Floating
shoulder
The term floating shoulder refers to when a clavicle fracture or AC separation is coupled with
a fracture of the scapula. There are a few variation of the floating
shoulder fracture pattern. Because conservative treatment may result
in displacement (medialization) of the shoulder girdle, a floating shoulder
is usually thought to represent an unstable injury pattern that requires
operative stabilization .
Figure
1. As described by Goss,* the superior shoulder suspensory
complex consists of a bone and soft-tissue ring consisting
of the glenoid, coracoid process, coracoclavicular ligaments
(conoid and trapezoid), distal part of the clavicle, acromioclavicular
joint, and acromion process. Some authors feel that the
CA ligament should also be included as part of the complex.
*
Goss TP. Scapular Fractures and Dislocations: Diagnosis and
Treatment. J Am Acad Orthop Surg. Jan 1995;3(1):22-33.
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The superior
shoulder suspensory complex (Figure 1) consists of a bone and soft-tissue
ring. Injuries to the shoulder may often be treated conservatively
if only one structure of the shoulder suspensory complex is disrupted.
However, disruption of two or more elements usually leads to an unstable
shoulder (Figures 2 and 3), and operative treatment may be necessary
to achieve a good functional result.
Figure
2.
The floating shoulder. Note that the shoulder suspensory complex
as seen in Figure 1 has been disrupted by the injury. The
shoulder may become unstable if more than one element of the
shoulder suspensory complex has been disrupted. In this case,
surgery may be recommended.
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Figure
3. A floating shoulder variant. In this case, the ligaments appear
to be intact, but there is a fracture of the clavicle and
the scapular neck. This patient's shoulder displaced after
one week of conservative treatment in a sling, thus requiring
surgical treatment.
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