We evaluated thirty patients with a fracture of the scapula in a
prospective study over a seven-year period. Sixteen patients were found to
have an associated pneumothorax, of which more than two-thirds were
associated with a fracture of the left scapula. Ten of the pneumothoraces
were delayed for one to three days. All of the scapular fractures were
treated using a shoulder immobilizer, and early range-of-motion exercises
of the involved extremity were instituted as tolerated. Information
obtained from pulmonary auscultation and percussion, determination of
initial values for arterial blood gases, and daily chest radiographs for
three days after injury confirmed the diagnosis. Closed suction drainage
using anteriorly or laterally placed thoracostomy tubes was performed
successfully in all patients and avoided the potential sequelae of shock,
respiratory failure, and pneumonia, as well as recurrence.