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immature patients. Typically the arm is immobilized in the adducted and
internally rotated position by using a sling. Following a period of immobilization,
physical therapy is generally recommended.

FIGURE 111.12 Radiograph of a 13-year-old boy who sustained an isolated right scapular
fracture as the result of a skateboarding accident (arrow ).

Disposition. Once the shoulder has been reduced, the patient may be discharged
provided there is no neurovascular compromise. Since traumatic shoulder
dislocations in adolescents have a high rate of recurrence and persistent
instability, outpatient orthopedic follow-up is recommended within 1 week for
monitoring and appropriate physical rehabilitation.

Injuries of the Scapula
CLINICAL PEARLS AND PITFALLS
Scapula fractures are uncommon and generally associated with a highenergy mechanism of injury, and concurrent thoracic, intracranial,
spine, or other potentially life-threatening injuries.
Scapula fractures are typically seen after injuries of significant force, such as a
fall from a height, a motor vehicle collision, or a severe direct blow ( Fig. 111.12