Clinical outcome and radiographic change of ipsilateral scapular neck and clavicular shaft fracture: comparison of operation and conservative treatment

Journal of Orthopaedic Surgery and Research

Chun-Hao Tsai²  Horng-Chaung Hsu²  Yi-Chin Fong¹  Chi-Chang Lin³  Chih-Hung Hung³  Chin-Jung Hsu¹  Yu-Fen Li⁴  Tsung-Li Lin³ 

[1] School of Chinese Medicine, China Medical University, China Medical University Hospital, Taichung, Taiwan;Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University, Taichung, Taiwan;Department of Orthopedic Surgery, China Medical University Hospital, #2 Yue-Der Road, Taichung 40447, Taiwan;Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan

关键词: Glenopolar angle;    Floating shoulder;    Clavicle fracture;    Scapular fracture;   

Others  :  1138713
DOI  :  10.1186/s13018-014-0141-0

 received in 2014-10-02, accepted in 2014-12-15,  发布年份 2015

【 摘 要 】

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.

【 授权许可】

   
2015 Lin et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Goss TP: Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma 1993, 7(2):99-106.
• [2]HerscoviciJr D, Fiennes AG, Allgower M, Ruedi TP: The floating shoulder: ipsilateral clavicle and scapular neck fractures. J Bone Joint Surg (Br) 1992, 74(3):362-364.
• [3]Goss TP: Scapular fractures and dislocations: diagnosis and treatment. J Am Acad Orthop Surg 1995, 3(1):22-33.
• [4]Edwards SG, Whittle AP, Wood GW 2nd: Nonoperative treatment of ipsilateral fractures of the scapula and clavicle. J Bone Joint Surg Am 2000, 82(6):774-780.
• [5]van Noort A, teSlaa RL, Marti RK, van der Werken C: The floating shoulder. A multicentre study. J Bone Joint Surg (Br) 2001, 83(6):795-798.
• [6]Low CK, Lam AW: Results of fixation of clavicle alone in managing floating shoulder. Singapore Med J 2000, 41(9):452-453.
• [7]Owens BD, Goss TP: The floating shoulder. J Bone Joint Surg (Br) 2006, 88(11):1419-1424.
• [8]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):93-97.
• [9]Leung KS, Lam TP: Open reduction and internal fixation of ipsilateral fractures of the scapular neck and clavicle. J Bone Joint Surg Am 1993, 75(7):1015-1018.
• [10]Stegeman SA, de Jong M, Sier CF, Krijnen P, Duijff JW, van Thiel TP, et al.: Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentrerandomised controlled trial. BMC Musculoskelet Disord 2011, 12:196. BioMed Central Full Text
• [11]Cole PA, Gauger EM, Herrera DA, Anavian J, Tarkin IS: Radiographic follow-up of 84 operatively treated scapula neck and body fractures. Injury 2012, 43(3):327-333.
• [12]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):313-316.
• [13]Gauger EM, Cole PA: Surgical technique: a minimally invasive approach to scapula neck and body fractures. Clin Orthop Relat Res 2011, 469(12):3390-3399.
• [14]Hudak PL, Amadio PC, Bombardier C: Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996, 29(6):602-608.
• [15]Constant CR, Murley AH: A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987, 214:160-164.
• [16]Obuchowski NA: An ROC-type measure of diagnostic accuracy when the gold standard is continuous-scale. Stat Med 2006, 25(3):481-493.
• [17]Nguyen P: NonbinROC: software for evaluating diagnostic accuracies with non-binary gold standards. J Stat Softw 2007, 21(10):1-10.
• [18]Pace AM, Stuart R, Brownlow H: Outcome of glenoid neck fractures. J Shoulder Elbow Surg 2005, 14(6):585-590.
• [19]Chadwick EK, van Noort A, van der Helm FC: Biomechanical analysis of scapular neck malunion--a simulation study. Clin Biomech (Bristol, Avon) 2004, 19(9):906-912.
• [20]Egol KA, Connor PM, Karunakar MA, Sims SH, Bosse MJ, Kellam JF: The floating shoulder: clinical and functional results. J Bone Joint Surg Am 2001, 83-A(8):1188-1194.
• [21]Hashiguchi H, Ito H: Clinical outcome of the treatment of floating shoulder byosteosynthesis for clavicular fracture alone. J Shoulder Elbow Surg 2003, 12(6):589-591.
• [22]Oh W, Jeon IH, Kyung S, Park C, Kim T, Ihn C: The treatment of double disruption of the superior shoulder suspensory complex. Int Orthop 2002, 26(3):145-149.
• [23]Bestard EA SH, Bestard EH: Glenoplasty in the management of recurrent shoulder dislocation. Contemp Orthop 1986, 12:47-55.
• [24]Bozkurt M, Can F, Kirdemir V, Erden Z, Demirkale I, Basbozkurt M: Conservative treatment of scapular neck fracture: the effect of stability and glenopolar angle on clinical outcome. Injury 2005, 36(10):1176-1181.
• [25]Kim KC, Rhee KJ, Shin HD, Yang JY: Can the glenopolar angle be used to predict outcome and treatment of the floating shoulder? J Trauma 2008, 64(1):174-178.
• [26]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-E13.