Dislocations of the acromioclavicular and sternoclavicular joint in children and adolescents: A retrospective clinical study and big data analysis of routine data

Abstract

Background Dislocations of the sternoclavicular joint (anterior/posterior) and acromioclavicular joint (SCJ and ACJ, respectively) are rare injuries in childhood/adolescence, each having its own special characteristics. In posterior SCJ dislocation, the concomitant injuries in the upper mediastinum are most important complication, while in anterior SCJ dislocation there is a risk of permanent or recurrent instability. Methods In a retrospective analysis from seven pediatric trauma centers under the leadership of the Section of Pediatric Traumatology of the German Trauma Society, children (<18 years) were analyzed with focus on age, gender, trauma mechanism, diagnostics, treatment strategy and follow-up results. Additional epidemiological big data analysis from routine data was done. Results In total 24 cases with an average age of 14.4 years (23 boys, 1 girl) could be evaluated (7x ACJ dislocation type ≥ Rockwood III; 17x SCJ dislocation type Allman III, including 12 posterior). All ACJ dislocations were treated surgically. Postoperative immobilization lasted 3–6 weeks, after which a movement limit of 90 degrees was recommended until implant removal. Patients with SCJ dislocation were posterior dislocations in 75%, and 15 of 17 were treated surgically. One patient had a tendency toward sub-dislocation and another had a relapse. Conservatively treated injuries healed without complications. Compared to adults, SCJ injuries were equally rarely found in children (< 1% of clavicle-associated injuries), while pediatric ACJ dislocations were significantly less frequent (p<0.001). Conclusions In cases of SCJ dislocations, our cohort analysis confirmed both the heterogeneous spectrum of the treatment strategies in addition to the problems/complications based on previous literature. The indication for the operative or conservative approach and for the specific method is not standardized. In order to be able to create evidence-based standards, a prospective, multicenter-study with a sufficiently long follow-up time would be necessary due to the rarity of these injuries in children. The rarity was emphasized by our routine data analysis.

Classification, Diagnosis, And Treatments for Acromioclavicular Joint Injury

“…CT) are very commonly used. Ultrasoundguided corticosteroid injections are both therapeutic and diagnostic and provide evidence for surgical decision-making and treatment [5]. Additionally, magnetic resonance imaging is a rarely used diagnostic method.…”

“…In 1984, Rockwood suggested a six-degree rating system for the spacing of AC joints. (See Figure 1) According to the researcher, Cadenat and Tossy's three-degree classification methods did not conclude all of the injury patterns adequately [5]. Types I-III correspond to the Grade I-III introduced by Allman and Tossy in Rockwood's classification.…”

Acromioclavicular Joint Injuries in Sport

“…A direct fall onto the shoulder that would typically result in an ACJ injury in an adult generally manifests as a distal clavicle physeal fracture in children. The exact incidence of the ACJ injuries in pediatrics is unknown, but appears to account for a small percentage of all ACJ injuries (8,(113)(114)(115). Similar to adults, Rockwood et al (116) created a pediatric ACJ injury classification that describes clavicle displacement and associated periosteal injury.…”

“…In general, children younger than 13 years are treated nonoperatively as the epiphyseal fragment, AC, and CC ligaments generally remain intact with great healing potential. However, given the rarity of these injuries in children, the literature is mixed without clear guidelines regarding treatment of pediatric ACJ injuries (113)(114)(115)117).…”

Fractures around the shoulder in the skeletally immature: A scoping review

“…The clavicle is surrounded by a thick periosteum around both ends. Sternoclavicular (SC) injuries and, to a lesser extent, acromioclavicular (AC) injuries, are often trans-physeal fractures rather than true AC or SC joint dislocations[ 5 , 6 ].…”