Simultaneous Injury of Mid-shaft Clavicle Fracture and Type IV Acromioclavicular Joint Dislocation

Abstract

Background: Combined injuries of Mid-shaft clavicle fracture and Acromioclavicular (AC) joint dislocation are rare, and only a few cases have been reported. Several treatment options including surgical, conservative and hybrid approach have been described. Yet, there is no consensus regarding the optimal management approach for this injury. Objectives: Here we reported a case of Mid-shaft clavicle fracture with associated type IV AC joint dislocation in a 29-year-old male following a cycling accident. Methods: Both parts of the injury were fixed surgically. Meanwhile, the patient did not follow the postoperative protocol and started the heavy sports activities one month after the surgery. Results: The patient showed up 6weeks after the surgery with slightly uncorrected AC joint. However, he was satisfied with the results and accordingly no intervention was done for the correction of the AC joint. Conclusion: Our case reveals the importance of adherence to the postoperative protocol in this combined and challenging injury and we recommend surgical fixation for such injury.

Monopolar and Bipolar Combination Injuries of the Clavicle: Retrospective Incidence Analysis and Proposal of a New Classification System

“…Our findings demonstrate that the combination injuries of the shoulder girdle, which have so far hardly been reported, seem to occur more frequently than previously assumed. So far, this entity has only been mentioned in case reports, which suggests that these injuries are rare since no definitive incidence of these injuries has been reported in the literature yet [2][3][4]10]. However, with 0.7% of clavicle injuries, these injuries make up a small, but not to be underestimated proportion, since a clavicle injury is relatively common overall [1,[26][27][28].…”

“…A high variety of treatment approaches with regard to CCI, including nonsurgical, surgical, and hybrid management of the two respective parts of this injury entity can generally be found [2,45]. The subgroup of surgical procedures was also heterogeneous without a predominant consensus [2,10]. The treatment strategy is mainly related to the involvement of the respective structures and the degree of severity [51].…”

“…Type II(b) injuries are the least observed CCI but are accompanied by a clear therapy recommendation due to the presence of a maximum version of the floating(-like) clavicle [9,51]. Whether a bipolar surgical repair via TightRope should be performed or whether an alternative therapy method should be chosen for one of the clavicle poles (such as a combination of TightRope at SCJ and hook plate at ACJ) remains to be discussed [2,12,51,[57][58][59]. At minimum, a bipolar rigid restoration can have consequences in the event of renewed trauma, even if it is only slight, since this mechanical conduction causes stress due to the lack of elasticity and creates a predetermined breaking point at the clavicle [9].…”

“…Bony and ligamentous injuries to the clavicle are relatively common, but the number of studies depends on the frequency of the respective injury entity: in common clavicle midshaft fractures and lateral injuries, more literature is detectable than in the rare medial ones [1]. A special and rare entity is the clavicular combination injury (CCI) [2][3][4][5].…”

“…Regarding CCI, only marginal data describing this type of injury have been published so far, and only a few case reports and a small case series have been published [2,6,7]. The maximum degree of a combination injury in the sense of the highest degree of instability occurs in a bipolar clavicular dislocation, which is also referred to as the "floating clavicle" [8][9][10].…”