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immature patients Typically the arm is immobilized in the adducted and internally rotated position by using a sling Following a period of immobilization, physical therapy is generally recommended FIGURE 111.12 Radiograph of a 13-year-old boy who sustained an isolated right scapular fracture as the result of a skateboarding accident (arrow ) Disposition Once the shoulder has been reduced, the patient may be discharged provided there is no neurovascular compromise Since traumatic shoulder dislocations in adolescents have a high rate of recurrence and persistent instability, outpatient orthopedic follow-up is recommended within week for monitoring and appropriate physical rehabilitation Injuries of the Scapula CLINICAL PEARLS AND PITFALLS Scapula fractures are uncommon and generally associated with a highenergy mechanism of injury, and concurrent thoracic, intracranial, spine, or other potentially life-threatening injuries Scapula fractures are typically seen after injuries of significant force, such as a fall from a height, a motor vehicle collision, or a severe direct blow ( Fig 111.12