Abstract

To study on surgical management of ipsilateral clavicle and scapular fractures (floating shoulder injury). Methodology: The study protocol was approved by an Ethical Committee for research studies of NRI Medical College. Patients of floating shoulder injury with gross displacement at fracture site of both clavicle and scapula attending the emergency department of NRI Medical College, Mangalagiri. Results: In our present study, we included patients in age range between 20-60 years with a mean age of 38.7 years with majority of the patients in range of 31-40 years (35%) In our present study males were predominant (75%) than females (25%) In our study Right sided injuries were more (60%) compared to left (40%). In our study majority of the injuries were due to high energy RTA (85%) followed by fall from height (15%). In our study ipsilateral side multiple rib fractures (40%) were the most common associated injury followed by head injury (15%) and C-spine fractures (5%). Among the 20 cases, Type C3 (Scapular neck displaced & unstable) was more common (60%) followed by C2 (Scapular neck un-displaced & unstable) (25%) and B3 (Scapular neck displaced & stable) (15%). The average duration for fixation of both clavicle and scapula in our study was 131.17 mins while for fixation of clavicle alone was 66.67 mins In our present study 17 cases (85%) were operated for both clavicle and scapula with LCP & RECON plates and 3 cases (15%) were operated for only clavicle with LCP. In our present study, the average blood loss in those patients who got operated for both clavicle and scapula is around 90ml while those operated for clavicle alone it was around 35ml. In our present study the mean time period (in weeks) for the union was 12.6 weeks for both clavicle and scapula when operated with clavicle fixation alone and 14.7 weeks respectively for both clavicle & scapula when operated with fixation of both clavicle & scapula. In our study the functional outcome of all patients was analyzed using HERSCOVICI SCORE. The mean HERSCOVICI SCORE in our study was 13.3 (EXCELLENT) in clavicle fixation alone group and 11.35 (EXCELLENT) in both scapula & clavicle fixation group. Conclusion: We concluded that successful indirect reduction of the displaced fracture of the glenoid neck can be achieved with surgical fixation of the clavicle alone using LCP. However, open reduction and internal fixation of the scapula with RECON plating must be performed if significant displacement of scapula is present which ultimately resulted in good functional outcome.

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