Abstract
BackgroundDouble disruptions of the superior suspensory shoulder complex, commonly referred to as ‘floating shoulder’ injuries, are ipsilateral midshaft clavicular and scapular neck/body fractures with a loss of bony attachment of the glenoid. The treatment of ‘floating shoulder’ injuries has been debated controversially for many years. The purpose of this study was to demonstrate the clinical and functional outcomes of patients with ‘floating shoulder’ injuries who underwent operative fixation of the clavicle fracture only.Materials and methodsBetween 2002 and 2010, 32 consecutive floating shoulder injuries were identified in skeletally mature patients at a level I trauma center and followed in a single private practice. Thirteen patients met the inclusion and exclusion criteria for this retrospective study with a minimum 12-month follow-up. Clavicle and scapular fractures were identified by Current Procedural Technology codes and classified based on Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen criteria. ‘Floating shoulder’ injuries were surgically managed with only clavicular reduction and fixation utilizing modern plating techniques. Nonunion, malunion, implant removal, range of motion, need for secondary surgery, pain according to the visual analog scale (VAS), and return to work were measured.ResultsAll injuries were the result of high-energy mechanisms. Fracture union of the clavicle was seen after initial surgical fixation in the majority of patients (12; 92.3 %). Final pain was reported as minimal (11 cases; 1–3 VAS), moderate (1 case; 4–6 VAS), and high (1 case; 7–10 VAS) at last follow-up. Excellent range of motion (180° forward flexion and abduction) was observed in the majority of patients (8; 61.5 %). The Herscovici score was 12.9 (range 10–15) at 3 months. Unplanned surgeries included two clavicular implant removals and one nonunion revision. None of the patients required reconstruction for scapula malunion after nonoperative management. Twelve patients returned to previous work without restrictions.Conclusions‘Floating shoulder’ injuries with only clavicular fixation return to function despite persistent scapular deformity and some residual pain.Level of evidence Level IV.
Highlights
Double disruptions of the superior suspensory shoulder complex (SSSC) resulting in ipsilateral midshaft clavicular and scapular body/neck fractures, are commonly referred to as a ‘floating shoulder’ injury, and result in a loss of bonyJ Orthopaed Traumatol (2015) 16:221–227 attachment of the glenoid [1, 2]
Fracture union of the clavicle was seen after initial surgical fixation in the majority of patients (12; 92.3 %)
Twelve patients returned to previous work without restrictions
Summary
Double disruptions of the superior suspensory shoulder complex (SSSC) resulting in ipsilateral midshaft clavicular and scapular body/neck fractures, are commonly referred to as a ‘floating shoulder’ injury, and result in a loss of bonyJ Orthopaed Traumatol (2015) 16:221–227 attachment of the glenoid [1, 2]. Double disruptions of the superior suspensory shoulder complex (SSSC) resulting in ipsilateral midshaft clavicular and scapular body/neck fractures, are commonly referred to as a ‘floating shoulder’ injury, and result in a loss of bony. In floating shoulder injuries with significant displacement, some studies have recommended fixation of both clavicular and scapular fractures [11, 13, 18,19,20]. The purpose of this study was to describe the clinical and functional outcomes of patients with displaced and unstable ‘floating shoulder’ injury following fixation of only the clavicular fracture. Double disruptions of the superior suspensory shoulder complex, commonly referred to as ‘floating shoulder’ injuries, are ipsilateral midshaft clavicular and scapular neck/body fractures with a loss of bony attachment of the glenoid. Clavicle and scapular fractures were identified by Current Procedural Technology codes and
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