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Original paper
A review of 10 years of scapula injuries sustained by UK military personnel on operations
  1. Darren C Roberts1,
  2. D M Power1 and
  3. S A Stapley2
  1. 1 Department of Hand, Upper Limb and Peripheral Nerve Surgery, Queen Elizabeth Hospital, Birmingham, UK
  2. 2 Department of Research and Academia, Royal Centre for Defence Medicine, Birmingham, UK
  1. Correspondence to Darren C Roberts, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, UK; robertsdc{at}doctors.org.uk

Abstract

Background Scapula fractures are relatively uncommon injuries, mostly occurring due to the effects of high-energy trauma. Rates of scapula fractures are unknown in the military setting. The aim of this study is to analyse the incidence, aetiology, associated injuries, treatment and complications of these fractures occurring in deployed military personnel.

Methods All UK military personnel returning with upper limb injuries from Afghanistan and Iraq were retrospectively reviewed using the Royal Centre for Defence Medicine database and case notes (2004–2014).

Results Forty-four scapula fractures out of 572 upper limb fractures (7.7%) were sustained over 10 years. Blast and gunshot wounds (GSW) were leading causative factors in 85%. Over half were open fractures (54%), with open blast fractures often having significant bone and soft tissue loss requiring extensive reconstruction. Multiple injuries were noted including lung, head, vascular and nerve injuries. Injury Severity Scores (ISS) were significantly higher than the average upper limb injury without a scapula fracture (p<0.0001). Brachial plexus injuries occurred in 17%. While military personnel with GSW have a favourable chance of nerve recovery, 75% of brachial plexus injuries that are associated with blast have poorer outcomes. Fixation occurred with either glenoid fractures or floating shoulders (10%); these were as a result of high velocity GSW or mounted blast ejections. There were no cases of deep soft tissue infection or osteomyelitis and all scapula fractures united.

Conclusion Scapula fractures have a 20 times higher incidence in military personnel compared with the civilian population, occurring predominantly as a result of blast and GSW, and a higher than average ISS. These fractures are often associated with multiple injuries, including brachial plexus injuries, where those sustained from blast have less favourable outcome. High rates of union following fixation and low rates of infection are expected despite significant contamination and soft tissue loss.

  • military
  • scapula
  • fracture

https://doi.org/10.1136/jramc-2017-000773

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    Footnotes

    • Contributors All authors have made substantial contributions to the conception, design of the study, and interpretation of data, drafting and revising the article critically for important intellectual content, as well as final approval of the version to be submitted. Darren Roberts.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.