We report the case of a 28-year-old male patient who came to the emergency department with pain and functional impotence of the left shoulder after direct lateral contusion in the context of a bicycle fall during a fall.
The patient comes conscious and oriented, holding the shoulder by the elbow with the other hand.
When performing the inspection, a fallen shoulder was observed in relation to the contralateral shoulder (dropping shoulder), functional impotence with pain on palpation of the clavicle and deformity at this level.
Vascular and neurological examination of the limb was not affected.
Investigations
An anteroposterior radiograph of the left shoulder showed fracture of the middle third of the clavicle and fracture of the surgical neck of the scapula type B with a glenopolar angle of 47o.
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Computed tomography (CT) showed a fracture of the middle third of the clavicle with a third fragment and a displaced fracture of the neck of the scapularis muscle without involvement of the medial surface of the coracoid (B).
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With the diagnosis of floating shoulder, it was decided to surgically treat the clavicle, performing open reduction and stabilization by means of osteosyntesis with an interfragmentary screw plate 8 to neutralization of the third fragment.
Intraoperative radioscopic control was used to check the reduction of the inferior appearance of the scapulae neck after synthesis of the clavicle.
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Initially, immobilization was performed with a sling that was maintained until 30 days after surgery.
There were no complications during admission or during follow-up.
Therefore, due to the stability of the assembly, it was decided to start rehabilitation 18 days after surgery.
Rehabilitation treatment consisted of passive assisted balance of the shoulder and active range of motion of the wrist and elbow.
At 6 weeks, active parascapular exercises were started according to tolerance and passive shoulder joint balance was finally achieved.
Three months later, active exercises were started, both for bladder and shoulder pain.
Once the active joint balance was achieved, supervised strength exercises were started up to 6 months.
Clinical controls were performed at month 1, 3 months and 6 months. Both fractures were correctly consolidated after the third month, as well as full joint balance recovery without active or passive pain.
After 6 months the patient restarted his sports activity without limitations (cycling 2.5 hours per week) and the functional evaluation was performed using the Constant Score of 100 points4.
The patient did not require the removal of the osteosynthesis material.
