The approach and the positioning of the patient are determined by the exact location of the fracture. Generally extra articular fractures of the scapular neck, posterior rim, and posterior articular segments are approached posteriorly.
In carrying out this approach one must be careful not to injure the suprascapular nerve coursing through the suprascapular notch on its way to supply the supra- and infraspinatus muscles. Teres minor is supplied by a posterior branch of the axillary nerve given off as the nerve emerges from the quadrilateral space with the posterior circumflex artery and vein.
3. Skin incision
The incision is made starting at the tip of the acromion posteriorly and proceeds towards the scapular angle parallel to the lateral border of the scapula. The extent of the incision will depend on the amount of exposure required.
Make sure to leave a small tissue border to facilitate subsequent reattachment.
Using sharp dissection, divide the deltoid from its insertion into the scapular spine and base of the acromion.
Continue freeing the deltoid muscle so that it can be reflected laterally. Avoid damaging the axillary nerve and posterior circumflex humeral artery laterally.
In order to expose the lateral margin of the scapula, identify the interval between the infraspinatus and the teres minor. Open the interval and as you separate the infraspinatus and teres minor, you will expose the posterior capsule of the joint and the axillary border of the scapula.
In elevating these muscles, be careful not to damage their nerve supply.
In order to verify articular reduction and fixations, a posterior arthrotomy is necessary and is part of the surgical exposure.
4. Wound closure
After surgery irrigate the wound and close the joint capsule.
A drain may be placed beneath the infraspinatus and the teres minor muscle.
Reattach the base of the deltoid muscle and its deep and superficial fascia to the remaining cuff of deltoid on the acromion and spine of the scapula. Close the subcutaneous tissues and the skin.