A Rare Injury of Ipsilateral Mid-Third Clavicle Fracture with Acromioclavicular Joint Dislocation

Abstract

IntroductionInjuries around the clavicle are quite common. Further-more, AC joint dislocation combined with fracture of thedistal end of the clavicle are quite frequent and wellrecognized [13]. However, the specific combination ofipsilateral fracture of the mid-shaft clavicle with AC jointdislocation is a rare injury, and there have been only fivereports (eight cases) in the literature [6, 8, 22–24].To our knowledge, there have been no published studyin the English literature for the treatment of this unusualipsilateral shoulder injury with the use of a TightRopefixation system in reconstructing the AC joint dislocationcombined with open reduction and internal fixation of theclavicle fracture with a locking plate.Case ReportA 38-year-old man was involved in a road traffic accidentand sustained an injury to his right shoulder and left elbow.He presented inability to use his shoulder with markedecchymosis, swelling, and tenderness at the mid-clavicleand a prominent distal end of the clavicle. The neuro-vascular status of the right upper extremity was normal.Radiographic examination of the right shoulder (anteropos-terior and axillary view) revealed a displaced mid-shaftfracture of the clavicle and a type-V dislocation of the ACjoint according to Rockwood classification (Fig. 1). He alsohad a transverse fracture of the olecranon of his left elbow.The risks and benefits of operative treatment werediscussed with the patient and he agreed to proceed.TechniqueThe patient was placed in a semi-beach chair position. Atransverse incision was made across the clavicle toward theAC joint. The distal clavicle was displaced, and there wasmajor detachment of deltoid and trapezius muscles from theclavicle. The AC and coracoclavicular (CC) ligaments werefound to be ruptured completely. The two fracture frag-ments of the clavicle were identified. After reduction of theclavicle fracture, fixation was performed with a specialprecontoured locking plate with eight holes (Acumed).Despite open reduction and internal fixation of the clavicle,the AC joint was still unstable, with superior and posteriordisplacement under stress, so it was decided to reconstructthe CC ligaments with a TightRope fixation system(Arthrex). The TightRope system is composed of two metalbuttons, one circular and one oblong, joined by a No. 5fiber-wire continuous loop. As sole fixation device, it isrecommended for an acute injury (less than 1 monthduration) (Fig. 2). The concept of this appliance is that ifthe joint is reduced acutely and held reduced during thehealing phase, the native ligaments will heal restoring thestability of the AC joint.