Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Floating Shoulder Injuries



                                                                       by James J. Davidson MD

- Discussion:
    - refers to scapular frx and clavicle frx (or AC joint injury);
    - single disruptions:
           - common injuries, often w/ minimal displacement;
           - types:
                   - midshaft clavicle fracture
                   - distal clavicle fracture
                   - AC separation
                   - scapular body fracture
                   - scapular neck fracture
                   - glenoid fracture
    - double disruptions:
           - rare, high energy injuries;
           - integrity compromised (ring/ring, strut/strut)
           - ring/strut combination potentially unstable
           - involves clavicle frx (or AC separation) which occurs along w/ scapular frx;
           - functional / healing limitations
           - surgical treatment indicated
           - surgical treatment:
                 - ORIF of simpler fracture (see ORIF of claviclar frx)
                 - reevaluation of displacement of remaining disruption
                 - ORIF if needed based on displacement

- Physical Examination:
    - r/o respiratory distress
    - note any decreased BS left/SQ emphysema
    - look for foreshortened shoulder girdle
    - palpate for prominent midshaft clavicle;
    - NV exam

- Surgical Results:
    - Herscovici D, et al (1992)
          - 9 patients with ipsilateral midshaft clavicle/ scapular neck fx ("floating shoulder")
          - 7 ORIF clavicle, 2 nonoperative
          - 4 year avg follow-up
          - 7 operative excellent
          - 2 nonoperative fair or poor with pain, deformity, decreased ROM
          - all fractures united
    - Leung and Lam (1993)
          - 15 patients with "floating shoulder"
          - all fractures treated with ORIF
          - 25 month avg. follow-up
          - 14/15 good or excellent (1 activity-related moderate pain
          - all fractures healed at 8 weeks avg;
    - Ramos L, et al (1997)
          - 13 patients with "floating shoulder"
          - managed nonoperatively
          - all fractures healed
          - 7.5 year avg. follow-up
          - 92% good or excellent
          - 3 patients had shoulder asymmetry
    - complications:
          - delayed union/nonunion
          - malunion
          - impingement
          - decreased function (strength, mobility)
          - early degenerative changes
          - NV compromise

- Case #1:
       

       


- Case #2:
       

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Double disruptions of the superior shoulder suspensory complex.

The floating shoulder: ipsilateral clavicle and scapular neck fractures.

Open reduction and internal fixation of ipsilateral fractures of the scapular neck and clavicle. 

Conservative treatment of ipsilateral fractures of the scapula and clavicle.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, January 3, 2013 3:08 pm