Background: Internal fixation of one or
both bones is the recommended treatment for floating shoulder injuries (ipsilateral
fractures of the scapula and clavicle). Perceived risks of nonoperative
treatment include abduction weakness, decreased range of motion, chronic
pain, malunion, and nonunion. None of these problems, however, have
been confirmed by clinical studies. The purpose of this retrospective study
was to analyze the clinical and radiographic results of nonoperative
treatment of floating shoulder injuries.
Methods: Twenty patients with a floating shoulder
injury were treated with either a sling or a shoulder immobilizer.
Eleven clavicular fractures were displaced ten millimeters or more,
and five scapular fractures were displaced more than five millimeters.
Physical therapy was begun three days to two weeks after the injury.
Patients were evaluated with three separate scoring systems: those
of Herscovici et al., Rowe, and Constant and Murley. Shoulder abduction
and flexion were measured, and abduction strength was evaluated
by clinical examination and comparison with the uninjured extremity.
The duration of follow-up averaged twenty-eight months (range, nine
to seventy-nine months).
Results: Nineteen of the twenty pairs of fractures
united uneventfully. One clavicular nonunion occurred secondary
to segmental bone loss from a gunshot wound. On the basis of the
Herscovici rating system, seventeen patients had an excellent result
and three had a good result. According to the Rowe system, eighteen
patients had an excellent result, one had a good result, and one
had a fair result. The average Rowe score was 95. The average Constant
score was 96. In all twenty patients, the strength of the injured
extremity was equal to that of the uninjured extremity. Eighteen
patients had a full, symmetrical range of shoulder motion, one lost
15 degrees of flexion, and one lost 20 degrees of abduction.
Conclusions: Nonoperative treatment of floating
shoulder injuries, especially those with less than five millimeters
of fracture displacement, can achieve satisfactory results that
are probably equal or superior to those reported after operative
treatment, without the risk of operative complications.