The Effect of Clavicle Fracture Fixation on Scapular Alignment in Ipsilateral Clavicle and Scapular Fractures

INTRODUCTION: Ipsilateral clavicle and scapular fractures, often termed "floating shoulder" injuries, represent a severe disruption of the superior shoulder suspensory complex. Although clavicle fixation is standard to restore stability, clinical consensus is lacking regarding its immediate effect on associated scapular displacement. This study aimed to determine whether anatomic fixation of a displaced clavicle immediately improves radiographic alignment of the ipsilateral scapula. METHODS: We conducted a prospective radiographic study of 10 consecutive patients. Intraoperative fluoroscopy (AP and transscapular views) was done immediately before and after definitive clavicular plating. Four alignment parameters were measured: glenopolar angle, medialization, sagittal angulation, and sagittal displacement. Prefixation and postfixation measurements were compared using a paired t-test. RESULTS: No statistically significant differences were found between prefixation and postfixation measurements for any parameter. Mean results (prefixation vs. postfixation) were glenopolar angle (27.24° vs. 27.35°; P = 0.954), medialization (28.32 mm vs. 25.71 mm; P = 0.153), sagittal angulation (30.06° vs. 30.28°; P = 0.948), and sagittal displacement (16.23 mm vs. 14.60 mm; P = 0.370). CONCLUSION: Surgical fixation of the clavicle alone does not result in notable immediate improvement in radiographic scapular alignment. These findings suggest that scapular malalignment is primarily dictated by the scapular fracture component and associated soft-tissue injury. Surgeons should evaluate the scapular fracture as a distinct entity and not rely on indirect reduction when determining the need for direct scapular stabilization.