Combination of a scapular-neck fracture and a mid-clavicular ipsilateral fracture.
Pathoanatomy
Superior shoulder suspensory complex (SSSC):
The SSSC consists of osseous and soft tissue structures that exist between two struts. The middle third of the clavicle acts as the superior strut, while the lateral scapular body and spine serves as the inferior strut. The components of the SSSC create a ring that includes the acromion, coracoid, distal clavicle, glenoid, coracoclavicular ligaments, and the acromioclavicular joint. The complex is responsible for maintaining a stable relationship between the axial skeleton and the upper extremity.
The superior shoulder suspensory complex (SSSC). A, Anteroposterior view of the bone-soft-tissue SSSC ring (dashed oval) as well as the superior and inferior bone struts (parallel dashed lines). B, Lateral view of the bone-soft-tissue ring. | Goss T: Scapular fractures and dislocations: Diagnosis and treatment. J Am Acad Orthop Surg 1995;3:22-33.
Injury patterns:
Floating shoulder injury patterns. Purely osseous injuries: A, Type IA: scapular neck fracture combined with a coracoid base fracture. B, Type IB: scapular neck fracture combined with a clavicle fracture and scapular spine or acromion fracture. Purely ligamentous injury: C, Type II: scapular neck fracture combined with coracoacromial and coracoclavicular ligament disruption. Combined osseoligamentous injuries: D, Type IIIA: scapular neck fracture combined with a clavicular shaft fracture plus coracoacromial and acromioclavicular ligament disruption. E, Type IIIB: scapular neck fracture combined with an acromion or scapular spine fracture plus coracoclavicular and acromioclavicular ligament disruption. | Wong KL, Ramsey ML, Williams GR Jr: Scapular fractures, in Norris TR [ed]: Orthopaedic Knowledge Update: Shoulder and Elbow, ed 2. Rosemont, IL: American Academy of Orthopaedic Surgeons, 2002, pp 227-236.
Comparison of the lateral offset of the gleno-humeral joint between involved (right) and healthy (left) side on a chest X-ray. Figures were calculated using a measuring tool and do not have a metric unit correlation | Pailhes, R. G., Bonnevialle, N., Laffosse, J., Tricoire, J., Cavaignac, E., & Chiron, P. (2013). Floating shoulders: Clinical and radiographic analysis at a mean follow-up of 11 years. International journal of shoulder surgery, 7(2), 59–64. https://doi.org/10.4103/0973-6042.114230
