A prospective study comparing conservative with operative treatment in patients with a ‘floating shoulder’ including assessment of the prognostic value of the glenopolar angle

V. Yadav, G. N. Khare, S. Singh, V. Kumaraswamy, N. Sharma, A. K. Rai, A. G. Ramaswamy, H. Sharma

Abstract

Both conservative and operative forms of treatment have been recommended for patients with a ‘floating shoulder’. We compared the results of conservative and operative treatment in 25 patients with this injury and investigated the use of the glenopolar angle (GPA) as an indicator of the functional outcome. A total of 13 patients (ten male and three female; mean age 32.5 years (24.7 to 40.4)) were treated conservatively and 12 patients (ten male and two female; mean age 33.67 years (24.6 to 42.7)) were treated operatively by fixation of the clavicular fracture alone. Outcome was assessed using the Herscovici score, which was also related to changes in the GPA at one year post-operatively.

The mean Herscovici score was significantly better three months and two years after the injury in the operative group (p < 0.001 and p = 0.003, respectively). There was a negative correlation between the change in GPA and the Herscovici score at two years follow-up in both the conservative and operative groups, but neither were statistically significant (r = -0.295 and r = -0.19, respectively). There was a significant difference between the pre- and post-operative GPA in the operative group (p = 0.017).

When compared with conservative treatment, fixation of the clavicle alone gives better results in the treatment of patients with a floating shoulder. The GPA changes significantly with fixation of clavicle alone but there is no significant correlation between the pre-injury GPA and the final clinical outcome in these patients.

Cite this article: Bone Joint J 2013;95-B:815–19.

Footnotes

  • The authors are very grateful to the support lent to this study by the Physiotherapy Department and the consultants of the Department of Radiodiagnosis of our institute for their assistance with this study. They would especially like to thank Professor O. P. Singh for his hard work in conducting regular physiotherapy sessions for all the patients included in this study.

    No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

    This article was primary edited by J. Scott and first-proof edited by G. Scott.

  • Supplementary material. A table detailing the components and grading of the Herscovici score is available with the electronic version of this article on our website www.bjj.boneandjoint.org.uk

  • Received October 16, 2012.
  • Accepted February 5, 2013.
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