title: Triple and quadruple disruptions of the superior shoulder suspensory complex.
abstract: OBJECTIVE
  The purpose of this study is to report on a series of patients who sustained triple and quadruple disruptions to the superior shoulder suspensory complex (SSSC), their associated injuries, and functional outcomes of open reduction and internal fixation.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Level 1 trauma center.
  
  
  METHODS
  Patients who sustained more than 2 lesions to the SSSC that underwent surgery.
  
  
  METHODS
  Disabilities of the Arm, Shoulder, and Hand (DASH) scores, range of motion, and shoulder strength measurements.
  
  
  RESULTS
  Fifteen patients with greater than 2 disruptions (12 triple and 3 quadruple) were identified. There were 14 scapula neck fractures, 8 clavicle fractures, 6 acromioclavicular separations, 10 coracoid, and 10 acromion fractures. Rib fractures were present in 87% (13 of 15) patients. Thirteen patients (87%) sustained nerve injuries with 13 lesions distal to the brachial plexus, 5 at the level of the brachial plexus, 3 nerve root, and 2 spinal cord injuries. At final follow-up (14 of 15 patients, mean follow-up = 30.7 months), DASH scores averaged 14.9 and mean range of motion when expressed as the percentage of injured shoulder over the contralateral shoulder was 95% forward flexion, 92% abduction, and 78% external rotation. Mean strength measured by a hand-held dynamometer and expressed as the percentage of injured over contralateral was 67% forward flexion, 61% abduction, and 65% external rotation.
  
  
  CONCLUSIONS
  Patients with triple and quadruple disruptions of the SSSC had a high rate of associated injuries including a majority with spinal and peripheral nerve lesions. Treatment with open reduction internal fixation of the scapula was associated with satisfactory functional outcomes despite decreases in shoulder strength measurements.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedics, University of New Mexico, Albuquerque, NM; and †Department of Orthopaedic Surgery, University of Minnesota, Regions Hospital, Saint Paul, MN.
authors.forename: Brett
authors.initials: B
authors.lastname: Mulawka
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Jacobson
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Schroder
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cole
mesh_terms: D000328:Adult; D005260:Female; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery*; D059348:Peripheral Nerve Injuries / Q000175:diagnosis / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012253:Rib Fractures / Q000175:diagnosis / Q000601:surgery*; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult