Pseudodislocation of the acromioclavicular joint

Transclavicular Osseous Sutures for the Treatment of Displaced Distal Clavicular Fractures in Children

“…Other authors recommend that patients with grossly displaced fractures or fixed displacement should be treated with reduction and surgical fixation to prevent definitive deformity. (4,(8)(9)(10) With increasing age, and decreasing capacity to remodel a deformity the indication for surgical reduction and fixation becomes stronger. (5) Previously described treatment options for displaced fractures involve percutaneous fixation with K-wires and suture repair of the superior periosteal sleeve or more extensive soft tissue repairs without the use of hardware.…”

“…(5) Previously described treatment options for displaced fractures involve percutaneous fixation with K-wires and suture repair of the superior periosteal sleeve or more extensive soft tissue repairs without the use of hardware. (4,16) However, severe complications caused by the migration of K-wires to the lungs and spinal canal have been reported. (17)(18)(19) Furthermore, K-wire fixation is associated with compulsory reoperations to remove the implant.…”

“…Therefore the trans-clavicular suture technique described here might be a more attractive alternative in some cases. The method is a simplified modification of a previously described technique, (4,16) aiming at using the strong point of fixation provided by the coraco-clavicular ligaments and without the use of cerclage wires.…”

“…In displaced distal clavicular injuries the thick periosteal sleeve remains partially intact, peeling off the fractured bone like the skin from a banana. (4) The inferior part of the periosteum usually remains attached to the coracoclavicular ligaments and the diaphysis is displaced superiorly thus mimicking the radiographic appearance of acromioclavicular dislocations in adults (5) . The intact periosteum enables rapid healing and good remodeling of the injured bone, making surgical interventions unnecessary in the majority of cases (6,7) .…”

“…However some patients will suffer persistent osseous deformity and limited function. (4,(8)(9)(10) The inferior periosteal sleeve and coracoclavicular ligaments often remain intact in distal clavicular fractures (4) and appear to provide sufficient anchorage to keep the clavicular shaft reduced in its periosteal sleeve, maintaining stable fixation during fracture healing. Based on these conditions of the soft tissue envelope, the senior author (LA) has developed an osseous suture technique to treat these fractures without the use of K-wires.…”