Decision-making for complex scapula and ipsilateral clavicle fractures: a review
- 177 Downloads
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.
KeywordsFloating 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.
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- 1.Ganz R, Noesberger B. Treatment of scapular fractures. Hefte zur Unfallheilkunde. 1975;126:59–62.Google Scholar
- 11.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.CrossRefGoogle Scholar
- 12.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.CrossRefGoogle Scholar
- 14.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.CrossRefGoogle Scholar
- 18.Ada JR, Miller ME. Scapular fractures. Analysis of 113 cases. Clin Orthop Relat Res. 1991;269:174–80.Google Scholar
- 24.Judet R. Surgical treatment of scapular fractures. Acta Orthop Belgica. 1964;30:673–8.Google Scholar
- 36.Low CK, Lam AW. Results of fixation of clavicle alone in managing floating shoulder. Singap Med J. 2000;41(9):452–3.Google Scholar