Vol. 11, Issue 4 (2025)

Scapular fractures are uncommon injuries that pose significant challenges in management due to their complex anatomy and the biomechanical role of the scapula in shoulder function. Although most scapular fractures have traditionally been managed conservatively, recent advances in surgical techniques and fixation devices have expanded operative indications, particularly in displaced and intra-articular fracture patterns. Among the various surgical approaches described, achieving adequate joint exposure remains difficult when fractures involve both the glenoid and scapular body.

This report describes the surgical management of a complex intra-articular glenoid fracture extending into the scapular neck and body in a 36-year-old male patient who sustained a gunshot wound. The fracture, classified as AO 14F2.1 + AO 14B1, was treated using the reverse Judet approach. This approach provided extensive posterior exposure of the glenoid cavity, scapular body, and neck, facilitating accurate reduction, stable internal fixation, and management of associated posterior labral injury. Postoperative imaging confirmed satisfactory articular reduction and fixation, and the patient was managed with structured immobilization and rehabilitation.

The reverse Judet approach offers panoramic visualization of complex scapular fracture patterns and allows simultaneous management of intra-articular and extra-articular components. Despite its advantages, including improved access and fracture control, it is associated with increased soft tissue dissection and rotator cuff tenotomy, which may delay early rehabilitation. Careful patient selection and surgical expertise are essential. This case highlights the reverse Judet approach as a valuable surgical option for complex scapular fractures when wide exposure is required to optimize functional outcomes.