohumeral musculature contractions, in
concert with biofeedback from the glenohu-
meral-capsuloligamentous complex, allows
normal motion and functional stability [10].
Scapulothoracic Joint
The scapulothoracic joint provides dy-
namic stability at the shoulder girdle through
biomechanical support of the scapula and ro-
tator cuff musculature [11]. The scapulotho-

AJR:205, September 2015 491


racic joint is fairly incongruent, with no di-
rect bony connection between the scapula
and thorax [12]. The serratus anterior, trape-
zius, rhomboid major and minor, and levator
scapulae muscles are the main muscular sta-
bilizers. The serratus anterior is most impor-
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tant for maintaining normal medial scapular
angle and chest wall alignment, and the tra-
pezius is most helpful for facilitating scapu-
lar motion in concert with the glenohumer-
al joint [6, 12]. The coordinated summation
of scapulothoracic muscular forces acting on
the scapula ultimately results in a movement
of protraction or retraction from the normal
resting orientation of the scapula [6, 13] (Fig.
2A). Protraction is the movement of the scap-
ula toward the anterior thorax, whereas re-
traction is the movement of the scapula to-
ward the vertebral column [12].
Three distinct individual variables of
scapulothoracic motion are internal-exter-
nal rotation, upward-downward rotation, and
anteroposterior tilting [14, 15] (Figs. 2B–
2D). Normal scapulothoracic motion is de-
pendent on simultaneous motion at the ac-
romioclavicular and sternoclavicular joints,
especially upward rotation; and, normal pos-
terior tilting is largely influenced by the bio-
mechanical motion of the acromioclavicular
joint [14]. The scapulothoracic joint con-
tributes to the stability of the glenohumeral
joint and increases the range of motion at the
shoulder girdle beyond that provided by the
glenohumeral joint alone [6, 16].
Glenohumeral Joint
Because the glenohumeral joint lacks ac-
tual inherent stability, the sensorimotor sys-
tem must continually balance counteracting
forces among the various muscles, liga-
ments, and bones at the shoulder girdle dur-
ing all phases of motion [6, 10]. To accom-
plish this feat, the glenohumeral joint relies
on the synchronized cooperation of static
and dynamic stabilizers. Injury to the static
or dynamic stabilizers can result in a func-
tionally unstable glenohumeral joint [10].
Static restraint depends on the osseous
geometry of the scapula, in addition to the
glenoid labrum, the glenohumeral capsulo-
ligamentous complex, and the negative in-
traarticular pressure of the joint [6, 11, 17].
The morphology of the glenoid fossa is im-
portant for stability and normal biomechan-
ics [6]. The articular surface of the glenoid
fossa is pear shaped, and the inferior half
is one fifth larger than the superior half [11,
18]. The normal anteroposterior composite
492 AJR:205, September 2015
Ropp and Davis
TABLE 1:  Ideberg Classification of Intraarticular Glenoid Fractures [33]
Type
1 Anterior glenoid rim fracture
2 Inferior glenoid fracture involving the inferior neck
3 Superior glenoid fracture involving the base of coracoid process
4 Horizontal fracture through the neck and body, inferior to the spine
5 Combination of types 2 and 4
depth of the glenoid fossa and labrum is 5
mm, compared with 9 mm for the superoin-
ferior depth [19]. A decrease in glenoid bone
stock has a negative effect on glenohumer-
al stability [6]. A loss of glenoid bone stock
of more than 21% in superoinferior depth or
more than 25% of the anterior glenoid places
stability at risk [20–22]. Additionally, the
glenoid fossa is retroverted by 7° relative
to the scapular body in healthy individuals
[23]. Excessive retroversion or anteversion of
the glenoid is also associated with glenohu-
meral joint instability [11, 23, 24].
Dynamic stability of the glenohumeral joint
during active arm movements is maintained by
a complex set of counterbalancing muscular
contractions that keep the humeral head cen-
tered at the glenoid fossa throughout all ranges
of motion [11]. At the mid range of the motion,
when the glenohumeral ligaments are lax, dy-
namic stabilizers are the primary mechanism
to keep the humeral head centered at the gle-
noid fossa [25]. The primary dynamic stabiliz-
ers of the glenohumeral joint include the rota-
tor cuff, long head of the biceps brachii, and
deltoid muscles, with additional support pro-
vided by the latissimus dorsi, teres major, and
pectoralis major muscles [10].
Acromioclavicular Joint
Stability at the acromioclavicular joint is
also maintained by static and dynamic stabi-
lizers. The acromioclavicular joint capsule and
the acromioclavicular, coracoclavicular, and
coracoacromial ligaments provide static stabil-
ity, whereas the deltoid and trapezius muscles
function as dynamic stabilizers [26]. Scapular
motion occurs at the acromioclavicular joint
and is defined as the degree of motion of the
scapula relative to the clavicle.
Imaging
Radiographs
An appropriate set of radiographs in the set-
ting of acute scapular trauma includes antero-
posterior, Grashey, axillary, and lateral scapu-
lar (Y) views [1, 9]. This radiographic series
allows diagnosis of scapular and ipsilateral
Description
clavicle fractures, as well as acromioclavicular
and glenohumeral joint injuries. Grashey and
axillary views are particularly useful for detec-
tion of intraarticular scapular fractures by pro-
viding direct visualization of the glenoid fossa
and glenohumeral joint space. Acquisition of
additional axillary views increases diagnostic
sensitivity for difficult to see acromion and cor-
acoid process fractures.
CT
Conventional 2D and 3D CT examinations
are commonly performed in the setting of
acute trauma. CT allows detailed character-
ization of bone, joint, muscle, or ligament in-
jury at the shoulder girdle and is particularly
helpful with identification of radiographically
occult injuries [9, 27]. Thus, CT is more reli-
able and accurate for the detection and stag-
ing of scapular injuries than radiographs are;
this is especially true for coracoid process,
glenoid, and scapular neck fractures [28–31].
Dedicated shoulder CT is often not neces-
sary in the setting of trauma, because refor-
matted 2D and 3D CT images are commonly
acquired from the chest CT scan obtained on
admission. CT image reformatting also allows
creation of optimal 3D scapular images that
correspond to the ideal scapular Y, Grashey,
and anteroposterior radiographic views [28,
32] (Fig. 3). In addition, 3D CT images add
value by mitigating artifacts produced by pa-
tient body habitus, patient positioning, and
imaging technique [28].
Intraarticular Scapular Fractures
Intraarticular fractures constitute 10–30%
of all scapular fractures [3, 33, 34]. Ideberg
et al. [33] classified intraarticular fractures of
the glenoid fossa (Table 1), and this method of
classification has been modified over time to
define further scapular fracture patterns [35].
The most common cause is blunt trauma dur-
ing a high-energy vehicular accident. Automo-
bile and motorcycle collisions are typical, but
bicycle, all-terrain vehicle, snowmobile, and
Jet Ski crashes are other varieties of vehicular
accidents that also result in scapular fracture

[32, 36–38] (Fig. 4). Falling from a height or
a pedestrian’s being struck by a moving vehi-
cle are other common mechanisms [36, 38]. In-
traarticular fractures of the glenoid account for
the vast majority of open reduction and inter-
nal fixation (ORIF) procedures performed for
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management of scapular fracture [39].
Anterior shoulder dislocation is an addi-
tional mechanism associated with intraartic-
ular fracture of the anterior glenoid [40] (Fig.
5). These Ideberg type 1 fractures of the gle-
noid are the most typical scapular fracture
pattern encountered after shoulder disloca-
tion, with shoulder dislocations accounting
for two thirds of type 1 fractures [33].
Most nondisplaced intraarticular glenoid
fractures are managed nonoperatively. How-
ever, displaced fractures demand consideration
for operative fixation, because the various myo-
tendinous units attaching to the scapula pull in
different directions and contribute to distrac-
tion and rotational malalignment [35]. Never-
theless, the criteria for surgical management
remain controversial, and the decision whether
to perform ORIF is dependent on the surgeon’s
preference and patient comorbidity, age, hand
dominance, overall health, activities of daily
living, and level of physical activity [1].
The most common goals for ORIF of dis-
placed intraarticular scapular fracture are to
reduce joint incongruity and prevent long-
term posttraumatic osteoarthritis, instability,
chronic pain, and decreased range of motion
[32, 36, 38]. Indications for surgery include
at least 4 mm of displacement at the artic-
ular surface and at least 20% involvement
of the glenoid, although operative interven-
tion is still considered to address instability
even when these criteria are not met [1, 35]
(Appendix 2). Other relative indications in-
clude an anterior rim fracture of greater than
25% of the articular surface or a posterior
rim fracture of greater than 33%, fractures
extending to the medial border of the scap-
ula with displacement, glenoid rim fractures
with associated persistent glenohumeral in-
stability, and open fractures [1, 35].
Extraarticular Scapular Fractures
Extraarticular fractures of the coracoid
process, acromion process, neck, body, and
spine account for the majority of scapular frac-
tures. Traditionally, management of nonarticu-
lar scapular fractures has been conservative in
nature. ORIF of extraarticular scapular frac-
ture has been rare owing to the belief that the
shoulder girdle’s wide range of motion suffi-
ciently allows maintenance of activities of daily
AJR:205, September 2015 493
Scapular Fractures
living despite scapular posttraumatic deformi-
ty [1]. Certain extraarticular fractures, wheth-
er occurring alone or in combination with oth-
er injuries, have more recently challenged this
dogma (Appendix 2). ORIF of displaced frac-
tures has been touted as an avenue to decrease
long-term pain, weakness, and functional dis-
ability [4, 8, 9, 41–43]; nevertheless, relative in-
dications for extraarticular scapular fractures
remain controversial [1].
Coracoid Process
Coracoid process fractures represent 2–13%
of scapular fractures [37, 42, 44]. These frac-
tures most often occur at the base with mini-
mal displacement [37, 45, 46]. Several mech-
anisms account for coracoid process fractures
including direct blunt trauma or indirect trau-
ma from a shoulder dislocation [47–49] (Fig.
6). An isolated fracture of the coracoid process
in association with an anterior dislocation is of-
ten overlooked on radiographs [48]. Additional
traumatic causes include axial loading related
to an ipsilateral clavicle fracture, avulsion by
myotendinous attachment, or avulsion by cora-
coclavicular ligament attachment during acro-
mioclavicular joint separation [50–54].
Fractures of the coracoid process have been
classified into five types according to anatom-
ic location [45] (Fig. 7). Ogawa et al. [55, 56]
described an alternative functional method of
classification based on the anatomic relation-
ship of the fracture to the coracoclavicular liga-
ment: Ogawa type I coracoid process fractures
are posterior to the coracoclavicular ligament,
whereas type II fractures are anterior to the
coracoclavicular ligament [55, 56]. Ogawa type
I fractures are more common and have a great-
er tendency to be unstable [55–57].
Conservative management is the most
common treatment of isolated coracoid proc-
ess fractures. Surgical management is consid-
ered for fractures with more than 1 cm of dis-
placement or intraarticular extension [37, 45].
Additional indications for surgical manage-
ment include patients with significant future
biomechanical demands, such as athletes and
manual laborers [37, 46]. ORIF may also be
considered after failed conservative manage-
ment if the displaced bone fragment produces
chronic irritation of the adjacent soft tissues
or if the coracoid fragment or fragments cause
an obstruction to the reduction of a shoulder
dislocation [46, 49].
Acromion Process
Acromion process fractures represent
8–16% of scapular fractures [3, 44, 58]. Motor
vehicle accidents are the most common cause
[37]. In addition to direct blunt trauma, other
mechanisms of acromion process fracture in-
clude indirect trauma after shoulder dislocation
and avulsion by the deltoid muscle [37, 46].
Fractures of the acromion process have been
classified according to anatomic location rela-
tive to the acromioclavicular joint, acromial
angle, or scapular spine [59]. Kuhn et al. [60],
however, described an alternative functional
method based on the presence or absence of
subacromial impingement: Kuhn type I frac-
tures are minimally displaced, type II fractures
are significantly displaced without subacromi-
al space narrowing, and type III fractures are
significantly displaced with subacromial space
narrowing. Patients with Kuhn type III acro-
mion fractures are prone to develop decreased
range of motion and rotator cuff injury [60].
Nondisplaced acromion process fractures
are most commonly treated with conservative
management with good outcomes [58]. How-
ever, potential complications of nonoperative
management include painful fracture non-
union or increasing fragment displacement
[37, 61] (Fig. 8A). Additional long-term com-
plications include decreased range of motion,
subacromial impingement of the rotator cuff,
pain, and shoulder weakness [37, 58, 60–62]
(Fig. 8B). Thus, surgical management is con-
sidered for fracture with more than 1 cm of
displacement, open fracture in the acute set-
ting, or painful nonunion after conservative
management [1, 37, 58, 63]. However, the op-
timal treatment remains controversial, and no
single algorithm for treatment is widely ac-
cepted for acromion process fractures [58].
Scapular Neck, Body, and Spine
As a group, extraarticular fractures of the
scapular neck, body, and spine constitute the
largest group of scapular fractures [5]. The scap-
ular neck is second only to the body as the most
common fracture site, accounting for 26–29%
and 35–45% of scapular fractures, respectively
[3, 5, 42]; fractures of the spine are less common
and account for 6–11% of scapular fractures [3,
5, 42]. The mechanism of injury is typically vi-
olent and most often the result of a high-ener-
gy motor vehicle accident, although falling and
a pedestrian’s being struck by a moving vehicle
are also common mechanisms [3].
Most extraarticular fractures are treated
conservatively. Isolated scapular body frac-
tures are typically treated conservatively
with good outcomes, even fractures with sig-
nificant displacement [5, 42]. Nondisplaced
scapular neck and spine fractures also have

favorable long-term outcomes with non-
operative management [5, 8].
Even though conservative management is
also the mainstay of treatment of most dis-
placed scapular neck and spine fractures, sur-
geons may choose to perform ORIF in certain
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instances. The displaced scapular neck fracture
has received the most attention, because mal-
union has been implicated for the loss of nor-
mal biomechanics at the shoulder, stemming
from rotator cuff dysfunction, scapulothoracic
muscular injury, muscular fibrosis, and altered
muscular efficiency [1, 5, 43]. Biomechani-
cal studies also have suggested that displaced
scapular neck fractures negatively affect the
stability of the glenohumeral joint by altering
the length of rotator cuff muscles during cer-
tain phases of movement [43]. Pain and weak-
ness also have been reported in patients with
significant displacement and malalignment of
scapular neck fractures [5, 41, 42].
Grading of scapular neck displacement and
rotation malalignment can be determined from
radiographs or CT (Fig. 3). The Grashey view
is useful for the measurement of the glenopolar
angle and lateral border offset [1]. The gleno­
polar angle is a measure of rotational malalign-
ment of the glenoid in relation to the antero-
posterior axis perpendicular to the plane of
the scapula [4, 32]. Normal glenopolar angle
is 30–45°, and a glenopolar angle of up to 20–
22°, in isolation or in combination with other
shoulder girdle injuries, is used as a relative in-
dication for surgery to avoid long-term pain,
weakness, and reduced capacity for activities
of daily living [1, 4, 38, 41]. The glenopolar an-
gle is formed by the intersection of two lines:
the first line is drawn through the superior and
inferior poles of the glenoid fossa, and the sec-
ond is drawn through the apex of the superior
pole of the glenoid fossa to the inferior angle of
the scapula.
Lateral border offset is defined by the dis-
tance of mediolateral displacement between
the lateral margins of the superior and infe-
rior scapular neck fracture fragments. A lat-
eral border offset of at least 1–2 cm is anoth-
er relative indication for ORIF [1, 9, 28, 38].
Angulation and translation are additional met-
rics for scapular neck malalignment obtained
on the radiographic Y view [1]. Angulation is
a measure of rotational deformity obtained in
the plane parallel to the mediolateral axis of the
scapula, and an angular deformity of at least
40–45° is a relative indication for surgery [1, 9,
38, 42]. Angulation is determined by drawing a
line parallel to the superior neck fragment cor-
tex and a line parallel to the inferior neck frag-
494 AJR:205, September 2015
Ropp and Davis
ment cortex. Translation is defined by the dis-
tance of anteroposterior displacement between
the superior and inferior scapular neck fracture
fragments. Translation is measured as the dis-
tance between the anterior cortex of the supe-
rior fragment and the anterior cortex of the in-
ferior fragment. Translation of at least 1 cm is a
relative indication for surgery [9].
Floating Shoulder Injuries
The original description of a “floating
shoulder” injury comprised simultaneous
scapular neck and ipsilateral clavicle fractures
[8] (Fig. 9); however, the meaning of this term
has more recently been expanded to include
two or more disruptions of the superior shoul-
der suspensory complex [9]. Floating shoulder
injuries are rare and represent less than 0.2%
of shoulder girdle fracture patterns [64]. An
unstable shoulder girdle occurs with two or
more displaced fractures involving the scap-
ular neck and clavicle, acromion process, or
coracoid process or disruption of the acromio-
clavicular joint and coracoclavicular ligament
[7, 8] (Figs. 10 and 11). Double disruptions of
the superior shoulder suspensory complex are
not isolated; for example, a clavicle fracture
or a complete acromioclavicular joint separa-
tion can worsen the displacement of a scapu-
lar fracture, or vice versa [8, 9]. Scapular dys-
kinesis occurs in the setting of clavicular and
scapular disassociation after clavicle fracture
or acromioclavicular joint separation [65, 66].
A single injury of the superior shoulder sus-
pensory complex is usually treated conserva-
tively. However, two or more disruptions may
have a negative impact on long-term heal-
ing and function [27, 37]. CT is particularly
helpful for identifying injuries that are radio-
graphically occult [27]. Displacements small-
er than 1 cm for double disruptions of the su-
perior shoulder suspensory complex usually
have good outcomes with conservative treat-
ment [67, 68]. Poor outcomes are most likely
to occur in the setting of significant displace-
ment at one or more sites in the ring [5, 7, 8].
Fracture displacements of more than 1 cm are
considered significant and lead to a floating
shoulder through the functional disassocia-
tion of the axial and appendicular skeletons [1,
5, 8, 69]. Bony complications include delayed
union, malunion, or nonunion, and long-term
functional deficits present as pain, subacromi-
al impingement, rotator cuff dysfunction, and
posttraumatic osteoarthritis [8, 9, 42]. Func-
tional imbalance among the dynamic muscular
glenohumeral and scapulothoracic forces at the
shoulder girdle ensues after multiple displaced
disruptions of the superior shoulder suspensory
complex [57, 62, 70].
The criteria for superior shoulder suspen-
sory complex double disruption ORIF re-
main controversial because no uniform stan-
dards exist, and nonoperative management
of extraarticular scapular fractures has been
the traditional norm. The minimum amount
of displacement to indicate surgical manage-
ment is still debated [9, 71]. The decision to
perform ORIF in these circumstances is de-
pendent on the surgeon’s preference and pa-
tient comorbidity, age, hand dominance, over-
all health, activities of daily living, and level
of physical activity [1]. The goal of surgical
intervention for floating shoulder injuries is to
reduce unstable fracture patterns, support an
early program of physical rehabilitation, and
prevent long-term functional deficits [58, 69].
Conclusion
Knowledge of scapular anatomy, func-
tion, injury patterns, imaging appearance,
and clinical management is important for the
radiologist to guide the care of patients who
present with acute shoulder trauma.
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APPENDIX 1: Muscles With Scapular Attachments APPENDIX 2:  Relative Indications for Operative Management
Scapulothoracic group of Scapular Fractures
Serratus anterior Intraarticular fractures: glenoid fossa
Trapezius Displacement of at least 4 mm
Pectoralis minor Articular surface fracture involving at least 20%
Rhomboid major Anterior rim fracture involving at least 25% of articular surface
Rhomboid minor Posterior rim fracture involving at least 33% of articular surface
Levator scapulae Extension to medial scapular border
Latissimus dorsi Extraarticular fractures
Scapulohumeral group Coracoid process (isolated)
Rotator cuff Displacement of at least 10 mm
Supraspinatus Intraarticular extension
Infraspinatus Significant future biomechanical demands
Subscapularis Acromion process (isolated)
Teres minor Displacement of at least 10 mm
Deltoid Painful nonunion
Long head of the biceps brachii Associated subacromial impingement
Short head of the biceps brachii Scapular neck
Coracobrachialis Glenopolar angle up to 22°
Teres major Lateral border offset of at least 10 mm
Triceps brachii Angulation of at least 40°
Translation of at least 10 mm
Superior shoulder suspensory complex
At least two disruptions with displacement of at least 10 mm

(Figures start on next page)

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 Fig. 1—Drawing shows scapular anatomy. 1 =
superior angle, 2 = medial border, 3 = neck, 4 = lateral Scapular Fractures
border, 5 = inferior angle, 6 = coracoid process, 7 =
glenoid fossa, 8 = body, 9 = acromion process, 10 =
spine.
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A B

Fig. 2—Scapular motion.

A, Drawing shows protraction (solid arrow) and
retraction (dashed arrow).
B, Drawing shows downward rotation (solid arrow)
and upward rotation (dashed arrow).
C, Drawing shows anterior tilting (solid arrow) and
posterior tilting (dashed arrow).
D, Drawing shows external rotation (solid arrow) and
internal rotation (dashed arrow).
C

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 Ropp and Davis
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A B C
Fig. 3—Example measurements for scapular neck fracture.
A, Coronal volume-rendered 3D CT image corresponding to anteroposterior radiograph shows measurement of
glenopolar angle by tracing confluence of lines between superior-inferior glenoid pole axis and superior glenoid
pole-inferior scapular angle axis. (Acromion is not shown.)
B, Coronal volume-rendered 3D CT image corresponding to anteroposterior radiograph shows measurement of
lateral border offset by tracing distance between lateral margins of superior and inferior scapular neck fracture
fragments.
C, Sagittal volume-rendered 3D CT image corresponding to scapular Y radiograph shows measurement of
angulation for scapular neck fracture by tracing confluence of lines parallel to superior and inferior neck
fragment cortexes.
D, Sagittal volume-rendered 3D CT image corresponding to scapular Y radiograph shows measurement of
translation for scapular neck fracture by tracing distance between superior and inferior fragment anterior
cortexes.

Fig. 4—Two patients with intraarticular glenoid

fractures.
A, 28-year-old woman after motor vehicle collision.
Grashey radiograph shows acute displaced
intraarticular fracture from glenoid to inferior portion
of neck (Ideberg type 2).
B, 22-year-old woman after motor vehicle collision.
Coronal volume-rendered 3D CT image shows acute
comminuted and displaced fracture extending from
glenoid articular surface to base of coracoid process
(Ideberg type 3).
A B

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A B C
Fig. 5—69-year-old man after fall from height.
A, Anteroposterior radiograph shows acute anterior shoulder dislocation.
B, Sagittal volume-rendered 3D CT image shows acute fracture and anterior displacement of large fracture fragment (arrow) from anterior glenoid rim (Ideberg type 1).
C, Axial T2-weighted fat-saturated image shows acute displaced bony Bankart fracture at anterior inferior glenoid rim (long arrow) with associated bone marrow edema
at posterolateral head (short arrow).

Fig. 6—Two patients with coracoid fractures.

A, 28-year-old woman after falling off horse. Axillary
radiograph shows acute fracture of coracoid process
with anterior displacement of more than 1 cm (line).
B, 23-year-old man after assault and seizure. Axial
CT image shows acute displaced coracoid fracture
(black arrow) and deep Hill-Sachs impaction fracture
at posterolateral humeral head (white arrow) after
anterior shoulder dislocation.
A B

Fig. 7—Drawing shows anatomic classification of

coracoid process fracture types. I = distal tip, II =
midpoint, III = base, IV = superior body of scapula
without intraarticular extension, V = superior body of
scapula with intraarticular extension.

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 Ropp and Davis

Fig. 8—Two patients with acromion process

fractures.
A, 44-year-old man who presented for fracture
follow-up 7 months after motorcycle collision. On
axial CT image, there is no sign of healing at displaced
acromion fracture site.
B, 76-year-old man after fall. Anteroposterior
radiograph shows acute fracture of acromion with
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inferior angulation (intersecting lines) concerning for

associated rotator cuff impingement.

A B

Fig. 9—48-year-old male pedestrian struck by motor

vehicle.
A, Anteroposterior radiograph shows displaced
scapular neck (black arrow) and ipsilateral midshaft
clavicle (long white arrow) fractures. Multiple
ipsilateral displaced rib fractures are also present
(short white arrows).
B, Sagittal volume-rendered 3D CT image shows
degree of scapular neck angulation and translation
to greater detail. Degree of displacement and
comminution of clavicle fracture is also better
shown.

A B

Fig. 10—36-year-old male pedestrian struck by motor

vehicle.
A, Anteroposterior radiograph shows acute scapular
neck fracture (black arrow) and Rockwood type III
acromioclavicular joint separation (white arrow).
B, Sagittal volume-rendered 3D CT image shows
degree of scapular neck angulation in greater detail.
A B

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A B
Fig. 11—42-year-old man after fall from ladder.
A, Oblique coronal volume-rendered 3D CT image shows acute displaced acromion and coracoid process
fractures. Nondisplaced acute fractures are also present at base of coracoid process and scapular body.
B, Sagittal volume-rendered 3D CT image shows associated intraarticular comminuted glenoid fracture with
significant displacement.

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