Bipolar Dislocation of the Clavicle: A Report of Two Cases with Different Injury Patterns and a Literature Review

Abstract

Bipolar dislocation of the clavicle is a rare injury that is defined as a concomitant dislocation of the ipsilateral acromioclavicular joint and sternoclavicular joint. This injury is also described as a floating clavicle. Although this injury has been known for nearly two centuries, knowledge about it is limited and the treatment strategy remains controversial. Bipolar dislocation includes several combinations of both joints' injury types. We reported two patients with bipolar dislocation of the clavicle: one with an anterior dislocation and the other with a posterior dislocation of the sternoclavicular joint. After reviewing the currently available literature, we discussed these cases to highlight the necessity of a specific treatment approach that is modified based on the pattern of each joint's lesion.

Traumatic Floating Clavicle: Is This a Rare Injury?

“…There is, however, a general consensus towards the fact that conservative treatment is more prone to failure. This is advocated by the fact that most of the cases that had to be operated upon a delayed post-injury period had received some form of conservative treatment beforehand, but remained symptomatic [2]. In our case, misdiagnosis by the physician and neglection by the patient had led to an almost disabling condition that had to be addressed upon surgically.…”

“…We have noticed that most recent papers advocate surgical address on this type of injury, taking into consideration that publication bias might have existed. These reports demonstrate adequate outcomes regardless of individual characteristics in every case [2,8,12]. When floating clavicle injury is treated operatively, surgical approach to the acromioclavicular dislocation is generally supported [6].…”

“…The floating clavicle is considered to be a rare entity [1,2,[6][7][8][9][10]. We present a misdiagnosed case of a 65-year-old male who underwent a motorcycle accident and was surgically treated six months post-injury.…”

“…The writers quote: "The frequency of this injury has undoubtedly increased since Beckman's report but we have been unable to find even a case report on the lesion" [5]. Since then, single case reports and small case series (consisting mostly of two cases; except for Sanders et al case series study) have been recorded [2,[6][7][8]. To our knowledge, more than 40 cases in total have been reported since the early 1980s, making us question the rarity of the injury [1,2,9].…”

“…Floating clavicle is the injury pattern describing simultaneous ipsilateral dislocation of sternoclavicular and acromioclavicular joints [1]. The terms bifocal or bipolar clavicle dislocation and panclavicular dislocation have also been used [1,2].…”