“Floating shoulder” injuries
© Heng. 2016
Received: 29 July 2015
Accepted: 7 March 2016
Published: 9 March 2016
“Floating shoulder” is a rare injury complex resulting from high-energy blunt force trauma to the shoulder, resulting in scapulothoracic dissociation. It is commonly associated with catastrophic neurovascular injury. Two cases of motorcyclists with floating shoulder injuries are described.
KeywordsFloating shoulder Scapulothoracic dissociation Neurovascular injury
Two cases of high-energy shoulder injuries involving motorcyclists are described. “Floating shoulder” injury, or scapulothoracic dissociation, is rare [1–3], but this unique injury pattern should be recognized earlier as it has devastating neurovascular implications and its management often requires a multi-disciplinary approach.
A floating shoulder represents a high-energy injury and is defined as a fracture of the scapular neck, ligament disruption, with or without a clavicular fracture . If the patient is upright, the affected limb often hangs lower than the contralateral side. Due to its proximity, the axillary vessels and brachial plexus are commonly injured [5, 6]. If a patient with floating shoulder presents with hypotension, bleeding from concomitant injuries in the traditional areas “blood on the floor plus four more” (intrathoracic, intraperitoneal, retroperitoneal, pelvis/thigh) needs to be excluded. However, as shown in both cases, hemorrhage from the right axillary artery into the soft tissue of the axilla and chest wall alone can result in hypovolemic shock due to the large amount of potential space where blood may accumulate. In case 1, there was delayed surgical hemostasis as the team elected to first perform radiographic investigations to look for a pelvic or intra-abdominal source of bleeding. It is recommended that in similar floating shoulder cases where there is no hemothorax or widened mediastinum on the chest radiograph and pelvic radiograph does not show pelvic disruption and point-of-care ultrasound does not identify hemoperitoneum, urgent transfer to the operating theater for exploration and hemostasis of axillary artery is required, bypassing unnecessary CT scans.
These two cases highlight the catastrophic neurovascular injuries that can occur with floating shoulder injuries, requiring prompt recognition, and the involvement of a multi-disciplinary team of orthopedic, trauma, and vascular surgeons to coordinate the management of this injury.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
- Herscovici Jr D, Fiennes AG, Allgower M, Rucdi TP. The floating shoulder: ipsilateral clavicle and scapular neck fractures. J Bone Joint Surg Br. 1992;74(3):362–4.PubMedGoogle Scholar
- Labler L, Platz A, Weishaupty D, Trentz O. Clinical and functional results after floating shoulder injuries. J Trauma. 2004;57:595–602.View ArticlePubMedGoogle Scholar
- Owens BD, Goss TP. The floating shoulder. J Bone Joint Surg Br. 2006;88(11):1419–24.View ArticlePubMedGoogle Scholar
- Wright DEP, Johnstone AJ. The floating shoulder redefined. J Trauma. 2010;68:E26–29.View ArticlePubMedGoogle Scholar
- DeFranco MJ, Patterson BM. The floating shoulder. J Am Acad Orthop Surg. 2006;14:499–509.PubMedGoogle Scholar
- Zhang GL, Zhang M. Surgical treatment of scapular fractures. Zhongguo Gushang. 2008;21:313–5.PubMedGoogle Scholar