title: Inferior angle of scapula fractures: a review of literature and evidence-based treatment guidelines.
abstract: BACKGROUND
  Inferior angle of scapula (IAS) fractures are rare, with very few cases reported. They typically present with pain, loss of shoulder motion, and scapula winging. Operative and nonoperative treatments have been trialed with varying success. The aim of this study was to gather data relating to IAS fractures to develop evidence-based treatment guidelines as none are currently available.
  
  
  METHODS
  A search was conducted of the PubMed and Google Scholar databases to identify cases of IAS fractures. Data collected about each case included age and gender of the patient, mechanism of injury, fracture displacement, treatment, and outcome. The authors report 2 additional IAS fracture cases.
  
  
  RESULTS
  Ten cases were identified for inclusion in this study, 8 from the literature and 2 described by the authors. Of the 10 cases, 7 described displaced IAS fractures and 3 described undisplaced fractures. All displaced fractures treated nonoperatively resulted in a painful nonunion. All that underwent operative fixation, whether acutely or after failed nonoperative treatment, had resolution of pain and a good functional outcome. All undisplaced fractures were treated nonoperatively; 1 had persisting pain. Surgical exploration identified the fracture fragment attached to serratus anterior in 2 cases and attached to both serratus anterior and latissimus dorsi in 2 cases.
  
  
  CONCLUSIONS
  There are limited data available about IAS factures. From the cases reviewed, treatment recommendations include the following: (1) displaced IAS fractures should undergo operative fixation to prevent the development of a painful nonunion; (2) suture repair provides adequate fixation; and (3) undisplaced fractures have a variable outcome when treated nonoperatively.
authors.affiliation: Department of Orthopaedic Surgery, Flinders Medical Centre, Bedford Park, SA 5000, Australia. Electronic address: ang.c.chang@gmail.com.
authors.forename: Angela C
authors.initials: AC
authors.lastname: Chang
authors.affiliation: Department of Orthopaedic Surgery, Flinders Medical Centre, Bedford Park, SA 5000, Australia.
authors.forename: Joideep
authors.initials: J
authors.lastname: Phadnis
authors.affiliation: Department of Orthopaedic Surgery, Flinders Medical Centre, Bedford Park, SA 5000, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Eardley-Harris
authors.affiliation: Department of Orthopaedic Surgery, Flinders Medical Centre, Bedford Park, SA 5000, Australia.
authors.forename: Vijai S
authors.initials: VS
authors.lastname: Ranawat
authors.affiliation: Department of Orthopaedic Surgery, Flinders Medical Centre, Bedford Park, SA 5000, Australia.
authors.forename: Gregory I
authors.initials: GI
authors.lastname: Bain
mesh_terms: D000328:Adult; D000368:Aged; D019317:Evidence-Based Medicine; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery* / Q000628:therapy; D005599:Fractures, Ununited / Q000601:surgery; D006801:Humans; D008297:Male; D059352:Musculoskeletal Pain / Q000209:etiology; D016059:Range of Motion, Articular; D012540:Scapula / Q000293:injuries* / Q000601:surgery; D012782:Shoulder / Q000503:physiopathology; D016896:Treatment Outcome
keywords: Scapula fracture; avulsion fracture; inferior angle of scapula