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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.