Special Considerations: The Floating Shoulder—Myths and Reality

The floating shoulder is a complex and frequent problem in high-energy trauma of the shoulder girdle. Some controversies in the literature in terms of a precise definition on this topic make this scenario unclear and sometimes confusing. Recent publications define floating shoulder as the disruption of the ligamentous structures associated with scapular neck fracture, with or without clavicle fracture, with the compromise of the superior shoulder suspensory complex (SSSC). Non-operative treatment is indicated in non- or minimally displaced injuries, which frequently lead to favorable outcomes. Unstable or displaced fractures usually require open reduction and internal fixation of the clavicle only, or both fractures, depending on the scapular displacement. In this chapter, we thoroughly outline the functional anatomy, the current definition of floating shoulder, and surgical tips and tricks for the treatment of this challenging shoulder injury.