Clavicle and scapula(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.
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.
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.