Mid-clavicle fracture with dislocation of the ipsilateral acromioclavicular joint treated with Endobutton system

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.

Surgical treatment for fracture of the medial end of the clavicle associated with ipsilateral acromioclavicular dislocation

“…Therefore, there is a lack of consensus about the best way to treat these lesions. Gao et al [ 4 ] recently published a short review of cases associating mid-clavicle fracture with dislocation of the ipsilateral ACJ, summarizing all the surgical treatment options existing for both clavicular fractures (plates or intramedullary nailing) and ACJ dislocation (TightRope fixation system, dog bone button, reconstruction with tendon allograft, preloaded suture fixation, Kirschner wires associated or not with tension band, clavicular hook plate, or screw fixation). The 26 reported cases showed almost exclusively good results regardless of the choice of treatment even when non-operative.…”

Treatment of acromioclavicular dislocations with a concomitant coracoid fracture: a systematic review of 37 patients

“…Recent articles on sole AC dislocations still show good anatomical and functional results after treatment with a hook plate, 32,39 while new anatomical reconstruction techniques are gaining popularity and show promising results. 13,15,23 Nonetheless, we decided to include older articles as well to provide a complete summary of the current available literature since the available data on this combined injury are limited. Fourth, we included studies that had notably longer times to reach a full ROM and full return to sport or daily life activities compared to the mean resulting in a widespread time to reach full ROM.…”