Skip to main content
Erschienen in: European Journal of Trauma and Emergency Surgery 2/2019

23.03.2018 | Review Article

Decision-making for complex scapula and ipsilateral clavicle fractures: a review

verfasst von: Florian Hess, Ralph Zettl, Daniel Smolen, Christoph Knoth

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 2/2019

Einloggen, um Zugang zu erhalten

Abstract

Introduction

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.

Results

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.

Discussion

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.
Literatur
1.
Zurück zum Zitat Ganz R, Noesberger B. Treatment of scapular fractures. Hefte zur Unfallheilkunde. 1975;126:59–62. Ganz R, Noesberger B. Treatment of scapular fractures. Hefte zur Unfallheilkunde. 1975;126:59–62.
2.
Zurück zum Zitat Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop trauma. 1993;7(2):99–106.CrossRefPubMed Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop trauma. 1993;7(2):99–106.CrossRefPubMed
3.
Zurück zum Zitat Herscovici D Jr, Fiennes AG, Allgower M, Ruedi TP. The floating shoulder: ipsilateral clavicle and scapular neck fractures. J Bone Jt Surg Br. 1992;74(3):362–4.CrossRef Herscovici D Jr, Fiennes AG, Allgower M, Ruedi TP. The floating shoulder: ipsilateral clavicle and scapular neck fractures. J Bone Jt Surg Br. 1992;74(3):362–4.CrossRef
4.
Zurück zum Zitat Goss TP. Scapular fractures and dislocations: diagnosis and treatment. J Am Acad Orthop Surg. 1995;3(1):22–33.CrossRefPubMed Goss TP. Scapular fractures and dislocations: diagnosis and treatment. J Am Acad Orthop Surg. 1995;3(1):22–33.CrossRefPubMed
7.
Zurück zum Zitat Williams GR Jr, Naranja J, Klimkiewicz J, Karduna A, Iannotti JP, Ramsey M. The floating shoulder: a biomechanical basis for classification and management. J Bone Jt Surg Am 2001;83-A (8):1182–7.CrossRef Williams GR Jr, Naranja J, Klimkiewicz J, Karduna A, Iannotti JP, Ramsey M. The floating shoulder: a biomechanical basis for classification and management. J Bone Jt Surg Am 2001;83-A (8):1182–7.CrossRef
9.
Zurück zum Zitat Ideberg R, Grevsten S, Larsson S. Epidemiology of scapular fractures. Incidence and classification of 338 fractures. Acta Orthop Scand. 1995;66(5):395–7.CrossRefPubMed Ideberg R, Grevsten S, Larsson S. Epidemiology of scapular fractures. Incidence and classification of 338 fractures. Acta Orthop Scand. 1995;66(5):395–7.CrossRefPubMed
11.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
12.
Zurück zum Zitat 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.CrossRef 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.CrossRef
15.
Zurück zum Zitat Romero J, Schai P, Imhoff AB. Scapular neck fracture–the influence of permanent malalignment of the glenoid neck on clinical outcome. Arch Orthop Trauma Surg. 2001;121(6):313–6.CrossRefPubMed Romero J, Schai P, Imhoff AB. Scapular neck fracture–the influence of permanent malalignment of the glenoid neck on clinical outcome. Arch Orthop Trauma Surg. 2001;121(6):313–6.CrossRefPubMed
17.
Zurück zum Zitat van Noort A, te Slaa RL, Marti RK, van der Werken C. The floating shoulder. A multicentre study. J Bone Jt Surg Br. 2001;83(6):795–8.CrossRef van Noort A, te Slaa RL, Marti RK, van der Werken C. The floating shoulder. A multicentre study. J Bone Jt Surg Br. 2001;83(6):795–8.CrossRef
18.
Zurück zum Zitat Ada JR, Miller ME. Scapular fractures. Analysis of 113 cases. Clin Orthop Relat Res. 1991;269:174–80. Ada JR, Miller ME. Scapular fractures. Analysis of 113 cases. Clin Orthop Relat Res. 1991;269:174–80.
19.
Zurück zum Zitat Hardegger FH, Simpson LA, Weber BG. The operative treatment of scapular fractures. J Bone Jt Surg Br. 1984;66(5):725–31.CrossRef Hardegger FH, Simpson LA, Weber BG. The operative treatment of scapular fractures. J Bone Jt Surg Br. 1984;66(5):725–31.CrossRef
20.
Zurück zum Zitat Nordqvist A, Petersson CJ. Shoulder injuries common in alcoholics. An analysis of 413 injuries. Acta Orthop Scand. 1996;67(4):364–6.CrossRefPubMed Nordqvist A, Petersson CJ. Shoulder injuries common in alcoholics. An analysis of 413 injuries. Acta Orthop Scand. 1996;67(4):364–6.CrossRefPubMed
21.
Zurück zum Zitat Edwards SG, Whittle AP, Wood GW 2nd. Nonoperative treatment of ipsilateral fractures of the scapula and clavicle. J Bone Jt Surg Am. 2000;82(6):774–80.CrossRef Edwards SG, Whittle AP, Wood GW 2nd. Nonoperative treatment of ipsilateral fractures of the scapula and clavicle. J Bone Jt Surg Am. 2000;82(6):774–80.CrossRef
24.
Zurück zum Zitat Judet R. Surgical treatment of scapular fractures. Acta Orthop Belgica. 1964;30:673–8. Judet R. Surgical treatment of scapular fractures. Acta Orthop Belgica. 1964;30:673–8.
26.
Zurück zum Zitat Obremskey WT, Lyman JR. A modified judet approach to the scapula. J Orthop Trauma. 2004;18(10):696–9.CrossRefPubMed Obremskey WT, Lyman JR. A modified judet approach to the scapula. J Orthop Trauma. 2004;18(10):696–9.CrossRefPubMed
31.
Zurück zum Zitat Labler L, Platz A, Weishaupt D, Trentz O. Clinical and functional results after floating shoulder injuries. J Trauma. 2004;57(3):595–602.CrossRefPubMed Labler L, Platz A, Weishaupt D, Trentz O. Clinical and functional results after floating shoulder injuries. J Trauma. 2004;57(3):595–602.CrossRefPubMed
33.
Zurück zum Zitat Egol KA, Connor PM, Karunakar MA, Sims SH, Bosse MJ, Kellam JF. The floating shoulder: clinical and functional results. J Bone Jt Surg Am. 2001;83-A(8):1188–94.CrossRef Egol KA, Connor PM, Karunakar MA, Sims SH, Bosse MJ, Kellam JF. The floating shoulder: clinical and functional results. J Bone Jt Surg Am. 2001;83-A(8):1188–94.CrossRef
34.
Zurück zum Zitat Ramos L, Mencia R, Alonso A, Ferrandez L. Conservative treatment of ipsilateral fractures of the scapula and clavicle. J Trauma. 1997;42(2):239–42.CrossRefPubMed Ramos L, Mencia R, Alonso A, Ferrandez L. Conservative treatment of ipsilateral fractures of the scapula and clavicle. J Trauma. 1997;42(2):239–42.CrossRefPubMed
36.
Zurück zum Zitat Low CK, Lam AW. Results of fixation of clavicle alone in managing floating shoulder. Singap Med J. 2000;41(9):452–3. Low CK, Lam AW. Results of fixation of clavicle alone in managing floating shoulder. Singap Med J. 2000;41(9):452–3.
45.
Zurück zum Zitat Goss TP. Fractures of the glenoid cavity. J Bone Jt Surg Br Am. 1992;74(2):299–305.CrossRef Goss TP. Fractures of the glenoid cavity. J Bone Jt Surg Br Am. 1992;74(2):299–305.CrossRef
46.
Zurück zum Zitat Mayo KA, Benirschke SK, Mast JW. Displaced fractures of the glenoid fossa. Results of open reduction and internal fixation. Clin Orthop Relat Res. 1998;347:122–30.CrossRef Mayo KA, Benirschke SK, Mast JW. Displaced fractures of the glenoid fossa. Results of open reduction and internal fixation. Clin Orthop Relat Res. 1998;347:122–30.CrossRef
48.
Zurück zum Zitat Rikli D, Regazzoni P, Renner N. The unstable shoulder girdle: early functional treatment utilizing open reduction and internal fixation. J Orthop Trauma. 1995;9(2):93–7.CrossRefPubMed Rikli D, Regazzoni P, Renner N. The unstable shoulder girdle: early functional treatment utilizing open reduction and internal fixation. J Orthop Trauma. 1995;9(2):93–7.CrossRefPubMed
Metadaten
Titel
Decision-making for complex scapula and ipsilateral clavicle fractures: a review
verfasst von
Florian Hess
Ralph Zettl
Daniel Smolen
Christoph Knoth
Publikationsdatum
23.03.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 2/2019
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-018-0946-3

Weitere Artikel der Ausgabe 2/2019

European Journal of Trauma and Emergency Surgery 2/2019 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.