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Wang C, Li X, Dong S, Xie W, Ling Z, Meng C, Stöckle U. Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a systematic review. BMC Surg 2025; 25:87. [PMID: 40022180 PMCID: PMC11871730 DOI: 10.1186/s12893-025-02815-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2025] [Accepted: 02/14/2025] [Indexed: 03/03/2025] Open
Abstract
BACKGROUND AND AIM Isolated midshaft clavicle fractures (MCF) and acromioclavicular joint (ACJ) injuries are common, but simultaneous cases are rare and often receive insufficient clinical attention, resulting in missed diagnoses. Moreover, there is no consensus on the injury mechanism, classification, and treatment, and the prognosis remains poorly summarized. This review aims to provide an overview of MCFs with ipsilateral ACJ injuries, focusing on injury mechanism, classification, treatment, and prognosis. METHODS We searched the literature published between 1962 and 2024 on PubMed, Web of Science, and EMBASE using the search terms "clavicle fracture [Title/Abstract]) AND (acromioclavicular [Title/Abstract])". Studies reporting clinical outcomes in patients with MCF and ipsilateral ACJ injuries were included. 37 studies were included after screening. The study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Data on study design, patient demographics, treatment approaches, and outcomes were extracted for qualitative analysis. We then summarized key findings and presented our insights. RESULTS MCFs with ipsilateral ACJ injuries are often associated with comorbidities such as rib fractures, hemopneumothorax, scapula fractures, neurovascular injuries, and atypical MCF displacement patterns. These cases should raise suspicion for combined injuries. Due to the "floating" nature of the lateral clavicle, the "Piano Key Sign" is typically negative and not reliable for diagnosis. Initial ACJ evaluation may be inconclusive, so reevaluation after MCF fixation is recommended. Type IV ACJ injuries can be underestimated on anteroposterior radiographs, and additional axillary radiographs and CT scans may better visualize posterior clavicle displacement. Most researchers believe ACJ capsule and ligament damage occurs first, but is insufficient to cause significant dislocation, suggesting that isolated MCF may involve combined ACJ injury with intact coracoclavicular ligaments. Notably, most patients reported favorable outcomes without major complications within two years, regardless of treatment approach. CONCLUSIONS MCFs with ipsilateral ACJ injuries are rare and often missed when ACJ injuries are mild. The injury mechanism is unclear, and no classification system exists to indicate severity. These injuries are typically treated separately without a unified protocol. Despite promising outcomes, further studies are needed to address these issues and improve understanding of long-term results.
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Affiliation(s)
- Chaoqun Wang
- Department of Traumatic Orthopaedics, The Affiliated Hospital of Wuhan Sports University, Hongshan District, NO.279 On Luoyu Road, Wuhan CityHubei Province, 430079, China.
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
| | - Xugui Li
- Department of Traumatic Orthopaedics, The Affiliated Hospital of Wuhan Sports University, Hongshan District, NO.279 On Luoyu Road, Wuhan CityHubei Province, 430079, China
| | - Shengnan Dong
- Department of Traumatic Orthopaedics, The Affiliated Hospital of Wuhan Sports University, Hongshan District, NO.279 On Luoyu Road, Wuhan CityHubei Province, 430079, China
| | - Wei Xie
- Department of Traumatic Orthopaedics, The Affiliated Hospital of Wuhan Sports University, Hongshan District, NO.279 On Luoyu Road, Wuhan CityHubei Province, 430079, China
| | - Zexi Ling
- Department of Traumatic Orthopaedics, The Affiliated Hospital of Wuhan Sports University, Hongshan District, NO.279 On Luoyu Road, Wuhan CityHubei Province, 430079, China.
| | - Chengfei Meng
- Department of Traumatic Orthopaedics, The Affiliated Hospital of Wuhan Sports University, Hongshan District, NO.279 On Luoyu Road, Wuhan CityHubei Province, 430079, China.
| | - Ulrich Stöckle
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
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Korkoman AJ, Alhamodi A, Alrusayni S, Almalki MM. Ipsilateral Rockwood type V acromioclavicular joint dislocation and midshaft clavicle fracture: A case report. World J Orthop 2024; 15:1208-1213. [DOI: 10.5312/wjo.v15.i12.1208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 10/21/2024] [Accepted: 11/08/2024] [Indexed: 12/17/2024] Open
Abstract
BACKGROUND Clavicle fractures are among the most common fractures seen in the emergency department. While acromioclavicular (AC) joint injuries are much less common. However, ipsilateral combinations of these injuries are quite rare with only a few cases reported in the literature.
CASE SUMMARY A 29-year-old man who sustained a combination of ipsilateral AC joint dislocation and midshaft clavicle fracture. He underwent open reduction and plate fixation of the clavicle fracture, as well as semi-rigid surgical implants used to restore both the AC ligaments and the coracoclavicular joint. one year follow-up revealed that the patient had a complete range of motion and excellent shoulder scores. This case presents a rare presentation of such combination of injuries, contributing valuable insights to the literature on such rare injuries.
CONCLUSION Combined midshaft clavicle fractures and AC joint dislocations are considered quite rare. Timely diagnosis of such injuries leads to great functional outcomes. AC joint dislocation should be suspected with midshaft clavicle fractures and should be investigated radiologically and clinically in an appropriate manner. Still, there is no consensus on the optimal management of such injuries.
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Affiliation(s)
| | - Abdullah Alhamodi
- Department of Orthopaedic Surgery, Prince Sultan Military Medical City, Riyadh 61415, Saudi Arabia
| | - Saleh Alrusayni
- Department of Orthopaedic Surgery, Prince Sultan Military Medical City, Riyadh 61415, Saudi Arabia
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Ribeiro GG, Figueiredo EG, Souza TA, Vilela JCS. Triple Clavicle Injury: A Fracture of the Middle Third Associated With Acromioclavicular Dislocation and Sternoclavicular Subluxation. Cureus 2024; 16:e74828. [PMID: 39737295 PMCID: PMC11684354 DOI: 10.7759/cureus.74828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2024] [Indexed: 01/01/2025] Open
Abstract
In this report, we present a case of a triple clavicle injury, acromioclavicular joint (ACJ) dislocation, a middle third clavicle fracture, and a sternoclavicular joint (SCJ) subluxation, and describe its successful surgical treatment. A 49-year-old female patient sustained a 3 m fall, resulting in direct trauma to her left shoulder. Initial radiographs and computed tomography (CT) scans revealed a displaced middle third clavicle fracture, a high-grade ACJ dislocation, and a posterior SCJ subluxation. Surgical intervention was proposed due to the severity of the ACJ dislocation. The patient underwent open reduction and internal fixation (ORIF) of the clavicle fracture with an anatomical locking plate (EVOS Clavicle Plate®; Smith & Nephew, Andover, MA) and ACJ stabilization using an Endobutton® (Smith & Nephew, Andover, MA) along with the transposition of the coracoacromial ligament. The SCJ subluxation was reduced indirectly. She returned to work after four weeks and, after six months, demonstrated excellent functional recovery achieving a full, pain-free range of motion. Outcome scores were favorable (Constant Shoulder Score: 73 bilaterally; University of California, Los Angeles {UCLA} Shoulder Rating Scale: 33). Follow-up radiographs at nine months demonstrated stable fixation with satisfactory anatomical alignment and fracture healing. Given the absence of specific guidelines for managing this combination, we based our method on established protocols for isolated injuries. Our patient's favorable outcome supports the effectiveness of this strategy and highlights the potential for successful functional recovery with careful management. This case underscores the importance of a high index of suspicion for concomitant ACJ and SCJ injuries in patients with midshaft clavicle fractures. This triad requires an individualized treatment plan for optimal outcomes, and future studies should focus on further documenting and evaluating treatment strategies for this rare injury pattern.
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Affiliation(s)
- Gustavo G Ribeiro
- Orthopedics and Traumatology, Hospital Francisco José Neves - Unimed Belo Horizonte (BH), Belo Horizonte, BRA
| | - Elisa G Figueiredo
- Orthopedics and Traumatology, Hospital Francisco José Neves - Unimed Belo Horizonte (BH), Belo Horizonte, BRA
| | - Thiago A Souza
- Orthopedics and Traumatology, Hospital Francisco José Neves - Unimed Belo Horizonte (BH), Belo Horizonte, BRA
| | - José Carlos S Vilela
- Orthopedics and Traumatology, Hospital Francisco José Neves - Unimed Belo Horizonte (BH), Belo Horizonte, BRA
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Karunaratne YG, Romeo PB. Vascularized Reconstruction of Recalcitrant Clavicular Nonunion with the Medial Femoral Condyle Free Flap: A Systematic Review of the Literature. J Hand Microsurg 2024; 16:100016. [PMID: 38854380 PMCID: PMC11127545 DOI: 10.1055/s-0043-1760767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Recalcitrant clavicular nonunion is an uncommon but challenging problem. Vascularized bone reconstruction is not first-line therapy due to complexity and donor morbidity, though it has utility in select cases. A systematic review of Embase and Medline databases was undertaken for cases of medial femoral condyle reconstruction for clavicle nonunion. Ten studies met inclusion, encompassing 26 patients. Mean age was 38.9 years. Ten patients were male and 16 female. Mean time of nonunion was 37.79 months prior to intervention; mean time to union following medial femoral condyle flap was 7.60 months. Two patients did not achieve union. Of the 11 patients who previously had at least one failed fixation with bone graft, considered the current "gold standard", 9 patients (81.81%) went on to achieve union, while 2 patients (18.19%) did not. There were six reported complications in five patients. Medial femoral condyle flap is a valuable option in recalcitrant clavicle nonunion.
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Affiliation(s)
- Yasiru Gehan Karunaratne
- Department of Plastic and Reconstructive Surgery, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia
| | - Pascalino Bruno Romeo
- Department of Plastic and Reconstructive Surgery, Nepean Hospital, Sydney, NSW, Australia
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van de Voort JC, van Doesburg PG, Leijnen M. Ipsilateral Rockwood type IV acromioclavicular joint dislocation and midshaft clavicle fracture: a case report and review of the literature. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:236-241. [PMID: 37588430 PMCID: PMC10426522 DOI: 10.1016/j.xrrt.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The combination of ipsilateral acromioclavicular joint dislocation and midshaft clavicle fracture is rare. In the last 30 years, only 29 cases have been reported in literature. We present a case of a 55-year-old woman with this combined injury pattern on the right side after a fall from a bicycle. She underwent open reduction and plate fixation of the clavicle fracture and repair of both the acromioclavicular ligaments and the coracoclavicular joint with semi-rigid surgical implants. Six months of follow-up showed satisfactory results with full range of motion. In addition, we provide an overview of the literature regarding this rare injury pattern with treatment options and functional outcomes.
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Affiliation(s)
| | - Peter G. van Doesburg
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel Leijnen
- Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands
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Kelley N, Tuttle M, Sylvia SM, Dragoo JL, Khodaee M. Acromioclavicular Joint Injuries in Sport. Curr Sports Med Rep 2023; 22:91-99. [PMID: 36866952 DOI: 10.1249/jsr.0000000000001046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
ABSTRACT Sport-related shoulder injuries, including disruptions to the acromioclavicular joint (ACJ), are common. An ACJ injury is classified by the degree and direction of the clavicle displacement. Although the diagnosis can be made clinically, standard radiographic views are important to determine the severity of the ACJ disruption and assess for concurrent injuries. The majority of ACJ injuries can be managed nonoperatively; however, surgical treatment is indicated in some cases. Long-term outcomes are generally favorable for most ACJ injuries, and athletes generally return to sport without functional limitations. This article provides an in-depth discussion regarding all aspects of ACJ injuries, including clinically relevant anatomy, biomechanics, evaluation, treatment, and complications.
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Affiliation(s)
- Naomi Kelley
- University of Colorado School of Medicine, Aurora, CO
| | - Matthew Tuttle
- Head of Soccer Medicine and Performance, New York Red Bulls, Harrison, NJ
| | - Stephen M Sylvia
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine, Englewood, CO
| | - Jason L Dragoo
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine, Englewood, CO
| | - Morteza Khodaee
- University of Colorado School of Medicine, Department of Family Medicine and Orthopedics, Division of Sports Medicine, Denver, CO
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7
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Fulton ZW, Singleton A, Miller RM. Coracoclavicular Ligament Reconstruction Using TightRope for Delayed Grade III Acromioclavicular Joint Injury After Ipsilateral Diaphyseal Clavicle Fracture Fixation: Surgical Technique and Review of Current Literature. Tech Hand Up Extrem Surg 2022; 26:208-211. [PMID: 35698303 DOI: 10.1097/bth.0000000000000386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Athletes commonly sustain high-energy direct impact injuries to the shoulder, with acromioclavicular joint (ACJ) injuries accounting for over half. Ipsilateral ACJ injury and diaphyseal clavicle fracture occur nearly 7% of the time. There is limited literature offering treatment suggestions for this unique injury pattern and limited evidence providing guidance to suggest which injury patterns should be treated operatively or nonoperatively. Here, we present successful treatment of a high-level athlete utilizing a Knotless TightRope XP placed through a superior clavicle plate with successful return to full activity at 6 months postoperation. The TightRope technique offers the ability to augment through a preexisting superior clavicular plate in a low-profile manner and promote easy suture tensioning to obtain and maintain reduction of the injured ACJ.
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Affiliation(s)
- Zachary W Fulton
- Department of Orthopedics, Mercy Health St. Vincent Medical Center, Toledo, OH
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Graf A, Wendler D, Court T, Talhelm J, Carver T, Beck C, Schmeling G. Acute clavicle fixation after blunt chest trauma: effect on pulmonary outcomes and patient disposition. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03368-y. [PMID: 36036820 DOI: 10.1007/s00590-022-03368-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Clavicle fractures are common in patients who sustain blunt chest trauma (BCT). Recently, surgical fixation of rib fractures in patients with BCT has been shown to improve pulmonary and clinical outcomes. Therefore, the purpose of this study is to assess the role of early clavicle fixation (ECF) versus non-operative (NO) treatment for midshaft clavicle fractures in this same population. METHODS A retrospective chart review was performed in patients with midshaft clavicle fractures and BCT at a Level I Trauma Center between 2007 and 2017. Patients with pre-existing pulmonary conditions and head injuries necessitating mechanical ventilation were excluded. Demographic data, injury mechanisms, and Thoracic Trauma Severity Scores (TTS) were analyzed. Inpatient pulmonary outcomes were assessed with serial vital capacity (VC) measurements, intubation, mechanical ventilation, and pulmonary complications data. In addition, intensive care unit (ICU) and hospital length of stay (LOS), mortality, discharge location, and incidence of postoperative complications in the ECF group were also measured. RESULTS Thirty-six patients underwent ECF, and 24 underwent NO treatment. The ECF cohort was statistically younger and had a greater incidence of clavicle fracture shortening than the NO group. There was no difference in pulmonary outcomes, ICU or hospital LOS, or mortality between groups. There were no complications associated with ECF. Patients who underwent ECF were more likely to discharge to home. There were no postoperative complications associated with ECF. CONCLUSION ECF of midshaft clavicle fractures does not improve pulmonary outcomes in patients with BCT. However, despite the lack of pulmonary benefit, there appears to be no added risk of harm. Therefore, ECF is a reasonable consideration in this patient population who otherwise meet clavicle fracture operative indications.
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Affiliation(s)
- Alexander Graf
- Department of Orthopaedic Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Ave, P.O. Box 26099, Milwaukee, WI, 53226-0099, USA.
| | | | - Tannor Court
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Jacob Talhelm
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas Carver
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Gregory Schmeling
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Bakir MS, Carbon R, Ekkernkamp A, Schulz-Drost S. Monopolar and Bipolar Combination Injuries of the Clavicle: Retrospective Incidence Analysis and Proposal of a New Classification System. J Clin Med 2021; 10:jcm10245764. [PMID: 34945058 PMCID: PMC8706334 DOI: 10.3390/jcm10245764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/25/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
Clavicle injuries are common, but only few case reports describe combined clavicular injuries (CCI). CCI include combinations between clavicular fractures and acromioclavicular/sternoclavicular joint dislocations (SCJD). We present the first general therapeutic recommendations for CCI based on a new classification and their distribution. A retrospective, epidemiological, big data analysis was based on ICD-10 diagnoses from 2012 to 2014 provided by the German Federal Statistical Office. CCI represent 0.7% of all clavicle-related injuries (n = 814 out of 114,003). SCJD show by far the highest proportion of combination injuries (13.2% of all SCJD were part of CCI) while the proportion of CCI in relation to the other injury entities was significantly less (p < 0.023). CCIs were classified depending on (1) the polarity (monopolar type I, 92.2% versus bipolar type II, 7.8%). Monopolar type I was further differentiated depending on (2) the positional relationship between the combined injuries: Ia two injuries directly at the respective pole versus Ib with an injury at one end plus an additional midshaft clavicle fracture. Type II was further differentiated depending on (3) the injured structures: IIa ligamento-osseous, type IIb purely ligamentous (rarest with 0.6%). According to our classification, the CCI severity increases from type Ia to IIb. CCI are more important than previously believed and seen as an indication for surgery. The exclusion of further, contra-polar injuries in the event of a clavicle injury is clinically relevant and should be focused.
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Affiliation(s)
- Mustafa Sinan Bakir
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17471 Greifswald, Germany;
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683 Berlin, Germany;
- Correspondence:
| | - Roman Carbon
- Department of Pediatric Surgery, University Hospital Erlangen, Krankenhausstraße 12, 91054 Erlangen, Germany;
| | - Axel Ekkernkamp
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17471 Greifswald, Germany;
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683 Berlin, Germany;
| | - Stefan Schulz-Drost
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683 Berlin, Germany;
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Krankenhausstraße 12, 91054 Erlangen, Germany
- Department of Trauma Surgery, Helios Hospital Schwerin, Wismarsche Str. 393-397, 19049 Schwerin, Germany
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Gao Z, Cai P, Yao K, Long N, Liu L, Xiao C. Mid-clavicle fracture with dislocation of the ipsilateral acromioclavicular joint treated with Endobutton system: A case report and review of the literature. Medicine (Baltimore) 2021; 100:e27894. [PMID: 34964758 PMCID: PMC8615337 DOI: 10.1097/md.0000000000027894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Acromioclavicular joint (ACJ) dislocation combined with ipsilateral midclavicular fracture is extremely unusual and is a high-energy injury to the shoulder. A review of the literature divides the treatment of clavicular fractures is divided into nonsurgical treatment, plates, and intramedullary nailing, while the options for ACJ dislocation are elastic fixation and rigid fixation. However, there is still a lack of consensus about the most appropriate way to treat this shoulder injury. This case report involves a mid-clavicle fracture with dislocation of the ipsilateral ACJ, which was classified as type V according to Rockwood classification. PATIENT CONCERNS A 65-year-old man came to the emergency department after a traffic accident in which he was driving a motorcycle that collided with another motorcycle and his right shoulder collided directly with the ground. Digital radiography (DR) and computed tomography (CT) scans of the right shoulder joint showed mid-clavicle fracture with dislocation of the ipsilateral ACJ, which was classified as type V according to Rockwood classification. DIAGNOSES The diagnosis of mid-clavicle fracture with dislocation of the ipsilateral ACJ was confirmed by DR and CT. INTERVENTIONS The patient was treated with a clavicle plate combined with the double Endobutton technique. OUTCOMES After a 6-month follow up, the patient had excellent results for shoulder range of motion and functional. The patient's Constant-Murley score is 92. LESSONS Mid-clavicular fracture with a high-energy injury is highly suspicious and requires perfect shoulder CT or bilateral shoulder stress position DR to confirm whether there is a combined ACJ dislocation.
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11
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López Palacios C, Sanchez-Munoz E, Pipa Muñiz I, Rodríguez García N, Maestro Fernández A. Simultaneous Clavicle Fracture and Acromioclavicular Joint Dislocation: Novel Surgical Technique: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00129. [PMID: 34161305 DOI: 10.2106/jbjs.cc.20.00775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 41-year-old man sustained a midshaft clavicle fracture with associated type IV ipsilateral acromioclavicular joint (ACJ) dislocation. The clavicle was fixed with a locking plate and ACJ stabilized with a novel technique: 2 metal anchors with preloaded suture fixed at the coracoid process, looping the sutures over the clavicle, and passing through the plate holes without clavicle bone drilling. Excellent functional outcomes for range of motion, pain, and functional scores persisted 2 and a half years after surgery. CONCLUSION The described surgical technique achieved exceptional short-term outcomes, sparing clavicle bone stock and allowing an early return to sports.
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Affiliation(s)
- Cristina López Palacios
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Toledo, Toledo, Spain
| | - Enrique Sanchez-Munoz
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Toledo, Toledo, Spain.,Knee Pathology and Sports Medicine Unit, HM IMI Clinic, Toledo, Spain
| | - Iván Pipa Muñiz
- Department of Orthopaedic Surgery, Begoña Hospital, Gijón, Spain
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12
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Lim KA, Lin CH, Lin CH. A 19-Year Experience With Clavicular Defects: An Algorithm for Flap Selection and Surgical Outcomes. Ann Plast Surg 2021; 86:562-567. [PMID: 33939654 DOI: 10.1097/sap.0000000000002547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The clavicle contributes to the stability and functional integrity of the shoulder. Clavicle bone defects are uncommon, and the strategy for their management is variable. METHOD Six patients presented with clavicle bone defects. The causes were as follows: traumatic defects (2 patients), electric injury (1 patient), osteoradionecrosis (2 patients), and nonunion (1 patient). One patient had upper limb palsy for 40 years, and another had posttraumatic shoulder function impairment. A pedicled pectoralis major myocutaneous flap was used for the patient with a dysfunctional limb, and 5 bone flaps (3 free fibular flaps, 1 free iliac flap, and 1 pedicled rib flap) were used for reconstruction in the other patients. RESULT All flaps (2 pedicled flaps and 4 free flaps) were successfully used for wound repair; the pedicled rib flap demonstrated partial marginal necrosis, and the free fibular flap required reexploration for venous kinking. Five functionally impaired upper limbs showed functional improvements postoperatively. CONCLUSION For functionless composite clavicles and soft tissue defects, a soft tissue flap will be required for wound repair. A bone flap, especially a fibular flap, is required for the upper limb to show functional recovery. The variety of flaps will be planned according to the defect size comparison between the bone and soft tissue, and ipsilateral upper limb function, and a proposed algorithm will be discussed.
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13
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Bakir MS, Lefering R, Haralambiev L, Kim S, Ekkernkamp A, Gümbel D, Schulz-Drost S. Acromioclavicular and sternoclavicular joint dislocations indicate severe concomitant thoracic and upper extremity injuries in severely injured patients. Sci Rep 2020; 10:21606. [PMID: 33303859 PMCID: PMC7730423 DOI: 10.1038/s41598-020-78754-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/26/2020] [Indexed: 11/09/2022] Open
Abstract
Preliminary studies show that clavicle fractures (CF) are known as an indicator in the severely injured for overall injury severity that are associated with relevant concomitant injuries in the thorax and upper extremity. In this regard, little data is available for the rarer injuries of the sternoclavicular and acromioclavicular joints (SCJ and ACJ, respectively). Our study will answer whether clavicular joint injuries (CJI), by analogy, have a similar relevance for the severely injured. We performed an analysis from the TraumaRegister DGU (TR-DGU). The inclusion criterion was an Injury Severity Score (ISS) of at least 16. In the TR-DGU, the CJI were registered as one entity. The CJI group was compared with the CF and control groups (those without any clavicular injuries). Concomitant injuries were distinguished using the Abbreviated Injury Scale according to their severity. The inclusion criteria were met by n = 114,595 patients. In the case of CJI, n = 1228 patients (1.1%) were found to be less severely injured than the controls in terms of overall injury severity. Compared to the CF group (n = 12,030; 10.5%) with higher ISS than the controls, CJI cannot be assumed as an indicator for a more severe trauma; however, CF can. Concomitant injuries were more common for severe thoracic and moderate upper extremity injuries than other body parts for CJI. This finding confirms our hypothesis that CJI could be an indicator of further specific severe concomitant injuries. Despite the rather lower relevance of the CJI in the cohort of severely injured with regard to the overall injury severity, these injuries have their importance in relation to the indicator effect for thoracic concomitant injuries and concomitant injuries of the upper extremity. A limitation is the collective registration of SCJ and ACJ injuries as one entity in the TR-DGU. A distorted picture of the CJI in favor of ACJ injuries could arise from the significantly higher incidence of the ACJ dislocation compared to the SCJ. Therefore, these two injury entities should be recorded separately in the future, and prospective studies should be carried out in order to derive a standardized treatment strategy for the care of severely injured with the respective CJI.
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Affiliation(s)
- M Sinan Bakir
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany. .,Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683, Berlin, Germany.
| | - Rolf Lefering
- Faculty of Health, IFOM - Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str.200, Haus 38, 51109, Cologne, Germany
| | - Lyubomir Haralambiev
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.,Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683, Berlin, Germany
| | - Simon Kim
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Axel Ekkernkamp
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.,Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683, Berlin, Germany
| | - Denis Gümbel
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.,Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683, Berlin, Germany
| | - Stefan Schulz-Drost
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683, Berlin, Germany.,Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany.,Department of Trauma Surgery, Helios Hospital Schwerin, Wismarsche Str. 393-397, 19049, Schwerin, Germany
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Müller SA, Müller-Lebschi JA, Müller AM. Komplikationsmanagement in der operativen Versorgung der Klavikulafraktur. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00341-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Kluijfhout WP, Tutuhatunewa ED, van Olden GDJ. Plate fixation of clavicle fractures: comparison between early and delayed surgery. J Shoulder Elbow Surg 2020; 29:266-272. [PMID: 31473135 DOI: 10.1016/j.jse.2019.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/17/2019] [Accepted: 06/24/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal treatment strategy for clavicle fractures remains a topic of debate. We evaluated our step-wise treatment protocol for patients with clavicle fractures to determine our success rate of conservative treatment. In addition, we evaluated the incidence of complications after clavicle plate fixation in patients undergoing acute surgery vs. delayed surgery. METHODS This was a retrospective analysis in which we registered all patients aged 14 years or older with a clavicle fracture between January 2010 and May 2018 and at least 6 weeks' follow-up. Patients who underwent surgery were included from a prospectively maintained database. Functional outcomes were measured by Disabilities of the Arm, Shoulder and Hand and Constant-Murley scores 6 weeks after surgery. RESULTS Conservative treatment was successful in 1627 of 1748 patients (93%). Primary fixation was performed in 73 patients (61%) and delayed fixation in 48 (39%). In 8 patients (6.6%), radiologic widening of the acromioclavicular (AC) joint was present after surgery, suggestive of AC injury. The incidence of complications was significantly higher among patients who underwent delayed fixation vs. those who underwent primary fixation: 15 of 48 patients (31.3%) vs. 9 of 73 patients (12.3%). CONCLUSION Most patients with clavicle fractures have an excellent outcome using conservative management. Acute surgery can be performed in high-demand patients, resulting in high performance scores. Delayed surgery is associated with a higher risk of complications, although the outcome is generally good. Associated AC joint dislocation found on postoperative radiographs does not influence outcomes. Shared decision making is key, and patients should be well aware of the potential risks and benefits of surgery.
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Affiliation(s)
- Wouter P Kluijfhout
- Department of Surgery, Meander Medical Center Amersfoort, Amersfoort, The Netherlands
| | - Eric D Tutuhatunewa
- Department of Surgery, Meander Medical Center Amersfoort, Amersfoort, The Netherlands; Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Ger D J van Olden
- Department of Surgery, Meander Medical Center Amersfoort, Amersfoort, The Netherlands.
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16
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Akromioklavikulargelenk. Radiologe 2019; 59:257-272. [DOI: 10.1007/s00117-019-0495-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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