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Functional outcomes of operative fixation of clavicle fractures in patients with floating shoulder girdle injuries.

Gilde AK, Hoffmann MF, Sietsema DL, Jones CB - J Orthop Traumatol (2015)

Bottom Line: All injuries were the result of high-energy mechanisms.None of the patients required reconstruction for scapula malunion after nonoperative management.Level IV.

View Article: PubMed Central - PubMed

Affiliation: Grand Rapids Medical Education Partners, Orthopaedic Surgery Residency, Grand Rapids, MI, 49503, USA, Alex.Gilde@grmep.com.

ABSTRACT

Background: Double disruptions of the superior suspensory shoulder complex, commonly referred to as 'floating shoulder' injuries, are ipsilateral midshaft clavicular and scapular neck/body fractures with a loss of bony attachment of the glenoid. The treatment of 'floating shoulder' injuries has been debated controversially for many years. The purpose of this study was to demonstrate the clinical and functional outcomes of patients with 'floating shoulder' injuries who underwent operative fixation of the clavicle fracture only.

Materials and methods: Between 2002 and 2010, 32 consecutive floating shoulder injuries were identified in skeletally mature patients at a level I trauma center and followed in a single private practice. Thirteen patients met the inclusion and exclusion criteria for this retrospective study with a minimum 12-month follow-up. Clavicle and scapular fractures were identified by Current Procedural Technology codes and classified based on Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen criteria. 'Floating shoulder' injuries were surgically managed with only clavicular reduction and fixation utilizing modern plating techniques. Nonunion, malunion, implant removal, range of motion, need for secondary surgery, pain according to the visual analog scale (VAS), and return to work were measured.

Results: All injuries were the result of high-energy mechanisms. Fracture union of the clavicle was seen after initial surgical fixation in the majority of patients (12; 92.3 %). Final pain was reported as minimal (11 cases; 1-3 VAS), moderate (1 case; 4-6 VAS), and high (1 case; 7-10 VAS) at last follow-up. Excellent range of motion (180° forward flexion and abduction) was observed in the majority of patients (8; 61.5 %). The Herscovici score was 12.9 (range 10-15) at 3 months. Unplanned surgeries included two clavicular implant removals and one nonunion revision. None of the patients required reconstruction for scapula malunion after nonoperative management. Twelve patients returned to previous work without restrictions.

Conclusions: 'Floating shoulder' injuries with only clavicular fixation return to function despite persistent scapular deformity and some residual pain.

Level of evidence: Level IV.

No MeSH data available.


Related in: MedlinePlus

The glenopolar angle as measured on 3D CT reconstruction. The apex created by two lines extending from the superior glenoid pole to the mid-point of the inferior angle and inferior glenoid pole determine the glenopolar angle
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Fig1: The glenopolar angle as measured on 3D CT reconstruction. The apex created by two lines extending from the superior glenoid pole to the mid-point of the inferior angle and inferior glenoid pole determine the glenopolar angle

Mentions: All patients were treated and followed by four fellowship-trained orthopedic trauma surgeons utilizing similar philosophies and techniques. At the time of injury, all patients had computed tomography (CT) scans with three-dimensional (3D) reconstruction of the scapular fracture to assess deformity which included the glenopolar angle [34] (Fig. 1) and medialization/lateralization [35] (Fig. 2) of the scapular fragments [GE LightSpeed VCT 64-slice CT scanner; GE Healthcare, Waukesha, WI, USA (1.25-mm slice thickness); 3D reconstruction with TeraRecon Aquarius iNtuition v.4.4.5.49; TeraRecon, Inc, Foster City, CA, USA].Fig. 1


Functional outcomes of operative fixation of clavicle fractures in patients with floating shoulder girdle injuries.

Gilde AK, Hoffmann MF, Sietsema DL, Jones CB - J Orthop Traumatol (2015)

The glenopolar angle as measured on 3D CT reconstruction. The apex created by two lines extending from the superior glenoid pole to the mid-point of the inferior angle and inferior glenoid pole determine the glenopolar angle
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4559540&req=5

Fig1: The glenopolar angle as measured on 3D CT reconstruction. The apex created by two lines extending from the superior glenoid pole to the mid-point of the inferior angle and inferior glenoid pole determine the glenopolar angle
Mentions: All patients were treated and followed by four fellowship-trained orthopedic trauma surgeons utilizing similar philosophies and techniques. At the time of injury, all patients had computed tomography (CT) scans with three-dimensional (3D) reconstruction of the scapular fracture to assess deformity which included the glenopolar angle [34] (Fig. 1) and medialization/lateralization [35] (Fig. 2) of the scapular fragments [GE LightSpeed VCT 64-slice CT scanner; GE Healthcare, Waukesha, WI, USA (1.25-mm slice thickness); 3D reconstruction with TeraRecon Aquarius iNtuition v.4.4.5.49; TeraRecon, Inc, Foster City, CA, USA].Fig. 1

Bottom Line: All injuries were the result of high-energy mechanisms.None of the patients required reconstruction for scapula malunion after nonoperative management.Level IV.

View Article: PubMed Central - PubMed

Affiliation: Grand Rapids Medical Education Partners, Orthopaedic Surgery Residency, Grand Rapids, MI, 49503, USA, Alex.Gilde@grmep.com.

ABSTRACT

Background: Double disruptions of the superior suspensory shoulder complex, commonly referred to as 'floating shoulder' injuries, are ipsilateral midshaft clavicular and scapular neck/body fractures with a loss of bony attachment of the glenoid. The treatment of 'floating shoulder' injuries has been debated controversially for many years. The purpose of this study was to demonstrate the clinical and functional outcomes of patients with 'floating shoulder' injuries who underwent operative fixation of the clavicle fracture only.

Materials and methods: Between 2002 and 2010, 32 consecutive floating shoulder injuries were identified in skeletally mature patients at a level I trauma center and followed in a single private practice. Thirteen patients met the inclusion and exclusion criteria for this retrospective study with a minimum 12-month follow-up. Clavicle and scapular fractures were identified by Current Procedural Technology codes and classified based on Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen criteria. 'Floating shoulder' injuries were surgically managed with only clavicular reduction and fixation utilizing modern plating techniques. Nonunion, malunion, implant removal, range of motion, need for secondary surgery, pain according to the visual analog scale (VAS), and return to work were measured.

Results: All injuries were the result of high-energy mechanisms. Fracture union of the clavicle was seen after initial surgical fixation in the majority of patients (12; 92.3 %). Final pain was reported as minimal (11 cases; 1-3 VAS), moderate (1 case; 4-6 VAS), and high (1 case; 7-10 VAS) at last follow-up. Excellent range of motion (180° forward flexion and abduction) was observed in the majority of patients (8; 61.5 %). The Herscovici score was 12.9 (range 10-15) at 3 months. Unplanned surgeries included two clavicular implant removals and one nonunion revision. None of the patients required reconstruction for scapula malunion after nonoperative management. Twelve patients returned to previous work without restrictions.

Conclusions: 'Floating shoulder' injuries with only clavicular fixation return to function despite persistent scapular deformity and some residual pain.

Level of evidence: Level IV.

No MeSH data available.


Related in: MedlinePlus