Fig. 7.

a: Preoperative AP and lateral scapular radiographic views of the left shoulder of a 42-years-old male polytraumatized patient done in the Intensive Care Unit (ICU), showing a comminuted displaced complex scapula fracture; b: Anteroposterior (AP) radiograph of the thorax done in the ICU, demonstrating a drain tube in the left hemithorax due to a traumatic haemopneumothorax; c: Preoperative CT axial cuts of the left shoulder and hemithorax, demonstrating the comminuted displaced complex scapula fracture, involving fragmentation of the glenoid fossa (orange arrowheads) and the scapular body (blue arrowheads). Note the multiple contiguous displaced rib fractures (black arrowheads), extending from the 3rd to the 9th left rib; d: Preoperative 3-D CT reconstructions showing comminuted displaced complex scapula fracture, involving fragmentation of the glenoid fossa and the scapular body. Observe the angled fracture of the spine of the scapular; e: Immediate postoperative true AP, AP, and lateral scapular views of the left shoulder demonstrating the fixation of the most proximal fractures of the scapula. Note the anatomic reduction of the glenoid fossa fracture. Patient was operated on in two steps, apart 5 days from each other; f: Intraoperative images of the 2nd operative procedure performed for the management of some rib fractures and the inferior angle of the scapular body. Observe the sequential reduction and fixation of the 6th left rib with a 2.0-mm straight non-locked plate; g: Intraoperative fluoroscopic images demonstrating the final fixation of the 6th, 7th, and 9th rib fractures, and the inferior angle of the scapular body; h, Postoperative AP, oblique, and lateral radiographs of the thorax, demonstrating the adequate reduction of both the complex left scapular and the multiple left rib fractures. Postoperative in-hospital and after discharge management protocols are the same as previously described for glenoid cavity fractures