DeFranco Michael J, Patterson Brendan M
Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, OH 44109, USA.
J Am Acad Orthop Surg. 2006 Aug;14(8):499-509. doi: 10.5435/00124635-200608000-00007.
The floating shoulder is an uncommon but important injury pattern. Although it is frequently defined as an ipsilateral fracture of the clavicle and scapular neck, recent studies suggest that ligament disruption associated with a scapular neck fracture contributes to the functional equivalent of this injury pattern, with or without an associated clavicle fracture. Determining the specific injury patterns indicates the potential for significant instability, and correlating these patterns with clinical outcome is a challenge. Because the degree of ligament disruption is difficult to assess on radiographs, indications for nonsurgical and surgical management are not well defined. Minimally displaced fractures typically do well with nonsurgical care. However, the degree of fracture displacement and ligament disruption that results in less predictable outcomes after nonsurgical treatment is uncertain, and the indications for surgery can be controversial. Internal fixation of a displaced clavicle fracture restores the contour of the shoulder, regulates soft-tissue tension, and often indirectly reduces the scapular neck fracture. Fixation of both fractures is recommended in certain fracture patterns. Because these controversies cannot be resolved by current evidence, surgeons must choose an individualized approach based on an understanding of the pathoanatomy and personal experience.
浮动肩是一种罕见但重要的损伤类型。尽管它常被定义为锁骨和肩胛颈的同侧骨折，但最近的研究表明，与肩胛颈骨折相关的韧带断裂导致了这种损伤类型在功能上的等效性，无论是否伴有锁骨骨折。确定具体的损伤类型可提示显著不稳定的可能性，而将这些类型与临床结果相关联是一项挑战。由于韧带断裂程度在X线片上难以评估，非手术和手术治疗的指征尚不明确。轻度移位骨折通常采用非手术治疗效果良好。然而，非手术治疗后导致预后较难预测的骨折移位和韧带断裂程度尚不确定，手术指征可能存在争议。移位锁骨骨折的内固定可恢复肩部轮廓，调节软组织张力，且常间接复位肩胛颈骨折。对于某些骨折类型，建议对两处骨折都进行固定。由于目前的证据无法解决这些争议，外科医生必须基于对病理解剖的理解和个人经验选择个体化的治疗方法。
