Floating Shoulder

Definition

 

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

 

Imaging

 

Floating Shoulder

 

Floating Shoulder 1Floating Shoulder 2

 

Glenoid Neck Fracture CTClavicle Fracture CT

 

Epidemiology

 

High velocity injuries

- MVA

- MBA

 

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

 

NHx

 

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

 

Indication

- 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

 

Options

 

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

 

Note:

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

- may need chest tube

 

Rib Fracture CT