Scapular fractures are relatively uncommon injuries, but present substantial challenges in the setting of high-energy polytrauma, particularly when complex articular or comminuted patterns occur in young, active patients ^[1,2]. Traditional management has relied on radiographic evaluation and surgeon experience; however, advances in three-dimensional (3D) computed tomography (CT) reconstruction have significantly improved pre-operative characterization of fracture morphology and operative decision-making ^[1,2]. The integration of 3D printing technology into orthopedic trauma care has further enhanced both pre-operative planning and intraoperative execution. Patient-specific 3D-printed models derived from CT data provide tactile and visual feedback that improves understanding of complex anatomy, facilitates rehearsal of reduction maneuvers, and enables precise pre-contouring of fixation implants ^{[3,4,5,6,7,8]}. Prior studies have demonstrated reductions in operative time, intraoperative blood loss, and procedural variability, with improvements in the accuracy of anatomical restoration ^{[3,4,5,9,10,11]}. In scapular fracture surgery, 3D-printed models allow for direct application of pre-contoured implants and simulation of surgical steps, which is particularly valuable in cases with distorted anatomy or limited surgical exposure ^[3,5,7,11]. These workflows can be implemented in-house, improving accessibility and cost-effectiveness ^[3,5,6,7,12]. This case report describes the use of 3D CT reconstruction and a sterilizable, patient-specific 3D scapular model in the operative management of a complex scapular fracture, highlighting its role in enhancing surgical planning and intraoperative efficiency.

A 22-year-old active-duty male sustained polytrauma following a high-speed motorcycle collision, resulting in fractures of the left radius and ulna, left scapula, left tibia and fibula, and left proximal femur, as well as cervical spine fractures and a left subclavian artery injury. Initial treatment occurred at a community hospital before transfer to a Level II military trauma center. Further evaluation revealed a comminuted left scapular body fracture with scapulothoracic dissociation. Neurologic examination raised concern for pan-brachial plexus injury, with complete motor and sensory deficits in the affected extremity. Imaging demonstrated transection of the suprascapular nerve branch to the supraspinatus, while the branch to the infraspinatus remained anatomically intact but non-functional. Radiographs of the left shoulder were collected, and high-resolution CT imaging of the scapula was used to render a 3D reconstruction of the scapular fracture. Imaging demonstrated a comminuted left scapula fracture with fractured margins isolating the glenohumeral joint from the scapular body (Fig. 1 and 2). Given the goals of pain control and shoulder girdle stabilization, operative management was indicated.

Figure 1: Pre-operative anteroposterior radiograph of the left shoulder demonstrating a comminuted left scapula fracture with displacement and medialization of the glenoid segment.

Figure 2: Pre-operative 3D computed tomography reconstruction of the left scapula further demonstrating the comminuted fracture pattern.

Utilizing the 3D reconstruction file, 3D modeling and printing software, and a non-commercial 3D printer, a full-scale, patient-specific 3D-printed scapular model was fabricated for pre-operative planning. The model was subsequently sterilized for intraoperative reference during the case. Open reduction and internal fixation of the left scapula was performed via a modified Judet approach. The 3D model facilitated visualization and planning of reduction at three critical regions: the lateral scapular body, spinoglenoid notch, and suprascapular fossa. Intraoperatively, the model served as a tactile reference for fracture reduction and implant positioning (Fig. 3).

Figure 3: Intraoperative photograph showing the application of the left scapula 3D model for surgical planning and reference.

A point-to-point reduction clamp was used to reduce the lateral scapular body as planned. Visualization through the supraspinatus and infraspinatus fossae enabled further reduction across the spinoglenoid notch; however, limited exposure complicated direct visualization of fracture margins. As determined preoperatively using the model, a contoured 3.5-mm compression plate was placed along the lateral scapular body. A 3.5-mm partially threaded cannulated screw was inserted from the spinoglenoid notch toward the glenoid using a Kirschner wire for guidance, achieving compression across the fracture. The 3D model enabled the precise determination of the screw start point and trajectory, simplifying this technically demanding step. A 2.0-mm T-plate was applied across the suprascapular fossa to neutralize the fracture. Fluoroscopy confirmed satisfactory hardware placement without joint penetration. The transected suprascapular nerve branch to the supraspinatus was identified and repaired.

Postoperatively, the patient was immobilized in a sling for 6 weeks. Post-operative radiographs and CT imaging confirmed anatomic reduction and appropriate hardware placement (Fig. 4 and 5). Pain was managed with an epidural and ketamine infusion, and neurorehabilitation planning was initiated. The patient tolerated the procedure well and was discharged with a comprehensive recovery plan.

Figure 4: Post-operative anteroposterior radiograph of the left shoulder demonstrating internal fixation of the comminuted left scapular fracture.

Figure 5: Post-operative 3D computed tomography reconstruction of the left scapula confirming anatomic reduction and appropriate hardware placement.

Three-dimensional CT reconstruction and 3D printing represent significant advances in the management of complex scapular fractures. Patient-specific models provide a tangible representation of fracture anatomy, enhancing pre-operative planning, intraoperative orientation, and implant selection in anatomically complex regions ^[3,4,5,7,13]. Pre-contouring implants and simulating surgical steps using 1:1 models have been shown to reduce operative time and intraoperative variability while improving anatomical restoration ^[3,11,14]. Advanced technologies such as augmented reality and virtual simulation further enhance precision, particularly in minimally invasive approaches ^{[11,12,13,14]}. Beyond trauma, 3D models have proven useful in oncologic reconstruction and malunion correction, supporting individualized surgical planning and patient education ^[7,14]. Model accuracy depends on high-quality imaging. Although ultra-low-dose CT protocols reduce radiation exposure, they may compromise geometric fidelity in complex scapular fractures ^[15]. High-resolution CT remains essential for accurate model generation ^[2,15]. Fracture mapping studies have identified reproducible scapular fracture patterns that inform surgical approach and implant design ^[2]. In cases with limited posterior visualization through a modified Judet approach, sterilized 3D models enhance spatial orientation and facilitate precise screw trajectory planning, as demonstrated in this case. Barriers to widespread adoption include technical expertise, equipment access, and workflow integration ^[3,4,13]. However, in-house printing has demonstrated feasibility and cost-effectiveness ^[3,13]. Future applications include patient-specific implants, bioprinting, and integration with advanced navigation technologies, expanding both trauma and elective orthopedic indications ^[11,13].

Three-dimensional CT reconstruction and 3D printing offer meaningful advantages in the management of complex scapular fractures by enhancing anatomical visualization, surgical planning, and intraoperative execution. This case supports extending the use of patient-specific 3D models to scapular fractures in both military and civilian trauma settings, particularly when fracture comminution and anatomic complexity limit conventional imaging interpretation. Continued technological advancement is expected to further integrate 3D printing into routine orthopedic practice.

This case demonstrates that a sterilizable, patient-specific three-dimensional (3D)-printed model can provide meaningful intraoperative guidance during fixation of a complex, comminuted scapular fracture when conventional imaging and limited surgical exposure impede accurate interpretation of fracture morphology. The use of a physical model facilitated the identification of bony corridors and precise implant positioning during a technically demanding procedure. Although 3D modeling has been described in other areas of orthopedic trauma, its application to scapular fracture fixation remains limited; this report highlights its potential value as an adjunct in select cases of severe anatomical complexity in both civilian and military trauma care.