The aim of this retrospective study was to review a series of patients with ipsilateral fractures of the neck of the scapula and of the clavicle. Between 1991 and 1996 a total of 79 general and orthopaedic surgeons treated 46 patients with a floating shoulder in The Netherlands. The records and radiographs of these patients were studied. Of the 35 patients available for follow-up, 31 had initially been treated conservatively and four by operation; three underwent secondary reconstructive surgery. The mean Constant score for the 28 patients treated conservatively was 76 and for the seven treated operatively it was 71 at a mean follow-up of 35 months. In six of the 28 patients treated conservatively the glenoid was dislocated caudally at the end of treatment; they had a score of 42. In the 22 patients without this dislocation the score was 85. We conclude that this rare injury is not inherently unstable and, in the absence of caudal dislocation of the glenoid, conservative treatment gives a good functional outcome

Both conservative and operative forms of treatment have been recommended for patients with a ‘floating shoulder’. We compared the results of conservative and operative treatment in 25 patients with this injury and investigated the use of the glenopolar angle (GPA) as an indicator of the functional outcome. A total of 13 patients (ten male and three female; mean age 32.5 years (24.7 to 40.4)) were treated conservatively and 12 patients (ten male and two female; mean age 33.67 years (24.6 to 42.7)) were treated operatively by fixation of the clavicular fracture alone. Outcome was assessed using the Herscovici score, which was also related to changes in the GPA at one year post-operatively.

The mean Herscovici score was significantly better three months and two years after the injury in the operative group (p < 0.001 and p = 0.003, respectively). There was a negative correlation between the change in GPA and the Herscovici score at two years follow-up in both the conservative and operative groups, but neither were statistically significant (r = -0.295 and r = -0.19, respectively). There was a significant difference between the pre- and post-operative GPA in the operative group (p = 0.017).

When compared with conservative treatment, fixation of the clavicle alone gives better results in the treatment of patients with a floating shoulder. The GPA changes significantly with fixation of clavicle alone but there is no significant correlation between the pre-injury GPA and the final clinical outcome in these patients.

Cite this article: Bone Joint J 2013;95-B:815–19.

Background. Floating shoulder (FS) is, according to Goss et al, a double disruption of the superior shoulder suspensory complex which usually results from a glenoid neck fracture and a ipsilateral midclavicular fracture. However, the interruption can interest the whole scapular belt from acromion to sterno-clavicular joint. It occurs mostly after a violent traumatism with direct lateral impact on the shoulder. That leads to complex therapeutic issues with sometimes uncertain results. Material. Between 1984 and 2009, 35 patients (30 men, 5 women), mean age 35 years [16–72] with FS, were treated in our department. Most of them sustained road accident (31cases) with polytraumatism context in 12 cases. A CT scan was realized in the majority of cases to specify the scapular fracture and look for intra-thoracic immediate complications. Mostly, glenoid neck fracture associated with a clavicular fracture has been found out (15cases). Orthopaedic treatment has been realized in 18 cases. Surgical management has been decided for open reduction of sterno-clavicular joint in 2 cases, isolated fixation of the clavicle in 9 cases, of the scapula in 3 cases, and of both scapula and clavicle in 3 cases. Criteria for clinical evaluation were an algo-functional scale (Oxford Shoulder Score, OSS), a subjective Constant Shoulder Score, a functional incapacity scale (Shoulder Simple Test, SST), scales of life quality (DASH and SF12) and global indications (Single Assessment Numeric Evaluation, SANE). Results. we noted a single migration of material. A patient presented a secondary displacement after orthopaedic treatment, and had additional surgical fixation before 6 months. In the mean follow up of 135 months [9–312], three patients were deceased and seven were unreachable. Five complained about rare pains, three of an important stiffness and chronic pains, and only one of brachial plexus injury. Functional results were satisfactory: OSS 14,75/60 [12–28], Subjective Constant score 79 [60–100], SST 10,75/12 [4–12], DASH 13,75/100 [0–84], SF12 physical 49,4 [36,8–54,8], SF12 mental 59,7 [57,2–61,8] andSANE 79% [50–100]. Discussion/conclusion. FS presents an immediate gravity because of possible intrathoracic injuries which can delay surgical treatment. FS which allowed orthopaedic treatments or required isolated fixation of the clavicle have excellent results. Scapular fractures which required surgical repair because of a significant displacement andan articular extension have more pejorative results

Aims

Tobacco, in addition to being one of the greatest public health threats facing our world, is believed to have deleterious effects on bone metabolism and especially on bone healing. It has been described in the literature that patients who smoke are approximately twice as likely to develop a nonunion following a non-specific bone fracture. For clavicle fractures, this risk is unclear, as is the impact that such a complication might have on the initial management of these fractures.