The floating shoulder: Ipsilateral clavicular and scapular neck fractures treatment by different methods

Abstract

Introduction: Double disruptions of the superior suspensory shoulder complex (SSSC) resulting in ipsilateral mid shaft clavicular and scapular body/neck fractures, are commonly referred to as a ‘floating shoulder’ injury. If not treated properly, this could lead to malunion, drooping shoulder deformity, shoulder pain and weakness, subacromial impingement syndrome, traumatic arthritis, and even delayed nerve and vascular damage and other complications. Materials and Methods: This is a retrospective type of study of 15 cases of floating shoulder injury treated by different surgical methods. All the cases were operated electively on regular operation theatre days. Results: The age range in total 15 patients was from 22 years to 62 years with mean age at the time of injury was 40.4 years. Out of 15 cases 12 (80%) were males and 3(20%) were females. High energy trauma in 12(80%) cases, fall from height in 2(13.3%) cases and fall of heavy metal object in one (6.6%) case. Associated injuries in the form of rib fractures with haemothorax in 5(33.3%) cases, head injury in 3 (20%) cases, tibial shaft fracture in one(6.6%) case and tibial spine avulsion in one (6.6%) case. Total of 7(46.6%) cases treated with only clavicle fixation, 5(33.3%) cases with both scapula and clavicle fixation and 3(20%) cases treated conservatively. Mean Herscovici score was 12.4 with excellent results in 4, good in 6, fair in 3 and poor in 2 cases. Conclusion: Significant displacement at one or both fracture sites of floating shoulder injury can result in a poor functional outcome which can be improved with surgical intervention. Conservative management with acceptable results reserved for patients with minimally-displaced fractures.