Clinical outcome and radiographic change of ipsilateral scapular neck and clavicular shaft fracture: comparison of opera
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RESEARCH ARTICLE
Open Access
Clinical outcome and radiographic change of ipsilateral scapular neck and clavicular shaft fracture: comparison of operation and conservative treatment Tsung-Li Lin1, Yu-Fen Li2, Chin-Jung Hsu1,3, Chih-Hung Hung1, Chi-Chang Lin1, Yi-Chin Fong1,3, Horng-Chaung Hsu1,4 and Chun-Hao Tsai1,4*
Abstract Objective: The purpose of this study is to compare glenopolar angle (GPA) and the functional outcomes of fixation of both the clavicle and the scapular neck, fixation of the clavicle alone, and conservative treatment for floating-shoulder injuries. Methods: A prospective stratified randomized study was performed in 39 adult patients who suffered floating-shoulder injuries and underwent fixation of both the clavicle and the scapular neck (group A), or fixation of the clavicle alone (group B), or conservative treatment (group C) between January 2005 and September 2011. The GPA, Disabilities of the Arm, Shoulder and Hand (DASH) score, and Constant-Murley Shoulder Outcome (Constant) score were compared between the three groups. Results: All 39 patients were followed up for more than 2 years. GPA after bony consolidation was significantly better in group A than in groups B and C (p = 0.015). Functional outcomes measured by DASH and Constant scores were significantly better in group A at final follow-up (p = 0.008 and 0.002, respectively). Both DASH and Constant scores were highly correlated with GPA after consolidation (p < 0.001, respectively). The receiver operating characteristic (ROC) analysis showed that of the two randomly selected DASH scores, the smaller DASH score would have a larger GPA than the larger DASH score. Similarly, the larger Constant score would have a larger GPA than the smaller Constant score. Conclusions: Fixation of both the clavicle and the scapular neck may correct GPA and improve functional outcomes for the treatment of floating-shoulder injuries. GPA after fracture consolidation is a useful prognostic indicator of a satisfactory clinical outcome as defined by either DASH score or Constant score. Keywords: Scapular fracture, Clavicle fracture, Floating shoulder, Glenopolar angle
Background Double disruption of the superior shoulder suspensory complex (SSSC) creates anatomic instability [1]. Floatingshoulder injuries, or ipsilateral fractures of the clavicle and the scapular neck, are double disruptions of the SSSC that render the entire shoulder girdle unstable [2,3]. Good results have previously been reported for both conservative * Correspondence: [email protected] 1 Department of Orthopedic Surgery, China Medical University Hospital, #2 Yue-Der Road, Taichung 40447, Taiwan 4 Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University, Taichung, Taiwan Full list of author information is available at the end of the article
treatment [3-5] and operative treatment of the clavicle alone [2,6-8] or of both the clavicle and the scapular neck [9]. There have been no randomized trials because the condition is rare; the criterion for surg
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