Simultaneous Clavicle Fracture and Acromioclavicular Joint Dislocation: Novel Surgical Technique

Abstract

Case: A 41-year-old man sustained a midshaft clavicle fracture with associated type IV ipsilateral acromioclavicular joint (ACJ) dislocation. The clavicle was fixed with a locking plate and ACJ stabilized with a novel technique: 2 metal anchors with preloaded suture fixed at the coracoid process, looping the sutures over the clavicle, and passing through the plate holes without clavicle bone drilling. Excellent functional outcomes for range of motion, pain, and functional scores persisted 2 and a half years after surgery. Conclusion: The described surgical technique achieved exceptional short-term outcomes, sparing clavicle bone stock and allowing an early return to sports.

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

“…Treatment options for ACJ dislocation are guided by the Rockwood classification: for Type I and Type II, opt for conservative treatment; treatment of Type III dislocations is controversial; and surgical management is recommended for Type IV, Type V, and Type VI. The 26 patients reported in the literature included 1 case of Type II, [9] which was treated conservatively; 6 cases of type III, [14,16,19,23,30] 13 cases of type IV, [8][9][10][11]17,18,[20][21][22]24] 1 case of type V, [7] and 4 cases of type VI [12,15,31,32] were treated with surgery. In these patients with rigid fixation, the fixative was removed after approximately 8 weeks to 8 months.…”

“…The surgical treatment of this shoulder injury has been described in the literature. The treatment of clavicular fractures is divided into nonsurgical treatment, plates, and intramedullary nailing, while the options for ACJ dislocation are elastic fixation (TightRope fixation system, [7,8] dog bone button, [9] reconstruction with tendon allograft, [10] or preloaded suture fixation [11] ) and rigid fixation (Kirschner wires, [12][13][14][15] clavicular hook plate, [16][17][18][19][20] and screw fixation [21][22][23] ) or a combination of both. [24] However, there is still a lack of consensus about the most appropriate way to treat this shoulder injury.…”