Triple disruption of the superior shoulder suspensory complex [presentation]
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OBJECTIVES: The purpose of this study is to report on a series of patients who sustained a triple disruption to the SSSC, their associated injuries, and functional outcomes of open reduction and internal fixation. METHODS: A prospective scapula fracture database was established in 2002 with the approval of the IRB to record surgical and functional outcomes of patients undergoing ORIF for scapula fractures. Our study cohort met published and clearly defined operative criteria and consisted of all patients, greater than 17 years of age, who had more than two lesions to the SSSC. RESULTS: Fifteen patients with greater than 2 disruptions (12 triple and 3 quadruple) were identified with a total of 48 disruptions. There were 14 scapula neck fractures (14 operatively treated), 8 clavicle fractures (4 operative), 6 AC separations (5 operative), 10 coracoid (7 operative), and 10 acromion fractures (8 operative). Associated injuries outside the shoulder girdle occurred in 100% (15/15). Rib fractures were present in 87% (13/15) with a mean of 4.5 ribs fractured (range 1-10) per patient. A fracture of the spine occurred in 53% (8/15) of which one complete spinal cord and three complete nerve root lesions. Traumatic brain injury was documented in 67%. Thirteen patients (87%) sustained single or multiple nerve injuries. Thirteen nerve lesions were noted distal to the brachial plexus, and 9 nerve lesions were at or proximal to the brachial plexus. Outcomes were obtained on 13 patients (87%) with a mean follow-up of 30 months (range 7.5 to 75 months). Dash scores averaged 14.2 (range 0-45). Mean range of motion, when expressed as the percentage of injured ROM over contralateral ROM, was 94% forward flexion, 91% abduction, and 76% external rotation. Mean strength measured by a hand held dynamometer and expressed as the percentage of injured over contralateral was 62% forward flexion, 60% abduction, and 66% external rotation. CONCLUSION: Patients who sustain triple and quadruple lesions to the SSSC who undergo operative stabilization of displaced fractures, demonstrated satisfactory functional outcomes.
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