Treatment and outcome in combined scapula and rib fractures: a retrospective study

Eur J Orthop Surg Traumatol. 2023 Aug;33(6):2337-2345. doi: 10.1007/s00590-022-03437-2. Epub 2022 Nov 19.


Purpose: The primary aim was to describe the population characteristics of patients with combined scapula and rib fractures and outcomes associated with different treatment strategies.

Methods: All adult (≥ 18 years) patients with concurrent ipsilateral scapula and rib fractures admitted to the study hospital between 1st January 2010 and 31st June 2021 were retrospectively reviewed.

Results: A total of 223 patients were admitted with concurrent ipsilateral rib and scapula fractures. A total of 160 patients (72%) were treated conservatively, 63 patients (28%) operatively. Among operatively treated patients, 32 (51%) underwent rib fixation (RF) only, 24 (38%) underwent scapula fixation (SF) only, and seven patients (11%) underwent combined fixation of scapula and ribs (SRF). In general, more severely injured patients were treated with more extensive surgery. RF patients had a median hospital length of stay of 16 days, the SF patients 11 days and SRF patients 18 days. There were no significant differences in complications (pneumonia, recurrent pneumothorax and revision surgery) between groups.

Conclusion: Injury severity resulted in different treatment modalities. As a result, different patient characteristics between treatment groups were observed, which makes direct comparison between treatment modalities impossible. All treatment modalities seem feasible; however, the additional value of both rib and scapula fixation has yet to be proven in large multicentre studies.

Keywords: Flail chest; Multiple rib fractures; Rib fixation; Scapula fixation; Scapula fractures.

MeSH terms

  • Adult
  • Flail Chest* / etiology
  • Flail Chest* / surgery
  • Fracture Fixation, Internal / adverse effects
  • Fracture Fixation, Internal / methods
  • Humans
  • Length of Stay
  • Retrospective Studies
  • Rib Fractures* / complications
  • Rib Fractures* / surgery
  • Thoracic Injuries* / complications
  • Treatment Outcome