Thompson WD. 10(4). 41 - 44. (Journal Article)
Abstract
This radiological case study of scapula fracture is reported in a 22 year-old active duty male Soldier who sustained a static line injury during an airborne operation at Fort Bragg, North Carolina. This is the first reported scapula fracture secondary to this mechanism since a 1973 report by Heckman and Levine. The fracture was neither identified by Emergency Department nor Orthopedic Surgery providers, and was reported in the radiologist's formal read. Ten emergency physicians and emergency medicine physician assistants reviewed the radiographical studies and none successfully identified the injury. Because this injury was uniformly missed by experienced emergency medicine providers it is presented as a radiographic case study in hopes that this injury will not go undiagnosed, potentially causing increased morbidity and mortality in this patient population. The patient was treated with a posterior splint and immobilization and seen by the orthopedic service the next day. Interestingly, the orthopedic surgeon also did not recognize this fracture. This mechanism of injury is rarely seen in clinical practice outside of the airborne community. Scapula fractures can be an indicator of serious thoracic trauma and may prompt the need for further diagnostic studies. The fact that so many providers missed the injury reinforces the need to evaluate the patient as a whole and to be ever suspicious of missing concomitant injuries in the trauma patient.
Keywords: Scapula Fracture; emergency department; Orthopedic; Radiograph; airborne