Abstract
Introduction
Complex scapula with ipsilateral clavicle fracures remains a challange and treatment recommendations are still missing. This review provides an overview of the evolution of the definition, classification and treatment strategies for complex scapula and ipsilateral clavicle fractures. As with other rare conditions, consensus has not been reached on the most suitable management strategies to treat these patients. The aim of this review is twofold: to compile and summarize the currently available literature on this topic, and to recommend treatment approaches.
Materials and methods
Included in the review are the following topics: biomechanics of scapula and ipsilateral clavicle fractures, preoperative radiological evaluation, surgical treatment of the clavicle only, surgical treatment of both the clavicle and scapula, and nonsurgical treatment options.
Results
A decision-making algorithm is proposed for different treatment strategies based on pre-operative parameters, and an example of a case treated our institution is presented to illustrate use of the algorithm.
Discussion
The role of instability in complex scapula with ipsilateral clavicle fractures remains unclear. The question of stability is preoperatively less relevant than the question of whether the dislocated fragments lead to compromised shoulder function.
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References
Ganz R, Noesberger B. Treatment of scapular fractures. Hefte zur Unfallheilkunde. 1975;126:59–62.
Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop trauma. 1993;7(2):99–106.
Herscovici D Jr, Fiennes AG, Allgower M, Ruedi TP. The floating shoulder: ipsilateral clavicle and scapular neck fractures. J Bone Jt Surg Br. 1992;74(3):362–4.
Goss TP. Scapular fractures and dislocations: diagnosis and treatment. J Am Acad Orthop Surg. 1995;3(1):22–33.
Goss TP. Fractures of the glenoid neck. J Shoulder Elbow Surg/Am Shoulder Elbow Surg. 1994;3 (1):42–52. https://doi.org/10.1016/S1058-2746(09)80007-4.
Owens BD, Goss TP. The floating shoulder. J Bone Jt Surg Br. 2006;88(11):1419–24. https://doi.org/10.1302/0301-620X.88B11.17997.
Williams GR Jr, Naranja J, Klimkiewicz J, Karduna A, Iannotti JP, Ramsey M. The floating shoulder: a biomechanical basis for classification and management. J Bone Jt Surg Am 2001;83-A (8):1182–7.
Cole PA, Gauger EM, Schroder LK. Management of scapular fractures. J Am Acad Orthop Surg. 2012;20(3):130–41. https://doi.org/10.5435/JAAOS-20-03-130.
Ideberg R, Grevsten S, Larsson S. Epidemiology of scapular fractures. Incidence and classification of 338 fractures. Acta Orthop Scand. 1995;66(5):395–7.
Friederichs J, Morgenstern M, Buhren V. Scapula fractures in complex shoulder injuries and floating shoulders: a classification based on displacement and instability. J Trauma Manag Outcomes. 2014;8:16. https://doi.org/10.1186/1752-2897-8-16.
Izadpanah K, Jaeger M, Maier D, Kubosch D, Hammer TO, Sudkamp NP. 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.
Yadav V, Khare GN, Singh S, Kumaraswamy V, Sharma N, Rai AK, Ramaswamy AG, Sharma H. 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 Jt J. 2013;95-B(6):815–9. https://doi.org/10.1302/0301-620X.95B6.31060.
Gilde AK, Hoffmann MF, Sietsema DL, Jones CB. Functional outcomes of operative fixation of clavicle fractures in patients with floating shoulder girdle injuries. J Orthop Traumatol. 2015;16(3):221–7. https://doi.org/10.1007/s10195-015-0349-8.
Lin TL, Li YF, Hsu CJ, Hung CH, Lin CC, Fong YC, Hsu HC, Tsai CH. 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. https://doi.org/10.1186/s13018-014-0141-0.
Romero J, Schai P, Imhoff AB. Scapular neck fracture–the influence of permanent malalignment of the glenoid neck on clinical outcome. Arch Orthop Trauma Surg. 2001;121(6):313–6.
Labronici PJ, Santos Filho FCD, Reis TB, Pires RES, Junior AFM, Kojima KE. Are diaphyseal clavicular fractures still treated traditionally in a non-surgical way? Revis Bras Orthop. 2017;52(4):410–6. https://doi.org/10.1016/j.rboe.2017.06.012.
van Noort A, te Slaa RL, Marti RK, van der Werken C. The floating shoulder. A multicentre study. J Bone Jt Surg Br. 2001;83(6):795–8.
Ada JR, Miller ME. Scapular fractures. Analysis of 113 cases. Clin Orthop Relat Res. 1991;269:174–80.
Hardegger FH, Simpson LA, Weber BG. The operative treatment of scapular fractures. J Bone Jt Surg Br. 1984;66(5):725–31.
Nordqvist A, Petersson CJ. Shoulder injuries common in alcoholics. An analysis of 413 injuries. Acta Orthop Scand. 1996;67(4):364–6.
Edwards SG, Whittle AP, Wood GW 2nd. Nonoperative treatment of ipsilateral fractures of the scapula and clavicle. J Bone Jt Surg Am. 2000;82(6):774–80.
Kim KC, Rhee KJ, Shin HD, Yang JY. Can the glenopolar angle be used to predict outcome and treatment of the floating shoulder? J Trauma. 2008;64(1):174–8. https://doi.org/10.1097/01.ta.0000240982.99842.b9.
Morey VM, Chua KHZ, Ng ZD, Tan HMB, Kumar VP. Management of the floating shoulder: does the glenopolar angle influence outcomes? A systematic review. Orthop Traumatol Surg Res OTSR. 2017. https://doi.org/10.1016/j.otsr.2017.11.004.
Judet R. Surgical treatment of scapular fractures. Acta Orthop Belgica. 1964;30:673–8.
Gauger EM, Cole PA. Surgical technique: a minimally invasive approach to scapula neck and body fractures. Clin Orthop Relat Res. 2011;469(12):3390–9. https://doi.org/10.1007/s11999-011-1970-3.
Obremskey WT, Lyman JR. A modified judet approach to the scapula. J Orthop Trauma. 2004;18(10):696–9.
Cole PA, Dubin JR, Freeman G. Operative techniques in the management of scapular fractures. Orthop Clin N Am. 2013;44(3):331–43, viii. https://doi.org/10.1016/j.ocl.2013.04.001.
Lantry JM, Roberts CS, Giannoudis PV. Operative treatment of scapular fractures: a systematic review. Injury. 2008;39(3):271–83. https://doi.org/10.1016/j.injury.2007.06.018.
Wijdicks CA, Armitage BM, Anavian J, Schroder LK, Cole PA. Vulnerable neurovasculature with a posterior approach to the scapula. Clin Orthop Relat Res. 2009;467(8):2011–7. https://doi.org/10.1007/s11999-008-0635-3.
Ai J, Kan SL, Li HL, Xu H, Liu Y, Ning GZ, Feng SQ. Anterior inferior plating versus superior plating for clavicle fracture: a meta-analysis. BMC Musculoskelet Disord. 2017;18(1):159. https://doi.org/10.1186/s12891-017-1517-1.
Labler L, Platz A, Weishaupt D, Trentz O. Clinical and functional results after floating shoulder injuries. J Trauma. 2004;57(3):595–602.
Oh W, Jeon IH, Kyung S, Park C, Kim T, Ihn C. The treatment of double disruption of the superior shoulder suspensory complex. Int Orthop. 2002;26(3):145–9. https://doi.org/10.1007/s00264-001-0325-1.
Egol KA, Connor PM, Karunakar MA, Sims SH, Bosse MJ, Kellam JF. The floating shoulder: clinical and functional results. J Bone Jt Surg Am. 2001;83-A(8):1188–94.
Ramos L, Mencia R, Alonso A, Ferrandez L. Conservative treatment of ipsilateral fractures of the scapula and clavicle. J Trauma. 1997;42(2):239–42.
Hashiguchi H, Ito H. Clinical outcome of the treatment of floating shoulder by osteosynthesis for clavicular fracture alone. J Shoulder Elbow Surg/Am Shoulder Elbow Surg. 2003;12 (6):589–91. https://doi.org/10.1016/S1058274603001794.
Low CK, Lam AW. Results of fixation of clavicle alone in managing floating shoulder. Singap Med J. 2000;41(9):452–3.
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. https://doi.org/10.1007/s00402-005-0044-y.
Bozkurt M, Can F, Kirdemir V, Erden Z, Demirkale I, Basbozkurt M. Conservative treatment of scapular neck fracture: the effect of stability and glenopolar angle on clinical outcome. Injury. 2005;36(10):1176–81. https://doi.org/10.1016/j.injury.2004.09.013.
Cole PA, Gauger EM, Herrera DA, Anavian J, Tarkin IS. Radiographic follow-up of 84 operatively treated scapula neck and body fractures. Injury. 2012;43(3):327–33. https://doi.org/10.1016/j.injury.2011.09.029.
Anavian J, Gauger EM, Schroder LK, Wijdicks CA, Cole PA. Surgical and functional outcomes after operative management of complex and displaced intra-articular glenoid fractures. J Bone Jt Surg Am. 2012;94(7):645–53. https://doi.org/10.2106/JBJS.J.00896.
Schroder LK, Gauger EM, Gilbertson JA, Cole PA. Functional outcomes after operative management of extra-articular glenoid neck and scapular body fractures. J Bone Jt Surg Am. 2016;98(19):1623–30. https://doi.org/10.2106/JBJS.15.01224.
Maquieira GJ, Espinosa N, Gerber C, Eid K. Non-operative treatment of large anterior glenoid rim fractures after traumatic anterior dislocation of the shoulder. J Bone Jt Surg Br. 2007;89(10):1347–51. https://doi.org/10.1302/0301-620X.89B10.19273.
Herrera DA, Anavian J, Tarkin IS, Armitage BA, Schroder LK, Cole PA. Delayed operative management of fractures of the scapula. J Bone Jt Surg Br. 2009;91(5):619–26. https://doi.org/10.1302/0301-620X.91B5.22158.
Jones CB, Cornelius JP, Sietsema DL, Ringler JR, Endres TJ. Modified Judet approach and minifragment fixation of scapular body and glenoid neck fractures. J Orthop Trauma. 2009;23(8):558–64. https://doi.org/10.1097/BOT.0b013e3181a18216.
Goss TP. Fractures of the glenoid cavity. J Bone Jt Surg Br Am. 1992;74(2):299–305.
Mayo KA, Benirschke SK, Mast JW. Displaced fractures of the glenoid fossa. Results of open reduction and internal fixation. Clin Orthop Relat Res. 1998;347:122–30.
Adam FF. Surgical treatment of displaced fractures of the glenoid cavity. Int Orthop. 2002;26(3):150–3. https://doi.org/10.1007/s00264-002-0342-8.
Rikli D, Regazzoni P, Renner N. The unstable shoulder girdle: early functional treatment utilizing open reduction and internal fixation. J Orthop Trauma. 1995;9(2):93–7.
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Florian Hess, Ralph Zettl, Daniel Smolen and Christoph Knoth declare that they have no conflict of interest.
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Hess, F., Zettl, R., Smolen, D. et al. Decision-making for complex scapula and ipsilateral clavicle fractures: a review. Eur J Trauma Emerg Surg 45, 221–230 (2019). https://doi.org/10.1007/s00068-018-0946-3
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DOI: https://doi.org/10.1007/s00068-018-0946-3