A direct blow to the shoulder, as may be sustained in a road traffic accident (RTA), can result in various combinations of fracture dislocations in the shoulder joint complex. Among these, a rare variety is an acromioclavicular joint (ACJ) dislocation coupled with ipsilateral mid-shaft clavicle fracture. Diverse treatment options have been described in the literature, ranging from non-operative and operative, to hybrid management. Treatment for this complex injury is predominantly dictated by the type of dislocation and displacement of the clavicle fracture, as well as age and demand of the patient. Acute high grades of ACJ dislocation require restoration of the coracoclavicular relationship (in place of torn coracoclavicular (CC) ligament) by some form of internal fixation, thereby maintaining the ACJ reduction. An arthroscopic reinstatement of the coracoclavicular relationship using a dog bone button and fibre tape implant for this composite injury pattern has not been previously described. Furthermore, a comprehensive review of the literature associated with this injury pattern is briefly described.

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SUMMARYInjury prevention measures in automobiles are mainly focused on the front seat passengers and driver. In the event of a head-on collision, rear seat passengers usually escape with minimal injuries. Most commonly observed injuries to rear passengers are to the head, chest wall or lower extremities. We report a case of bilateral anterior dislocation of the shoulders with asymmetrical fractures of the greater tuberosities in a 42-year-old man who was apparently injured in a head-on collision while travelling in a car as an unstrapped rear seat passenger. This kind of injury pattern in an unrestrained rear seat passenger is very unusual and has not been previously described. BACKGROUND