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Chir Main. 2014 Oct;33(5):370-4. doi: 10.1016/j.main.2014.07.002. Epub 2014 Aug 12.

PreFix™ external fixator used to treat a floating shoulder injury caused by gunshot wound.

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Institut chirurgical de la main et du membre supérieur, 17, avenue Condorcet, 69100 Villeurbanne, France. Electronic address:
Service de chirurgie orthopédique et traumatologie, hôpital Pellegrin-Tripode, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
Chirurgie du rachis, Orthopole, 33520 Bruges, France.
Chirurgie orthopédique, clinique des 4 pavillons, 33310 Lormont, France.


Open fractures of the shoulder are extremely rare, and their treatment is a major challenge for surgeons. Only cases encountered in military settings have been reported thus far. Such fractures are often the result of ballistic trauma, which causes extensive damage to both bony and soft tissues. Since these injuries are associated with a high risk of infection and the presence of comminuted fractures, external fixation is necessary for repair. Use of external fixators and revascularization techniques has reduced the number of cases requiring shoulder amputation or disarticulation. Injury to the proximal extremity of the humerus, acromion, and clavicle further complicates the treatment. No published studies have described the assembly of external fixators for fractures in the scapular region with significant bone loss. In addition, no cases have been described in civilian settings. However, with an increase in urban violence and the traffic of illegal arms, civilian surgeons are now encountering an increasing number of patients with these injuries. In this report, we not only present a rare case of floating shoulder injury in a civilian setting but also provide an overview of the existing treatment strategies for this type of trauma, with special focus on the use of external fixators in elective shoulder arthrodesis and on military cases.


Arthrodèse d’épaule; Ballistic trauma; External fixator; Fixateur externe; Floating shoulder injury; Shoulder arthrodesis; Traumatisme balistique; Épaule flottante

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