Case of a spontaneous comminuted scapular fracture and a review of literature

Background Spontaneous scapular fractures without preceding trauma are exceedingly rare as they are often occur in high-energy trauma. Recognised aetiological factors include rotator cuff-tear arthropathy, osteoporosis, and long-term corticosteroid or bisphosphonate use. The absence of a traumatic history poses a diagnostic challenge, as presenting complaints may be attributed to soft-tissue pathology alone. Case Report A 62-year-old male taxi driver with a background of hypertension, hyperlipidaemia and poorly controlled Diabetes Mellitus presented to the emergency department with a five-day history of sudden onset left shoulder blade pain and difficulty moving his left shoulder while resting at home. There was no preceding history of trauma, strenuous activity or heavy lifting. Examination revealed exquisite tenderness over the left scapula with significantly limited shoulder movement. Computed tomography of scapula revealed a comminuted fracture of the left scapula body with surrounding soft tissue swelling. Bone Mineral Density (BMD) scan revealed osteopenia, and the patient was commenced on cholecalciferol and calcium supplementation. The fracture was managed conservatively with an arm sling and physiotherapy, and subsequent follow-up showed persistent fracture deformity without callus formation. Why should an Emergency Physician be aware of this? Spontaneous scapular fracture is a rare but clinically significant diagnosis that warrants consideration in patients presenting with shoulder pain, particularly the elderly and those with predisposing conditions including osteoporosis, chronic corticosteroid or bisphosphonate use, and rotator cuff arthropathy. Its identification should prompt systematic evaluation for underlying pathological causes — notably metabolic bone disease and malignancy. Clinicians should also maintain awareness that systemic conditions such as diabetes mellitus may contribute to generalised bone fragility, broadening the differential for insufficiency fractures beyond conventional osteoporosis.