Floating clavicle after a high velocity biking accident: A case report of an acromioclavicular dislocation with simultaneous proximal clavicle fracture managed surgically

Abstract

Introduction Clavicle fractures and acromioclavicular joint dislocations are very common injuries. However, the combination of both, known as “floating clavicle” is extremely rare, with approximately 40 cases reported. Presentation of case We report a case of a healthy 51-year-old male who suffered a high-velocity biking accident, with a bipolar clavicle injury (type IV acromioclavicular joint dislocation and proximal clavicle fracture), with concomitant rib fractures and pulmonary contusion. He received early surgical treatment by open reduction and osteosynthesis of the proximal clavicle (distal ulna plate, Protean ®) and open reduction and stabilization with a MINAR ® implant for the acromioclavicular joint. After an initial one-month immobilization, he started physical therapy. In the 10-month follow-up he presented with a pain-free full range of motion, a good cosmetic result, and radiological consolidation. Discussion Bipolar clavicle injury is a rare clinical entity that encompasses a spectrum of combined clavicle fractures, acromioclavicular or sternoclavicular joint dislocations. They are sustained in a high-energy context, and accompanying injuries must be sought. Diagnosis is made through X-Ray and CT. Despite the lack of clinical guidelines, most authors agree on surgical management of at least one of the injuries, with multiple surgical techniques available. There is an emphasis in surgical treatment of the young and active patient. Conservative treatment is associated with poorer results. Conclusion It is advisable to have a high index of suspicion for floating clavicle in a high-energy trauma patient, given possible life-threatening injuries, and long-term shoulder sequelae. Surgery should be considered in a young and active patient.

Application of a new sternoclavicular hook plate in bipolar clavicle injuries

“…The exact mechanism of clavicular bipolar injury remains uncertain. Some believe that multidirectional forces cause the clavicle to rotate around its center resulting in bipolar clavicle injury ( 8 ). This fits the situation in our case.…”

Bipolar clavicular instability – open reduction and tape augmentation of both joints: A case report

“…The exact trauma mechanism has not yet been fully comprehended [4] , but high velocity trauma or a fall from heights >3 m are mostly associated with this rare injury [2] , [7] . According to Bakir et al, combined clavicle injuries, i.e.…”

“…Methods for the ACJ include hook plates [9] , [13] , K-wires [7] , K-wires + wire cerclage [8] , double- or triple-button fixation (e.g. MINAR® or Y-button) [1] , [2] or tendon augmentations [12] . Techniques used for the SCJ include plates [7] , [13] , FiberWire® cerclages [10] , PDS cerclage [9] , or tendon augmentations [1] , [12] .…”

“…The first case report on this injury was published by Porral in 1831 [3] , an incidence has not yet been determined [4] . The exact trauma mechanism is still unknown, it has been connected to high velocity accidents and falls from heights >3 m [2] . The integrity of both joints is essential, as loss of clavicular strut function can cause weakness, discomfort, or dyskinesia in the shoulder girdle [5] .…”

“…A guideline on how to treat BCD has yet to be created. Management remains controversial ranging from conservative [6] to varying surgical treatment options [2] , [7] , trending more towards open surgery in recent years – especially in young, physically active patients [7] .…”