Introduction

Scapula fracture consists of only 1% of all skeletal fracture and

bilateral scapula fracture is even rarest of all. High-velocity

trauma like road traffic injury with injury to the shoulder is the

most common cause for the scapula fracture. Scapula is shielded

from traumatic sources due to the surrounding bulky

musculature. Atraumatic presentation of scapula fractures is

reported in the literature following seizure or electrocution, but

non-traumatic bilateral and reciprocal scapular fractures is

COVID-19 infection, presented in the emergency department

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DOI: https://doi.org/10.13107/jocr.2023.v13.i05.3646

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Dr. Amir Ratna Shakya

Abstract

Learning Point of the Article:

cerebrovascular thrombosis on magnetic resonance imaging.

The patient was admitted in the intensive care for further

management, where he started appreciating pain over both the

shoulder on next day with restricted movement. No such

symptoms were appreciated in the interim period between the

seizures.

Clinical examination revealed painfully restricted active and

passive movements of the shoulder with markedly painful

abduction and external rotation. There was mild swelling over

the back of shoulder with no localized tenderness over the

reconstruction of bilateral

scapula for evaluation of the

m o r p h o l o g i c a l

pathoanatomy of the fracture

showed measurements, as

shown in (Table 1 and Fig. 2).

The severity of the injury and

displacement of the fracture

a l on g w i t h t h e a c t i ve

demanding profession of the

under general anesthesia on

7th day post-injury.

Modified Judet approach in

prone position was taken for both the sides. The fractures were

reduced and fixed using preoperatively contoured locking

plates on the medial side and the lateral borders were

reconstituted using 3.5 mm T-locking plates (Fig. 3). A

sebaceous cyst which was present on the line of the incision was

also excised on the left side. Following a meticulous layered

closure, a compression bandage along with negative suction

fracture in acceptable alignment (Fig. 5).

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Figure 3: Pre-operative contoured plate and intraoperative application of

implants.

Figure 4: One-year follow-up with full range of motion of shoulder joint.

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mechanism of scapula fracture: Direct injury or indirect injury.

Former being direct impact to the scapula whereas latter occurs

due to transmission of forces to the scapula during falls through

axial forces from the hand resulting to glenoid region fracture

[2]. Authors have reported vigorous contraction of scapular

musculature following the electrocution or an episode of

seizure as common cause for the non-traumatic bilateral scapula

fracture with very few cases reported so far [3]. Most of these

patients were managed conservatively.

Seizures patients are at risk for injuries which may be due to

bilateral scapula fracture [5]. Tuček et al. did a review of 17

patients with bilateral scapular fractures of which six patients

had muscle spasm; out of them two were due to seizure and four

were secondary to electrical shock [6].

Scapula fracture is one of the most difficult fractures to be

diagnosed in normal radiograph due to rib bones interface and it

may be initially overlooked [7]. Three-dimensional computed

tomographic scan is considered as gold standard tool [8].

Various measurement tools are required to decide upon

conservative management and surgical fixation to prevent

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