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The Floating Shoulder: Clinical and Functional Results
Kenneth A. Egol, MD; Patrick M. Connor, MD; Madhav A. Karunakar, MD; Stephen H. Sims, MD; Michael J. Bosse, MD; James F. Kellam, MD
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Investigation performed at the Carolinas Medical Center, Charlotte, North Carolina
Kenneth A. Egol, MD
Department of Orthopaedic Surgery, NYU-Hospital for Joint Diseases, 89-06 135th Street, Suite 7C, Jamaica, NY 11418

Patrick M. Connor, MD
Stephen H. Sims, MD
Miller Orthopaedic Clinic, 1000 Blythe Boulevard, Charlotte, NC 28203

Madhav A. Karunakar, MD
Department of Orthopaedic Surgery, University of Michigan, 1500 East Medical Center Drive, Taubman Center 2912G, Ann Arbor, MI 48109-0328

Michael J. Bosse, MD
James F. Kellam, MD
Department of Orthopaedic Surgery, Carolinas Medical Center, P.O. Box 32861, MEB 503, Charlotte, NC 28232

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from a Charlotte-Mecklenburg Health Services Foundation grant. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

J Bone Joint Surg Am, 2001 Aug 01;83(8):1188-1194
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Background: Displaced ipsilateral fractures of the clavicle and the glenoid neck are a complex injury pattern that is usually the result of high-energy trauma. The treatment of these injuries is controversial, as good results have been reported with both operative and nonoperative treatment.

Methods: Nineteen patients who had sustained a displaced fracture of the glenoid neck with an ipsilateral clavicular fracture or acromioclavicular separation (floating shoulder) were retrospectively evaluated. The treatment was nonoperative in twelve patients and operative in seven. At the time of final follow-up, standard radiographs were made and all patients were examined by a physical therapist and either a fellowship-trained shoulder surgeon or an orthopaedic traumatologist. In addition, each patient responded to three different validated objective functional outcome measures: the Short Form-36, the American Shoulder and Elbow Surgeons Shoulder Scale, and the Disabilities of the Arm, Shoulder and Hand Questionnaire. Isokinetic strength-testing was performed, and strength in internal and external rotation was compared with that of the uninvolved shoulder. The main outcome measures included fracture-healing, functional outcome, patient satisfaction, and muscular strength.

Results: With regard to range of motion, only the amount of forward flexion was found to be significantly greater in the operatively treated group (p = 0.03). The operatively treated shoulders were found to be weaker in external rotation at 300°/sec and weaker in internal rotation at 180°/sec. When normalized to hand dominance, however, the numbers were too small to identify any significant difference. There was no significant difference between groups with regard to the three functional outcome measures.

Conclusions: Good results may be seen both with and without operative treatment. Therefore, we cannot universally recommend operative treatment for a double disruption of the superior suspensory shoulder complex. Treatment must be individualized for each patient.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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