Management of a floating shoulder accompanied by a scapular surgical neck fracture: a case report and review of the literature

In this article, we want to present a floating shoulder case accompanied by a scapular surgical neck fracture and review the literature about its diagnosis and management. CASE PRESENTATION: Our patient was a 40-year-old man who suffered a severe left shoulder injury as a result of a car-to-pedestrian accident. Computed tomography scan revealed a scapular surgical neck and body fracture, a spinal pillar fracture, and a dislocation of the acromioclavicular (AC) joint. The medial-lateral displacement and glenopolar angle were 21.65 mm and 19.8°, respectively. There was a 37° angular displacement and a greater than 100% translational displacement. Initially, the AC joint dislocation was approached via a superior incision on the clavicle and reduced with a single hook plate. A Judet approach was then used to expose the scapula fractures. The scapular surgical neck was fixed with a reconstruction plate. The spinal pillar was stabilized with two reconstruction plates following reduction. Following a year of follow-up, the patient’s shoulder range of motion was acceptable, and an American Shoulder and Elbow Surgeons score of 88 was achieved. DISCUSSION AND CONCLUSION: Floating shoulder management is still controversial. Floating shoulders are often treated surgically due to their consequent instability and potential risk of nonunion and malunion. As shown in this article, the indications for operating on isolated scapula fractures may also apply to floating shoulders. A well-planned approach to fractures is also imperative, and the AC joint should always be a priority.