Floating shoulder

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Ron

I'll go with the orthopod on this one - I've never seen one fixed in this country though!

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
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-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Ronald Gross
Sent: Friday, December 07, 2007 8:12 PM
To: Trauma & Critical Care mailing list
Subject: RE: Floating shoulder


Makes sense --- I'm a believer.  Tim, still convinced not to fix the clavicle?

>>> "Rajesh" <rajesh84 at asianetindia.com> 12/7/2007 1:07 PM >>>
Ron,

If we dont fix all 3 components,we will end up delaying mobilisation while the clavicle is healing. After extensive dissection in the infraspinous fssa and interfering wih the cuff during nailing, the sooner we move it ,the better. Also, to me the clavicle fracture looks as if it is distracted and not the usual overlapping. this might be du to the high energy impact and such fractures have a tendency to go into delayed or non-union.

-----Original Message-----
From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Ronald Gross
Sent: 07 December 2007 18:07
To: Trauma &amp; Critical Care mailing list
Subject: RE: Floating shoulder


Rajesh,

Why do you need to plate the clavicle in this instance, and not address it in an isolated humerus or isolated scapula?  I get the fact that the shoulder is, in this case, truly floating, but how much integrity/strength does repairing the clavicle have in this case?

Ron

>>> "Rajesh" <rajesh84 at asianetindia.com> 12/6/2007 9:42 PM >>>
I would nail the humerus, plate and bone graft the clavicle (primary bone grafting is advisable in trauma as severe as this) and then turn her over,do an L shaped approach to the scapula with elevation of the infraspiantus from the medial border and back of scapula upto the glenoid (taking care not to strech the neurovascular bundle at the pedicle).I would then use some recon plates to fix the scapula together.

what is the status of the brachial plexus?

good luck

Mr.K.R.Rajesh, MS,DNB, FRCS, FRCS(Tr & Orth) .
Consultant Orthopaedic Surgeon
Division of Upper Limb surgery, Arthroscopy and Joint Replacement
Cosmopolitan Hospital
Trivandrum
Kerala
India.

Mobile- +919447191205

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]On Behalf Of Wojciech Ambrozy
Sent: 07 December 2007 00:44
To: Trauma &amp; Critical Care mailing list
Subject: Floating shoulder


19 yo female , RTA
Fractured clavicle , shaft of humerus , neck of scapula , ribs 2,3,4 
left side
RHD

what are Yours suggestions regarding managment ?

Regards


Ambrozy


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