Type IV acromioclavicular joint dislocation associated with a mid-shaft clavicle malunion

Abstract

This reports presents the case of a combined clavicle fracture malunion and chronic Type IV acromioclavicular (AC) joint dislocation. The patient was seen acutely in the emergency department following a mountain bike accident at which time the clavicle fracture was identified and managed conservatively however the AC dislocation was not diagnosed. The patient presented 25 months following the injury with persistent pain and disability and was treated with clavicle osteotomy and AC stabilization. We document the clinical details, surgical treatment and outcome.

Injuries of the Medial Clavicle: A Cohort Analysis in a Level-I-Trauma-Center. Concomitant Injuries. Management. Classification

“…The epidemiology of the combination between the single types of injuries should be another starting point to evaluate this so far only in case reports described entity (29)(30)(31).…”

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

“…We therefore assume that a relevant number of CCIs are overlooked in everyday clinical practice or are only diagnosed secondarily after a delay, which would also provide a possible explanation for the limited number of studies in this regard [9,17]. Even in a case when the ACJD with a lateral CCI type Ib did not always seem to be symptomatic (in the short-term follow-up), we believe as do other authors that a missed CCI can, however, seriously cause unnecessary pain and post-traumatic osteoarthritis [14][15][16][17][18]. To avoid these potential consequences, a conceivable alternative would be the recommendation of a CT scan or an MRI in case of a certain grade of trauma mechanism in order to be able to reliably prove or exclude the presence of further injuries in the sense of a CCI.…”

“…As already published in case reports, when diagnosing a suspected mono-injury of the shoulder girdle, there is a risk of overlooking (or misinterpreting/misdiagnosing) further trauma consequences in this area [5,9,12,13,16,18]. It is often assumed that the trauma impact only develops its full force at one point and causes one single injury since the exact mechanism that is responsible for a combination of clavicle injuries is still unknown [3,39].…”

“…While the CCI is usually detected at least at one end or occurs as a single injury, due to the rarity of the combined injury, a coincident injury at the clavicle is often not expected [3,9,[11][12][13]. Therefore, the risk of missed injuries with this entity has proven to be particularly high, and a high number of unreported cases can be assumed [12,[14][15][16][17][18][19]. A combination injury diagnosed secondarily, however, can have serious consequences in the short-term with prolonged pain and restricted mobility, and in the long-term with post-traumatic joint arthritis, which is highly likely in the event of complete instability [15][16][17]20].…”

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

“…However, the dislocation of the AC joint combined with the fracture of the middle third of the clavicle is rare, and only a few reports are available in this regard. Thus, the diagnosis and treatment of these cases could be challenging [9,10].…”