We systematically reviewed the published evidence regarding the operative treatment of scapular fractures. Publications were identified using MEDLINE databases and were included if they reported operative indications, surgical approach and implants, postoperative complications, and functional outcomes. Seventeen investigations encompassing 243 cases met our eligibility criteria. All were retrospective case series (evidence-based medicine level IV). The most common injuries treated with surgery were glenoid fossa fractures and scapular neck fractures. Approximately 25% of the cases had a concomitant injury to the clavicle or acromioclavicular ligaments. Internal fixation was most often achieved with a plate and screws through a posterior approach. The complication rate was low with infection, shoulder stiffness, and implant failure the most commonly reported problems. Good to excellent functional results were obtained in approximately 85% of the cases an average of 49.9 months postoperatively.