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