Double internal fixations of clavicle and scapula and intraoperative reduction of glenopolar angle for treatment of floating shoulder injuries_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XUE Jianqiang ¹ , ZHANG Hanwen ¹ , JIA Le ¹ , HU Xin ¹ ,  LU Xiaobo ^1,2 , GE Jianhua ^1,2

1. Department of Bone & Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;
2. Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou Sichuan, 646000, P.R.China;

Corresponding author：

LU Xiaobo, Email: xiaobol1963@163.com

Keywords：

Floating shoulder injury; internal fixation; superior shoulder suspensory complex; clavicle; scapula; glenopolar angle

DOI：

10.7507/1002-1892.202007104

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Objective To investigate the effectiveness of double internal fixations of clavicle and scapula and intraoperative reduction of glenopolar angle in the treatment of floating shoulder injuries.Methods Between January 2010 and June 2019, 13 patients with floating shoulder injury were treated with double internal fixation of clavicle and scapula and intraoperative reduction of glenopolar angle. There were 11 males and 2 females with an average age of 48 years (range, 25-65 years). The causes of injury included falling from height in 2 cases, traffic accident injury in 3 cases, heavy object injury in 2 cases, and other injuries in 6 cases. There were 2 cases of Ⅰ-B-3 type, 1 case of Ⅰ-C-2 type, 1 case of Ⅰ-C-3 type, 3 cases of Ⅱ-B-2 type, 1 case of Ⅱ-B-3 type, 1 case of Ⅱ-B-4 type, 2 cases of Ⅱ-C-2 type, 1 case of Ⅱ-C-4 type, and 1 case of Ⅱ-D-3 type according to the classification of floating shoulder injury. All patients had unilateral clavicle fracture with scapular neck fracture, 1-4 superior shoulder suspensory complex (SSSC) injuries. The time from injury to operation was 7-17 days, with an average of 12 days. The glenopolar angle, subacromail space, anteroposterior inclination angle of scapular glenoid, scapular glenoid up and down angle were measured before and after operation; Constant-Murly score and Herscovici score were used to evaluate the recovery of shoulder joint function.Results All incisions healed by first intention, and there was no early postoperative complications such as infection. All 13 cases were followed up 12-48 months, with an average of 25.2 months. Both the clavicle and the scapula had bone union, and the average healing time was 6 months and 4 months respectively. There were no complications such as nonunion, shoulder deformity, plate fracture or failure of internal fixation, acromion impingement syndrome, and frozen shoulder. At last follow-up, the glenopolar angle, subacromail space, anteroposterior inclination angle of scapular glenoid, and scapular glenoid up and down angle were all corrected significantly (P<0.05). The pain, function, activity, muscle strength scores, and total score in Constant-Murly score were significantly improved when compared with preoperative scores (P<0.05). According to the Herscovici scoring standard, the shoulder joint function was evaluated as excellent in 8 cases, good in 3 cases, and fair in 2 cases. The excellent and good rate was 84.6%.Conclusion Double internal fixation of clavicle and scapula to stabilize SSSC and reduct glenopolar angle during operation is an effective method for treating the floating shoulder injury.

Citation： XUE Jianqiang, ZHANG Hanwen, JIA Le, HU Xin, LU Xiaobo, GE Jianhua. Double internal fixations of clavicle and scapula and intraoperative reduction of glenopolar angle for treatment of floating shoulder injuries. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(1): 76-81. doi: 10.7507/1002-1892.202007104 Copy

1.	Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg, 2002, 11(6): 587-594.
2.	Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma, 1993, 7(2): 99-106.
3.	McKee MD, Pedersen EM, Jones C, et al. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg (Am), 2006, 88(1): 35-40.
4.	Kim KC, Rhee KJ, Shin HD, et al. Can the glenopolar angle be used to predict outcome and treatment of the floating shoulder? J Trauma, 2008, 64(1): 174-178.
5.	van Noort A, van Kampen A. Fractures of the scapula surgical neck: outcome after conservative treatment in 13 cases. Arch Orthop Trauma Surg, 2005, 125(10): 696-700.
6.	Hess F, Zettl R, Smolen D, et al. Decision-making for complex scapula and ipsilateral clavicle fractures: a review. Eur J Trauma Emerg Surg, 2019, 45(2): 221-230.
7.	Yadav V, Khare GN, Singh S, et al. A prospective study comparing conservative with operative treatment in patients with a ‘floating shoulder’ including assessment of the prognostic value of the glenopolar angle. Bone Joint J, 2013, 95-B(6): 815-819.
8.	Lin TL, Li YF, Hsu CJ, et al. Clinical outcome and radiographic change of ipsilateral scapular neck and clavicular shaft fracture: comparison of operation and conservative treatment. J Orthop Surg Res, 2015, 10: 9.
9.	Wong KL, Ramsey ML, Williams GR Jr. Scapular fractures//Norris TR. Orthopaedic knowledge update: shoulder and ellow. 2nd eds. Rosemont: American Academy of Orthopaedic Surgeons, 2002: 227-236.
10.	Churchill RS, Brems JJ, Kotschi H. Glenoid size, inclination, and version: an anatomic study. J Shoulder Elbow Surg, 2001, 10(4): 327-332.
11.	Kikuchi K, Itoi E, Yamamoto N, et al. Scapular inclination and glenohumeral joint stability: a cadaveric study. J Orthop Sci, 2008, 13(1): 72-77.
12.	Weishaupt D, Zanetti M, Nyffeler RW, et al. Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability. Skeletal Radiol, 2000, 29(4): 204-210.
13.	Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res, 1987, (214): 160-164.
14.	Herscovici D, Fiennes AG, Allgöwer M, et al. The floating shoulder: ipsilateral clavicle and scapular neck fractures. J Bone Joint Surg (Br), 1992, 74(3): 362-364.
15.	贾健. 肩胛骨骨折的分类及手术治疗. 中华骨科杂志, 2003, 23(2): 100-104.
16.	付中国, 张堃. Judet 入路治疗肩胛骨骨折. 中华肩肘外科电子杂志, 2014, (1): 63-68.
17.	Meinberg EG, Agel J, Roberts CS, et al. Fracture and dislocation classification compendium-2018. J Orthop Trauma, 2018, 32 Suppl 1: S1-S170.
18.	Bartonícek J, Tucek M, Lunácek L. Judet posterior approach to the scapula. Acta Chir Orthop Traumatol Cech, 2008, 75(6): 429-435.
19.	Gosens T, Speigner B, Minekus J. Fracture of the scapular body: functional outcome after conservative treatment. J Shoulder Elbow Surg, 2009, 18(3): 443-448.
20.	George DM, McKay BP, Jaarsma RL. The long-term outcome of displaced mid-third clavicle fractures on scapular and shoulder function: variations between immediate surgery, delayed surgery, and nonsurgical management. J Shoulder Elbow Surg, 2015, 24(5): 669-676.
21.	吴康, 徐晓峰, 陈奇, 等. 重建肩胛骨稳定性对手术治疗漂浮肩损伤效果的影响. 华中科技大学学报 (医学版), 2018, 47(5): 620-623.
22.	Williams GR, Naranja J, Klimkiewicz J, et al. The floating shoulder: a biomechanical basis for classification and management. J Bone Joint Surg (Am), 2001, 83(8): 1182-1187.
23.	周青, 李坤, 陈波, 等. 漂浮肩不同治疗方式的疗效评价. 中国骨伤, 2016, 29(9): 847-852.
24.	Bartonicek J, Klika D, Tucek M. Classification of scapular body fractures. Rozhl Chir, 2018, 97(2): 67-76.
25.	徐桂军. 肩胛骨骨折及浮肩损伤的治疗. 国际骨科学杂志, 2018, 39(5): 267-271.
26.	陈健荣, 吴峰, 张宏宁, 等. 两种内固定术式治疗浮肩损伤 60 例疗效对比. 中国矫形外科杂志, 2014, 22(18): 1711-1714.
27.	Badam VK, Harsha TSS, Sankineani SR, et al. Triple disruption of the superior shoulder suspensory complex-A case report. J Orthop Case Rep, 2019, 9(3): 39-42.
28.	Izadpanah K, Jaeger M, Maier D, et al. The floating shoulder—clinical and radiological results after intramedullary stabilization of the clavicle in cases with minor displacement of the scapular neck fracture. J Trauma Acute Care Surg, 2012, 72(2): E8-13.
29.	Samy MA, Darwish AE. Fixation of clavicle alone in floating shoulder injury: functional and radiological outcome. Acta Orthop Belg, 2017, 83(2): 292-296.
30.	Dombrowsky AR, Boudreau S, Quade J, et al. Clinical outcomes following conservative and surgical management of floating shoulder injuries: a systematic review. J Shoulder Elbow Surg, 2020, 29(3): 634-642.
31.	Bozkurt M, Can F, Kirdemir V, et al. Conservative treatment of scapular neck fracture: the effect of stability and glenopolar angle on clinical outcome. Injury, 2005, 36(10): 1176-1181.
32.	Morey VM, Chua KHZ, Ng ZD, et al. Management of the floating shoulder: Does the glenopolar angle influence outcomes? A systematic review. Orthop Traumatol Surg Res, 2018, 104(1): 53-58.
33.	李坤, 刘云鹏. 两种入路治疗肩胛骨骨折的效果及对肩关节功能恢复的影响. 中南医学科学杂志, 2020, 48(3): 304-306, 319.
34.	Porcellini G, Palladini P, Congia S, et al. Functional outcomes and clinical strength assessment after infraspinatus-sparing surgical approach to scapular fracture: Does it really make a difference? Orthop Traumatol, 2018, 19(1): 15.

1. Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg, 2002, 11(6): 587-594.
2. Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma, 1993, 7(2): 99-106.
3. McKee MD, Pedersen EM, Jones C, et al. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg (Am), 2006, 88(1): 35-40.
4. Kim KC, Rhee KJ, Shin HD, et al. Can the glenopolar angle be used to predict outcome and treatment of the floating shoulder? J Trauma, 2008, 64(1): 174-178.
5. van Noort A, van Kampen A. Fractures of the scapula surgical neck: outcome after conservative treatment in 13 cases. Arch Orthop Trauma Surg, 2005, 125(10): 696-700.
6. Hess F, Zettl R, Smolen D, et al. Decision-making for complex scapula and ipsilateral clavicle fractures: a review. Eur J Trauma Emerg Surg, 2019, 45(2): 221-230.
7. Yadav V, Khare GN, Singh S, et al. A prospective study comparing conservative with operative treatment in patients with a ‘floating shoulder’ including assessment of the prognostic value of the glenopolar angle. Bone Joint J, 2013, 95-B(6): 815-819.
8. Lin TL, Li YF, Hsu CJ, et al. Clinical outcome and radiographic change of ipsilateral scapular neck and clavicular shaft fracture: comparison of operation and conservative treatment. J Orthop Surg Res, 2015, 10: 9.
9. Wong KL, Ramsey ML, Williams GR Jr. Scapular fractures//Norris TR. Orthopaedic knowledge update: shoulder and ellow. 2nd eds. Rosemont: American Academy of Orthopaedic Surgeons, 2002: 227-236.
10. Churchill RS, Brems JJ, Kotschi H. Glenoid size, inclination, and version: an anatomic study. J Shoulder Elbow Surg, 2001, 10(4): 327-332.
11. Kikuchi K, Itoi E, Yamamoto N, et al. Scapular inclination and glenohumeral joint stability: a cadaveric study. J Orthop Sci, 2008, 13(1): 72-77.
12. Weishaupt D, Zanetti M, Nyffeler RW, et al. Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability. Skeletal Radiol, 2000, 29(4): 204-210.
13. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res, 1987, (214): 160-164.
14. Herscovici D, Fiennes AG, Allgöwer M, et al. The floating shoulder: ipsilateral clavicle and scapular neck fractures. J Bone Joint Surg (Br), 1992, 74(3): 362-364.
15. 贾健. 肩胛骨骨折的分类及手术治疗. 中华骨科杂志, 2003, 23(2): 100-104.
16. 付中国, 张堃. Judet 入路治疗肩胛骨骨折. 中华肩肘外科电子杂志, 2014, (1): 63-68.
17. Meinberg EG, Agel J, Roberts CS, et al. Fracture and dislocation classification compendium-2018. J Orthop Trauma, 2018, 32 Suppl 1: S1-S170.
18. Bartonícek J, Tucek M, Lunácek L. Judet posterior approach to the scapula. Acta Chir Orthop Traumatol Cech, 2008, 75(6): 429-435.
19. Gosens T, Speigner B, Minekus J. Fracture of the scapular body: functional outcome after conservative treatment. J Shoulder Elbow Surg, 2009, 18(3): 443-448.
20. George DM, McKay BP, Jaarsma RL. The long-term outcome of displaced mid-third clavicle fractures on scapular and shoulder function: variations between immediate surgery, delayed surgery, and nonsurgical management. J Shoulder Elbow Surg, 2015, 24(5): 669-676.
21. 吴康, 徐晓峰, 陈奇, 等. 重建肩胛骨稳定性对手术治疗漂浮肩损伤效果的影响. 华中科技大学学报 (医学版), 2018, 47(5): 620-623.
22. Williams GR, Naranja J, Klimkiewicz J, et al. The floating shoulder: a biomechanical basis for classification and management. J Bone Joint Surg (Am), 2001, 83(8): 1182-1187.
23. 周青, 李坤, 陈波, 等. 漂浮肩不同治疗方式的疗效评价. 中国骨伤, 2016, 29(9): 847-852.
24. Bartonicek J, Klika D, Tucek M. Classification of scapular body fractures. Rozhl Chir, 2018, 97(2): 67-76.
25. 徐桂军. 肩胛骨骨折及浮肩损伤的治疗. 国际骨科学杂志, 2018, 39(5): 267-271.
26. 陈健荣, 吴峰, 张宏宁, 等. 两种内固定术式治疗浮肩损伤 60 例疗效对比. 中国矫形外科杂志, 2014, 22(18): 1711-1714.
27. Badam VK, Harsha TSS, Sankineani SR, et al. Triple disruption of the superior shoulder suspensory complex-A case report. J Orthop Case Rep, 2019, 9(3): 39-42.
28. Izadpanah K, Jaeger M, Maier D, et al. The floating shoulder—clinical and radiological results after intramedullary stabilization of the clavicle in cases with minor displacement of the scapular neck fracture. J Trauma Acute Care Surg, 2012, 72(2): E8-13.
29. Samy MA, Darwish AE. Fixation of clavicle alone in floating shoulder injury: functional and radiological outcome. Acta Orthop Belg, 2017, 83(2): 292-296.
30. Dombrowsky AR, Boudreau S, Quade J, et al. Clinical outcomes following conservative and surgical management of floating shoulder injuries: a systematic review. J Shoulder Elbow Surg, 2020, 29(3): 634-642.
31. Bozkurt M, Can F, Kirdemir V, et al. Conservative treatment of scapular neck fracture: the effect of stability and glenopolar angle on clinical outcome. Injury, 2005, 36(10): 1176-1181.
32. Morey VM, Chua KHZ, Ng ZD, et al. Management of the floating shoulder: Does the glenopolar angle influence outcomes? A systematic review. Orthop Traumatol Surg Res, 2018, 104(1): 53-58.
33. 李坤, 刘云鹏. 两种入路治疗肩胛骨骨折的效果及对肩关节功能恢复的影响. 中南医学科学杂志, 2020, 48(3): 304-306, 319.
34. Porcellini G, Palladini P, Congia S, et al. Functional outcomes and clinical strength assessment after infraspinatus-sparing surgical approach to scapular fracture: Does it really make a difference? Orthop Traumatol, 2018, 19(1): 15.

Chinese Journal of Reparative and Reconstructive Surgery

Double internal fixations of clavicle and scapula and intraoperative reduction of glenopolar angle for treatment of floating shoulder injuries

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