Background:
Scapula fractures are historically managed conservatively. Although surgical treatment has become increasingly common and is associated with favorable outcomes, comparative studies of surgical vs. nonsurgical management remain scarce. To the best of our knowledge, this meta-analysis is the first systematic comparison of outcomes in extra-articular scapula fractures according to fracture localization.

Methods:
MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform were systematically searched in April 2024 for studies on extra-articular scapula fractures. Two reviewers independently conducted a two-stage screening process. Patients were grouped into scapular neck, scapular body, and floating shoulder fractures, each stratified by surgical or nonsurgical management. Surgically treated floating shoulder injuries were further categorized by clavicle fixation alone or combined scapula–clavicle fixation. Outcomes included the Constant Score (CS), University of California Los Angeles Shoulder score, and Disabilities of the Arm, Shoulder, and Hand score. A random-effects meta-analysis was performed.

Results:
Twenty-six studies including 601 patients met the inclusion criteria. No statistical difference was observed for scapular neck fractures (P = .62; mean CS: surgical 93.6 vs. nonsurgical 89.6). In scapular body fractures, CS differences were not significant, while Disabilities of the Arm, Shoulder, and Hand scores showed a trend favoring surgery (P = .05; surgical 5.9 vs. nonsurgical 12.8). For floating shoulder injuries, CSs were similar between nonsurgical management (77.3) and clavicle fixation alone (76.7), whereas combined scapula–clavicle fixation yielded higher scores (87.0; P = .14).

Conclusion:
Surgical intervention for extra-articular scapular fractures showed no significant overall benefit, though floating shoulder injuries trended toward clinically meaningful improvement. Current evidence is limited by heterogeneity, highlighting the need for high-quality prospective studies to guide optimal management