The Clinical Outcome of a Floating Shoulder Treated by Osteosynthesis for a Clavicular Fracture Alone

Abstract

[Purpose] A floating shoulder is an unstable fracture involving the scapular neck and ipsilateral midclavicular fractures. It is almost necessary to treat this fracture surgically. In this study, we report the clinical outcome in cases with a floating shoulder which were treated surgically for a clavicular fracture alone.
[Materials and methods] From 1994 to 1999, we observed five male cases with a floating shoulder, whose average age was 38.6 years old (range,22 to 54 years old). Four patients had their right sides affected; four of the injuries had been caused by traffic accidents, and one by falling. The average duration from injury to surgery was 10days(range,3 to 20 days). Fixation of the clavicular fracture was achieved with a bone plate in one case and with Kirschner wires in four cases. Postoperatively, after three weeks immobilization by Desault's bandage, physical therapy was started. The average follow-up period was 43 months (range,8 to 66 months).
[Results]All the cases obtained union of the both fractures, The average time for both fracturehealing was 17 weeks (10 to 24 weeks), as assessed by the disappearance of the fracture lines on the radiographs. According to the JOA scoring system, the average score was 98 points (95 to 100 points).
[Conclusion] Herscovici et al reported that in floating shoulder, muscle forces and the weight of the arm pull the fracture fragment, and that internal fixation of the clavicular fracture was recommended to prevent late deformity. In our cases, we obtained excellent outcomes by fixing the clavicular fracture alone. The severity of the displacement of scapular neck fracture and the presence or absence of a coracoclavicular ligament rupture should be evaluated before the operation.