Gilde Alex K, Hoffmann Martin F, Sietsema Debra L, Jones Clifford B
Grand Rapids Medical Education Partners, Orthopaedic Surgery Residency, Grand Rapids, MI, 49503, USA,
J Orthop Traumatol. 2015 Sep;16(3):221-7. doi: 10.1007/s10195-015-0349-8. Epub 2015 May 5.
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.
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.
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.
'Floating shoulder' injuries with only clavicular fixation return to function despite persistent scapular deformity and some residual pain.
Level IV.
肩上部悬吊复合体的双重损伤，通常称为“漂浮肩”损伤，是同侧锁骨中段和肩胛颈/体部骨折，同时伴有肩胛盂骨质附着丧失。多年来，“漂浮肩”损伤的治疗一直存在争议。本研究的目的是展示仅接受锁骨骨折手术固定的“漂浮肩”损伤患者的临床和功能结局。
2002年至2010年期间，在一家一级创伤中心对骨骼成熟患者中连续发现的32例漂浮肩损伤进行了识别，并在单一私人诊所进行随访。13例患者符合本回顾性研究的纳入和排除标准，且随访时间至少为12个月。通过当前操作技术编码识别锁骨和肩胛骨骨折，并根据骨科创伤协会/骨内固定研究学会标准进行分类。“漂浮肩”损伤仅通过使用现代钢板技术进行锁骨复位和固定的手术方式进行治疗。测量了骨不连、畸形愈合、植入物取出、活动范围、二次手术需求、根据视觉模拟量表（VAS）评估的疼痛程度以及恢复工作情况。
所有损伤均由高能机制导致。大多数患者（12例；92.3%）在初次手术固定后可见锁骨骨折愈合。在最后一次随访时，最终疼痛程度报告为轻微（11例；VAS评分为1 - 3）、中度（1例；VAS评分为4 - 6）和重度（1例；VAS评分为7 - 10）。大多数患者（8例；61.5%）观察到了良好的活动范围（前屈和外展均达180°）。3个月时的赫斯科维奇评分为12.9（范围为10 - 15）。计划外手术包括2例锁骨植入物取出和1例骨不连翻修。非手术治疗后，无一例患者因肩胛骨畸形愈合需要进行重建。12例患者无限制地恢复了先前工作。
尽管肩胛骨持续畸形且存在一些残留疼痛，但仅进行锁骨固定的“漂浮肩”损伤患者仍恢复了功能。
四级。
