ObjectiveTo investigate the effectiveness of open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex (SSSC) with coracoid process fracture.MethodsBetween January 2014 and October 2018, 22 patients with multiple injuries of SSSC with coracoid process fracture were treated by open reduction and internal fixation. There were 16 males and 6 females, aged from 24 to 72 years with an average age of 36.6 years. There were 10 cases of falling injury, 5 cases of traffic accident injury, and 7 cases of falling from height injury. All of them were fresh closed injuries. The time from injury to operation ranged from 2 to 17 days with an average of 6.9 days. Both X-ray film and CT showed the coracoid process fracture complicated with clavicular fracture in 14 cases, acromioclavicular joint dislocation in 12 cases, and acromioclavicular fracture in 5 cases. There were 14 cases of two places of SSSC, 7 cases of three places of SSSC, and 1 case of four places of SSSC.ResultsAll incisions healed in primary stage after operation. All patients were followed up 10-24 months with an average of 14.1 months. X-ray films showed that all fractures healed and the acromioclavicular joint was normal. The healing time ranged from 6 to 12 months, with an average of 6.2 months. No complications such as internal fixation failure and nonunion occurred. According to University of California Los Angeles (UCLA) shoulder scoring system, the shoulder joint function was rated as excellent in 15 cases, good in 5 cases, and poor in 2 cases at last follow-up. The excellent and good rate was 90.9%.ConclusionOpen reduction and internal fixation for treatment of multiple injuries of SSSC with coracoid process fracture is firm and reliable. Combined with active postoperative rehabilitation program intervention, it can accelerate the recovery of shoulder joint function and achieve satisfactory effectiveness.
ObjectiveTo investigate the effectiveness of double internal fixations of clavicle and scapula and intraoperative reduction of glenopolar angle in the treatment of floating shoulder injuries.MethodsBetween January 2010 and June 2019, 13 patients with floating shoulder injury were treated with double internal fixation of clavicle and scapula and intraoperative reduction of glenopolar angle. There were 11 males and 2 females with an average age of 48 years (range, 25-65 years). The causes of injury included falling from height in 2 cases, traffic accident injury in 3 cases, heavy object injury in 2 cases, and other injuries in 6 cases. There were 2 cases of Ⅰ-B-3 type, 1 case of Ⅰ-C-2 type, 1 case of Ⅰ-C-3 type, 3 cases of Ⅱ-B-2 type, 1 case of Ⅱ-B-3 type, 1 case of Ⅱ-B-4 type, 2 cases of Ⅱ-C-2 type, 1 case of Ⅱ-C-4 type, and 1 case of Ⅱ-D-3 type according to the classification of floating shoulder injury. All patients had unilateral clavicle fracture with scapular neck fracture, 1-4 superior shoulder suspensory complex (SSSC) injuries. The time from injury to operation was 7-17 days, with an average of 12 days. The glenopolar angle, subacromail space, anteroposterior inclination angle of scapular glenoid, scapular glenoid up and down angle were measured before and after operation; Constant-Murly score and Herscovici score were used to evaluate the recovery of shoulder joint function.ResultsAll incisions healed by first intention, and there was no early postoperative complications such as infection. All 13 cases were followed up 12-48 months, with an average of 25.2 months. Both the clavicle and the scapula had bone union, and the average healing time was 6 months and 4 months respectively. There were no complications such as nonunion, shoulder deformity, plate fracture or failure of internal fixation, acromion impingement syndrome, and frozen shoulder. At last follow-up, the glenopolar angle, subacromail space, anteroposterior inclination angle of scapular glenoid, and scapular glenoid up and down angle were all corrected significantly (P<0.05). The pain, function, activity, muscle strength scores, and total score in Constant-Murly score were significantly improved when compared with preoperative scores (P<0.05). According to the Herscovici scoring standard, the shoulder joint function was evaluated as excellent in 8 cases, good in 3 cases, and fair in 2 cases. The excellent and good rate was 84.6%.ConclusionDouble internal fixation of clavicle and scapula to stabilize SSSC and reduct glenopolar angle during operation is an effective method for treating the floating shoulder injury.
Objective To investigate the clinical characteristics and injury mechanisms of lateral segment floating clavicle (LSFC), and to establish a comprehensive classification system for this specific triple injury of the superior shoulder suspensory complex (SSSC), so as to provide a reference for clinical diagnosis and treatment. Methods A retrospective analysis was performed on 354 patients with midclavicular fractures who underwent surgical treatment between January 2021 and December 2024. Among them, 11 patients met the diagnostic criteria for LSFC, defined as a combination of midclavicular fracture, ipsilateral coracoid process fracture or coracoclavicular ligament rupture, and ipsilateral acromioclavicular ligament rupture, distal clavicular fracture, or acromial fracture. There were 9 males and 2 females, with an age range of 21-53 years (mean, 39.3 years). LSFC was classified into two main types: Type Ⅰ was characterized by coracoclavicular ligament rupture, and type Ⅱ by coracoid process fracture. According to the injury pattern at the acromioclavicular joint-distal clavicle complex, each type was further subdivided into three subtypes: subtype a (acromioclavicular ligament rupture or acromioclavicular joint dislocation), subtype b (distal clavicular fracture), and subtype c (acromial fracture). Of the 11 patients, 4 were classified as type Ⅰa, 5 as type Ⅱa, and 2 as type Ⅱb. All patients underwent open reduction and internal fixation. Missed diagnosis occurred in 3 cases (27.3%), intraoperative revision of the surgical plan was required in 1 case, and postoperative delayed diagnosis was found in 2 cases during follow-up, with 1 patient undergoing reoperation. Results All 11 LSFC patients were followed up 13-26 months (mean, 17.8 months). Bony union was achieved in all fractures at last follow-up. A total of 7 complications were noted: 3 cases of acromioclavicular joint subluxation, 3 cases of periprosthetic osteolysis around the clavicular hook plate, and 1 case of wire breakage. The incidence of ipsilateral multiple rib fractures in LSFC patients was 45.5% (5/11), which was significantly higher than that in patients with isolated midclavicular fractures (1.7%, 6/343) (P<0.001). Conclusion LSFC is mostly caused by high-energy trauma, with a high rate of missed diagnosis and frequent associated injuries. In particular, ipsilateral multiple rib fractures are a highly suggestive sign of LSFC. The classification system proposed in this study summarizes the characteristics of this triple injury of SSSC, which is conducive to improving clinicians’ understanding of the injury and reducing the rate of missed diagnosis.