Supraspinatus and infraspinatus compartment syndrome following scapular fracture
A 64-year-old male involved in a motor vehicle collision presented with left shoulder and facial pain. Examination revealed a swollen, soft shoulder [] with scapular and acromioclavicular (AC) joint tenderness and painful motion. X-rays showed a comminuted scapular body and spine fracture extending to acromion base with AC joint widening [Figures , and ]. The patient's airway later became compromised secondary to facial fracture swelling, requiring intubation.\nLater, evaluation revealed increased swelling and tenseness over the left scapula. Supraspinatus and infraspinatus compartment pressures were measured at 49 mmHg and 32 mmHg, respectively, with a diastolic blood pressure of 43 mmHg.\nFifteen hours after presentation, emergent fasciotomy was performed.\nThe incision extended over the scapular spine similar to a modified Judet incision.[] Upon release, the supraspinatus and infraspinatus compartments showed good muscle escape, beefy red coloration, adequate bleeding, and contracture with stimulation []. Elevated serum myoglobin levels prior to fasciotomy were 2705 ng/ml, which declined to 1221 ng/ml and 630 ng/ml on postoperative day #1 and #2, respectively. The combination of scapular spine, acromion base, and AC joint separation prompted plans for open reduction internal fixation (ORIF),[] which were delayed until hospital day #13 due to pneumonia []. Twenty-week post-op examination revealed active shoulder motion of 50° requiring removal of the AC plate and manipulation under anesthesia. Final 10-month follow-up revealed full strength and near-full flexion and abduction with complete radiographic bony healing. There were no signs of sequelae from compartment syndrome at any point.