Traumatic pseudodislocation of the acromioclavicular joint in children

Abstract

Traumatic acromioclavicular separation in the skeletally immature patient is frequently overdiagnosed and overtreated. Fifty-eight children, aged 5 to 16 years, who presented over a 15 year period with injuries to the distal clavicle, were reviewed retrospectively. The majority showed coracoclavicular widening radiographically, suggesting acromioclavicular separation. In 45 cases, a distal clavicular fracture was identified, while an acromioclavicular separation without fracture was initially diagnosed in 13. Long-term followups of these patients demonstrate excellent results with conservative management. "Pseudodislocation" involves a clavicular fracture of the lateral metaphysis or metaphyseal epiphyseal separation and not an acromioclavicular disruption. This pseudodislocation of the acromioclavicular joint in the skeletally immature patient must be differentiated from the adult counterpart to avoid unnecessary operative intervention.

What Role Do Plain Radiographs Have in Assessing the Skeletally Immature Acromioclavicular Joint?

“…In pediatric patients, transphyseal fractures of the distal clavicle usually occur, rather than true acromioclavicular joint dislocation. Because the fracture may mimic an acromioclavicular joint dislocation, it often is called pseudodislocation of the acromioclavicular joint [3]. However, true acromioclavicular joint dislocation in skeletally immature patients sometimes may occur [2,8].…”

Transclavicular Osseous Sutures for the Treatment of Displaced Distal Clavicular Fractures in Children

“…It remains unclear if these patients in our series profited from the surgical intervention since several other authors have stated that the majority of patients with fracture types I, II and III can be treated nonsurgical with a good functional and cosmetic result. (6-8, 10, 15) For the displaced fracture types IV, V and VI some authors suggest that most patients will regain full function without cosmetic deficits (6,7) . Other authors recommend that patients with grossly displaced fractures or fixed displacement should be treated with reduction and surgical fixation to prevent definitive deformity.…”

“…(4) The inferior part of the periosteum usually remains attached to the coracoclavicular ligaments and the diaphysis is displaced superiorly thus mimicking the radiographic appearance of acromioclavicular dislocations in adults (5) . The intact periosteum enables rapid healing and good remodeling of the injured bone, making surgical interventions unnecessary in the majority of cases (6,7) . However some patients will suffer persistent osseous deformity and limited function.…”

Anatomía y función de la articulación acromioclavicular

“…La otra forma consiste en una lesión de tipo epifisiólisis Salter-Harris I o II en la que la articulación se mantiene íntegra con los ligamentos acromioclaviculares y la epífisis sin desplazarse. Lo que se desplaza en estos casos es la metáfisis clavicular 48 .…”