CopyrightOrthopedic © Karunakgaran Research K CRIMSON PUBLISHERS C Wings to the Research Online Journal Case Report Scapula Winging With a Clavicle Fracture: A Case Report Karunakgaran K1* and Taran Singh Pall Singh2 Department of Orthopaedic, Malaysia. *Corresponding author: Karunakgaran K, Department of Orthopaedic, Malaysia Submission: September 22, 2017; Published: May 18, 2018 Abstract We report a case of a patient who sustained closed comminute mid-shaft right clavicle fracture with ipsilateral scapula winging. The winging winging is caused by scapular dyskinesia secondary to shortening of the clavicle. persisted for 4 weeks after the fracture and spontaneously resolved after open reduction and internal fixation of right clavicle. We suspect that the Introduction Clavicle fracture association with scapula winging is a rare Upon pushing both palms against the wall with the elbows entity. Prevalence of scapula winging in clavicle fractures is less than 0.05% [1]. Damage to the long thoracic nerve is a classic cause of the serratus anterior, trapezius and rhomboid muscles were extended, the deformity disappeared. Specific assessment of medial scapula winging [2]. There are reports of scapula winging in normal. Nerve conduction study of the long thoracic and spinal association with malunions and non-union’s of acromian fractures accessory nerves was also normal. Radiographs revealed a [3], as well as clavicle fractures [3]. displaced comminute clavicle shaft fracture with a shortening of 3cm (Figure 2). The clavicle fracture was treated surgically with Case Report A previously healthy 21-year-old Malay girl presented to our compression plate (Synthes®) and augmented with autologous open reduction and internal fixation using a distal clavicle locking clinic 6 weeks after sustaining a closed comminute mid-shaft right cortico-cancellous iliac crest bone graft (Figure 3). There was near clavicle fracture following a motor vehicle accident. She had no complete resolution of the scapular winging upon inspection on the second day after surgery (Figure 4). The patient was also prescribed right mid-clavicular area and crepitus upon attempted shoulder physiotherapy with emphasis on serratus anterior, rhomboid and other significant injuries. Examination revealed a deformity in the of surgery, complete resolution of winging. During second follow motion. There was no evidence of brachial plexus injury clinically trapezius muscle strengthening. On the first follow up after 2 weeks up after 2 months of post-operative, she had good shoulder range as her sensory and motor examination was all normal. She had was prominence of the medial border of the right scapula which of motion. limited shoulder abduction and flexion due to pain. Posterior, there was also displaced laterally (Figure 1). Figure 2: Chest radiograph showing right clavicle mid- Figure 1: Right scapula winging. shaft fracture with 3cm shortening. Volume 2 - Issue - 4 Copyright © All rights are reserved by Karunakgaran K. 159 Ortho Res Online J Copyright © Karunakgaran K Discussion Our patient presented with a unique case of scapula winging. We suspect that the winging is caused by scapular dyskinesia secondary to shortening of the clavicle. The clavicle acts as a strut skeleton. Alteration in this linkage may lead to abnormalities in the for the shoulder complex, connecting the scapula to the axial static or dynamic position of the scapula [4]. Dyskinesia can be a clinical sign of potentially harmful alteration of clavicle anatomy, Figure 3: Post-operative Chest radiograph showing restoration of right clavicle length. of these cases, scapula winging resolves completely after surgery. hence, justifying surgical treatment for these fractures. In majority Other possible contibutory factors to produce winging with a clavicle fracture include loss of scapular suspensory mechanism and pain. References 1. recurrent scapula winging. Hindawi publishing corporation. Kendra E Keenan, John G Skedro (2012) A Patient Clavicle fracture with 2. related research.185: 228-236. Fiddian NJ, king RJ (1984) The winged scapula clinical orthopaedic and 3. Figure 4: Right scapula winging resolved during inspection Rasyid HN, Nakajima T (2008) Winging of scapula caused by disruption of on the second day after surgery. 4. Scapularsternoclavicularscapular dyskinesis. Scott linkage.Sevinsky Journal MSPT. of shoulder and elbow surgery. Creative Commons Attribution 4.0 Orthopedic Research Online Journal International License Benefits of Publishing with us Submit Article • High-level peer review and editorial services For possible submissions Click Here • Freely accessible online immediately upon publication • Authors retain the copyright to their work • Licensing it under a Creative Commons license • Visibility through different online platforms Volume 2 - Issue - 4 How to cite this article: Karunakgaran K, Taran S P S. Scapula Winging With a Clavicle Fracture: A Case Report .Ortho Res Online J. 2(4). 160 OPROJ.000543.2018. DOI: 10.31031/OPROJ.2018.02.000543.