Segmental clavicle fracture and acromio-clavicular joint disruption: an unusual case report

Abstract

Clavicle fractures are common, accounting for 2.6% of all adult fractures. We describe a most unusual segmental fracture pattern of the clavicle with concurrent disruption of acromioclavicular (AC) joint. We were unable to find any publications or reports describing this fracture pattern. During surgery for a medial one-third shaft of clavicle fracture and AC joint dislocation, the medial clavicle was exposed, leading to the discovery (on table) of a previously unidentified additional undisplaced fracture of the medial clavicle cleaving the bone into three distinct fragments. An anatomical plate was successfully applied, fixing both fractures. The AC joint was then reduced with a hook plate. At 8 months, after removal of the hook plate, the patient has an excellent outcome with an Oxford Shoulder Score of 45/48 and a full range of movement without instability of the AC joint. We describe the operative management of this rare fracture pattern. This also highlights that segmental fractures of the clavicle are easily missed. It was successfully treated with a medial anatomic plate and lateral hook plate. We were unable to find any publications or reports describing the fracture pattern in this case.

Injuries of the Medial Clavicle: A Cohort Analysis in a Level-I-Trauma-Center. Concomitant Injuries. Management. Classification

“…The epidemiology of the combination between the single types of injuries should be another starting point to evaluate this so far only in case reports described entity (29)(30)(31).…”

Fratura segmentar da clavícula em paciente politraumatizado: Relato de caso

“…Esse tipo de fratura, porém, parece ligado a traumatismos de alta energia com lesões associadas ou mesmo dois traumatismos sucessivos. 1,2,4,6-8, [10][11][12][13][14][15] Esses tipos de fraturas são geralmente observados em radiografias nas projeções usuais de ombro e clavícula. [1][2][3][4]7,8,[11][12][13][14]16,17 Há também relatos de diagnóstico tardio, principalmente em pacientes politraumatizados, devido à não identificação de uma das duas linhas de fratura em radiografias convencionais, com necessidade de TC.…”

“…1,2,4,6-8, [10][11][12][13][14][15] Esses tipos de fraturas são geralmente observados em radiografias nas projeções usuais de ombro e clavícula. [1][2][3][4]7,8,[11][12][13][14]16,17 Há também relatos de diagnóstico tardio, principalmente em pacientes politraumatizados, devido à não identificação de uma das duas linhas de fratura em radiografias convencionais, com necessidade de TC. [4][5][6][7]10,11,15 A literatura relata desfechos diversos, sem consenso quanto ao melhor tratamento para esse tipo de fratura.…”

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

“…Because the lever arm was shorter in patients with posterior SCJ dislocation than in those with anterior SCJ dislocation, the authors stated that a greater force was needed to cause bipolar dislocation in those with posterior SCJ dislocation than in those with anterior SCJ dislocation, and it was more likely to be accompanied by a proximal clavicle fracture at the intersection with the first rib. Some patients have a medial clavicle fracture at the intersection of the first rib and ipsilateral ACJ dislocation [ 5 , 26 – 28 ]. Even though it cannot account for the mechanism of all bipolar dislocations, we think that the “first rib pivot theory” can be used to explain the characteristics of bipolar dislocation as well as the occurrence of another type of “floating clavicle” such as medial clavicle fracture with ACJ dislocation.…”