Neglected Nonunion Of Scapular Spine Fracture as an unusual cause of shoulder impingement. - importance of diagnosis and its management

BACK GROUND To emphasis the importance and diagnosis of neglected nonunion scapular spine fracture presenting as an unusual cause of shoulder impingement. Also the functional outcome following open reduction, internal fixation and bone grafting. MATERIAL AND METHOD 63 years old male patient who had Road Traffic Accident and sustained direct injury to his right shoulder for which he had native treatment for a period of four months .He presented as persistent pain crepitus on over head abduction. X ray (supraspinatus outlet view) reveals fracture spine of scapula nearer to its acromion base. 3D CT Scan and MRI Scan was taken to know further extent of fracture and soft tissue involvement.. Fracture ends curetteted and sclerosed ends freshened and fracture fragments fixed with 2.7 mm 10 holed DCP with cortical screws and cancellous bone graft applied over fracture site(harvested from rightside illiac crest).RESULTS He continued to make excellent progress and had full painless function in the shoulder girdle at his last review two year post surgery and subsequently returned to full work duties .CONCLUSION Underlying cause of shoulder impingement should be identified and treated appropriately.All scapular spine fracture nonunion will invariably go for bony union(even in late cases) when fixed by open reduction and internal fixation bone grafting whereas nonunion occurs in conservative management however prolonged it is. Patient regained excellent full range of shoulder movements following surgical fixation.