Wide approach to the posterior aspect of the scapula for internal fixation of unstable fractures of neck of scapula and glenoid.

Unstable scapular neck and glenoid fractures of Ideberg types II, III, IV and V.

Minimally displaced and stable fractures of scapular neck. Immediate intervention in polytrauma patients with respiratory insufficiency.

Curvilinear skin incision from acromion to inferior scapular angle. Thefirst portal is made at the cranial border of the infraspinatus muscle avoiding injury to the suprascapular nerve. This allows access to the superior scapular neck and posterior glenoid. Thesecond portal is made between infraspinatus and teres minor to reach the inferior parts of the scapular neck and glenoid. The 2 portals are connected by undermining the infraspinatus, thus exposing the entire posterior surface of the scapular neck and of glenoid fossa. The scapular fractures can then be reduced and stabilized.

The two-portal approach was used in 19 patients, 6 of whom had an unstable scapular neck fracture. The remaining 13 patients had a glenoid fracture of Ideberg types II to V. The fixation was stable in all patients allowing an early functional treatment. The reduction of glenoid fractures was anatomical in 6, and in 6 a gap of <2 mm remained. No intra- or postoperative complications occurred.