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The floating shoulder: clinical and functional results.
K A Egol1, P M Connor, M A Karunakar
1Department of Orthopaedic Surgery, NYU-Hospital for Joint Diseases, Jamaica, NY 11418, USA.
The Journal of Bone and Joint Surgery. American Volume
|August 17, 2001
Summary
Displaced clavicle and glenoid neck fractures, known as a floating shoulder, show similar functional outcomes whether treated operatively or nonoperatively. Individualized treatment plans are recommended for this complex injury pattern.
Area of Science:
- Orthopaedic Surgery
- Traumatology
- Sports Medicine
Background:
- Displaced ipsilateral clavicle and glenoid neck fractures represent a complex injury pattern often resulting from high-energy trauma.
- The optimal treatment strategy for this 'floating shoulder' injury remains a subject of debate, with varying outcomes reported for both surgical and non-surgical approaches.
Purpose of the Study:
- To evaluate and compare the outcomes of operative versus nonoperative management for displaced glenoid neck fractures combined with ipsilateral clavicular fractures or acromioclavicular separations.
- To assess fracture healing, functional outcomes, patient satisfaction, and muscular strength in patients with this specific injury pattern.
Main Methods:
- A retrospective evaluation of nineteen patients diagnosed with a displaced glenoid neck fracture and an ipsilateral clavicular fracture or acromioclavicular separation.
- Patients were categorized into nonoperative (n=12) and operative (n=7) treatment groups.
- Outcomes were assessed using standard radiographs, physical examinations, validated questionnaires (Short Form-36, American Shoulder and Elbow Surgeons Scale, Disabilities of the Arm, Shoulder and Hand Questionnaire), and isokinetic strength testing.
Main Results:
- The operative group demonstrated significantly greater forward flexion range of motion (p = 0.03).
- Operatively treated shoulders exhibited reduced strength in external rotation (300°/sec) and internal rotation (180°/sec).
- No significant differences were observed between the groups regarding the three validated functional outcome measures or overall fracture healing.
Conclusions:
- Both operative and nonoperative treatments can yield favorable results for the double disruption of the superior suspensory shoulder complex.
- A universal recommendation for operative intervention is not supported; therefore, treatment should be tailored to the individual patient's needs and circumstances.