Pediatric Clavicle Fractures and Congenital Pseudarthrosis Unraveled

Clavicle fractures are commonly seen in the pediatric and adolescent populations. In contrast, congenital pseudarthrosis of the clavicle is rare. Although both conditions may present with similar signs and symptoms, especially in the very young, clear differences exist. Clavicle fractures are often caused by trauma and are tender on palpation, while pseudarthrosis often presents with a painless protuberance on the clavicle, which becomes more prominent as the child grows. Its presence may only become apparent after trauma, as it is usually asymptomatic. The diagnosis is confirmed on plain radiography, which shows typical features to distinguish both entities. Both clavicle fractures and congenital pseudarthrosis are generally treated conservatively with a high success rate. Operative treatment for a fracture can be indicated in the case of an open fracture, severely displaced fracture, floating shoulder, neurovascular complications or polytrauma. Congenital pseudarthrosis requires operative treatment if the patient experiences progressive pain, functional limitation and late-onset thoracic outlet symptoms, but most operations are performed due to esthetic complaints.

Acromial Fracture Associated with Coracoid Fracture Not Belong to Floating Shoulder : A Case Report

Floating shoulder is no osseoligamentous connection between the humeral shoulder joint with the axial skeleton. The osseoligamentous of shoulder joint connection compose a ring, including clavicle,acromion, coracoid, glenoid fossa, surgical or anatomical scapula neck, acromioclavicular ligament and coracolclavicular ligament. This ring is known as superior shoulder suspensory complex (SSSC). The double disruptions of this ring are recognized to create a potentially unstable anatomical situation. Thus, floating shoulder is also characterized as double or more disruptions of SSSC. Surgical reduction and fixation for the displacement of those fractures at one or more sites is recommended in previous reports. We present 2 cases of patients with acromial and coracoid displaced fractures which belong to a type of the double disruptions of SSSC, there were still osseoligamentous connection between the humeral shoulder joint with the axial skeleton. The patient’s shoulder function after nonoperative management was satisfactory.

The Association of a Floating Elbow and a Homolateral Dislocated Floating Shoulder (About a Case)

The floating elbow is a rare lesion, characterized by the presence of a fracture of the humerus and one or both bones of the homolateral forearm. Double disturbances of the upper suspensory shoulder complex, commonly referred to as “floating shoulder” injuries, are ipsilateral fractures of the clavicle and scapula with loss of bone attachment of the glenoid. The combination of a floating elbow and floating shoulder is extremely rare, added an ipsilateral dislocation of the glenohumeral remains exceptional. No case has been reported in the literature of such a lesional association. This observation makes it possible to describe an extremely rare lesion, by proposing the therapeutic attitude and the prognosis.

Floating Shoulder Injury Resulting in Delayed Onset of Infraclavicular Brachial Plexus Palsy

As the brachial plexus traverses the costoclavicular space, it is susceptible to compression by pathologies affecting the clavicle. Clavicle nonunions with hypertrophic callus may cause a delayed onset of brachial plexus palsy. We present a rare case of a floating shoulder injury causing medial and posterior cord brachial plexus palsy two months after initial injury. After the diagnosis was established, the patient was treated successfully with expeditious brachial plexus decompression, callus excision, and rigid osteosynthesis, with healing of the clavicle nonunion and scapular fracture, and recovery of sensory and motor deficits.

Short and medium term outcome of surgical treatment of the floating shoulder

<p class="abstract"><strong>Background:</strong> Floating shoulder are rare injuries just because of high velocity of trauma and road traffic accidents. The aim of this study was to evaluate the functional outcome of surgically treated clavicle, glenoid and both bone injuries.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted in the department of orthopaedics, Sir. T. Hospital, Bhavnagar from October 2009 to November 2013. Out of 25 patients all turned up for follow up. Functional and clinical assessments done with range of movements in surgically treated fractures of clavicle, glenoid and both bone group.<strong></strong></p><p class="abstract"><strong>Results:</strong> All bone fractures are united in all the patients. The mean follow up period was 30 months. The mean functional result was assessed using Rowe score to assesses the function, pain, stability and motion. All the cases showed excellent to fair results after follow up period.</p><p class="abstract"><strong>Conclusions:</strong> Surgical treatment for double disruption of the superior shoulder suspensory complex, which is inherently an unstable and rare injury, is a good option, allowing early rehabilitation and improving the functional outcome.</p>

The floating flail chest: Acute management of an injury combination of the floating shoulder and flail chest

Background/purpose: The combination of ipsilateral floating shoulder and flail chest is a unique injury pattern that has not been previously described in the literature. We termed the injury pattern floating flail chest (FFC). The purpose of this study was to evaluate the effect of operative treatment of the shoulder girdle component to overall hospital length of stay (LOS). Methods: Forty-one patients were enrolled between two level I trauma centers identifying with a combination ipsilateral floating shoulder and flail chest injury, 23 treated with operative stabilization and 18 treated non-operatively. This retrospective cohort study evaluated the overall LOS and intensive care unit (ICU) days. Results: The operative group had decreased overall LOS (10.1 vs. 19.8 days, p = 0.02) and decreased ICU days (3.4 vs. 10.3, p = 0.04). Conclusion: This study describes a unique injury pattern that combines the floating shoulder and flail chest, FFC. Our study suggests that operative treatment of the shoulder girdle may decrease both overall LOS and ICU days in patients with FFC.