Scapular fractures are important in that they are often associated with high morbidity and mortality. Frequently they are overlooked because of the severity of other associated injuries. Extraarticular scapular fractures are often treated conservatively, even when displaced. There is no significant long-term evaluation on this type of treatment and on the management of scapular malunion. This case report presents a missed scapular fracture and associated rib fractures with subsequent malunion and a 23-year follow-up assessment. Surgical resection of a distorted inferior medial border of the scapula and dorsal rib prominences relieved the patient's symptoms. The case presentation, diagnostic modalities, treatment, and possible long-term sequelae of this complex fracture are reviewed.