Floating Shoulder



Combination of scapular neck fracture and ipsilateral clavicle fracture / CC ligament disruption




Floating Shoulder


Floating Shoulder 1Floating Shoulder 2


Glenoid Neck Fracture CTClavicle Fracture CT




High velocity injuries




Fractures usually of scapular neck


Potential Problems


Disrupts the suspensory mechanism of the shoulder

- displacement disrupts normal stability of GHJ

- changes biomechanics

- subacromial pain / impingement




Little evidence

- concern with displacement of fractures

- weakness of abduction / subacromial pain / poor shoulder function

- risk of non / malunion


Used to be recommended surgery for floating shoulder


Non operative Management



- undisplaced fractures


Edwards et al JBJS Am 2000

- 20 patients with floating shoulder treated non operatively

- 11 with displaced clavicle fractures (>10mm)

- 5 with displaced scapula fracture (>5mm)

- 19/20 united (one had segmental clavicle bone loss from gunshot)

- excellent functional scores


Labler J Trauma 2004

- 8 treated non operative, 9 treated operative

- 5 good results in each group

- recommend nonoperative treatment for less displaced fractures

Egol et al JBJS Am 2001

- 19 patients with clavicle fracture and displaced fracture glenoid neck

- 12 non operative, 7 operative

- good results in each group

- recommend individualized treatment


Operative Management




1.  ORIF clavicle


Minimally displaced glenoid fracture


Floating Shoulder Clavicle ORIF


2.  ORIF glenoid and clavicle


Displaced scapular neck

- > 40o angulation

- > 1cm displacement

- CT useful


Leung et al JBJS Br 1993

- 15 patients floating shoulder

- all scapular neck

- ORIF clavicle + glenoid (posterior approach)

- good functional outcome in all patients



- risk of PTX during surgery if rib fracture (secondary to PPV)

- may need chest tube


Rib Fracture CT