Floating shoulders: Clinical and radiographic analysis at a mean follow-up of 11 years

CONTEXT: The floating shoulder (FS) is an uncommon injury, which can be managed conservatively or surgically. The therapeutic option remains controversial. AIMS: The goal of our study was to evaluate the long-term results and to identify predictive factors of functional outcomes. SETTINGS AND DESIGN: Retrospective monocentric study. MATERIALS AND METHODS: Forty consecutive FS were included (24 nonoperated and 16 operated) from 1984 to 2009. Clinical results were assessed with Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Single Assessment Numeric Evaluation (SANE), Short Form-12 (SF12), Disabilities of the Arm Shoulder and Hand score (DASH), and Constant score (CST). Plain radiographs were reviewed to evaluate secondary displacement, fracture healing, and modification of the lateral offset of the gleno-humeral joint (chest X-rays). New radiographs were made to evaluate osteoarthritis during follow-up. STATISTICAL ANALYSIS USED: T-test, Mann-Whitney test, and the Pearson's correlation coefficient were used. The significance level was set at 0.05. RESULTS: At mean follow-up of 135 months (range 12-312), clinical results were satisfactory regarding different mean scores: SST 10.5 points, OSS 14 points, SANE 81%, SF12 (50 points and 60 points), DASH 14.5 points and CST 84 points. There were no significant differences between operative and non-operative groups. However, the loss of lateral offset influenced the results negatively. Osteoarthritis was diagnosed in five patients (12.5%) without correlation to fracture patterns and type of treatment. CONCLUSIONS: This study advocates that floating shoulder may be treated conservatively and surgically with satisfactory clinical long-term outcomes. However, the loss of gleno-humeral lateral offset should be evaluated carefully before taking a therapeutic option.