Decision-making for complex scapula and ipsilateral clavicle fractures: a review

  • Florian HessEmail author
  • Ralph Zettl
  • Daniel Smolen
  • Christoph Knoth
Review Article



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.


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.


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.


Floating shoulder Complex scapula and ipsilateral clavicle fractures Open reduction and internal fixation 



There is no funding source.

Compliance with ethical standards

Conflict of interest

Florian Hess, Ralph Zettl, Daniel Smolen and Christoph Knoth declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Florian Hess
    • 1
    Email author
  • Ralph Zettl
    • 1
  • Daniel Smolen
    • 2
  • Christoph Knoth
    • 1
  1. 1.Department of Orthopedic Surgery and TraumatologyKantonsspital FrauenfeldFrauenfeldSwitzerland
  2. 2.EtzelclinicPfaeffikonSwitzerland

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