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Randomized Controlled Trial
. 2015 Jan 28:10:9.
doi: 10.1186/s13018-014-0141-0.

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

Tsung-Li Lin  1 , Yu-Fen Li  2 , Chin-Jung Hsu  3   4 , Chih-Hung Hung  5 , Chi-Chang Lin  6 , Yi-Chin Fong  7   8 , Horng-Chaung Hsu  9   10 , Chun-Hao Tsai  11   12
Affiliations
Randomized Controlled Trial

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

Tsung-Li Lin et al. J Orthop Surg Res. .

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.

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Figures

Figure 1
Figure 1
Course of double fixation. Anteroposterior (A) and lateral (B) radiographs of the patient with ipsilateral fracture of the clavicle and the scapula neck before the treatment. The glenopolar angle was 3°; three-dimensional computerized tomography image showed the scapular neck fracture angulation was up to 43° (C); post-operative follow-up radiographs revealed the glenopolar angle was 36° (D, E); the post-operative photograph showed the operated shoulder (F) and a straight incision over the glenoid neck to access minimal dissection between the teres minor and the infraspinatus (arrow).
Figure 2
Figure 2
The simple linear regression model of (A) the Disabilities of the Arm, Shoulder and Hand (DASH) score and (B) the Constant-Murley Shoulder Outcome (Constant) score with the post-operative glenopolar angle (GPA).
See this image and copyright information in PMC

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