Can an acute high-grade acromioclavicular joint separation be reduced and stabilized without surgery? A surgeon\u2019s experience

Tazio Maleitzke,Fabian Plachel,Nina Maziak,Philipp Moroder,Tobias Winkler

doi:10.1007/s00402-020-03630-0

Abstract

IntroductionWhile the management of Rockwood type III injuries is still a topic of debate, high-grade Rockwood type V injuries are mostly treated surgically, to anatomically reduce the acromioclavicular (AC) joint and to restore functionality. In this case report, we present a method for non-operative reduction and stabilization of a high-grade AC joint injury.CaseA 31-year-old male orthopaedic resident sustained a Rockwood type V injury during a snowboarding accident. His AC joint was reduced and stabilized with an AC joint brace for six weeks. The brace provided active clavicle depression and humeral elevation. After removal of the brace the AC joint showed a nearly anatomic reduction. Six-month follow-up weighted X-ray views showed an AC joint which had healed in a Rockwood type II position and the patient returned to full pre-injury function with a satisfying cosmetic appearance.ConclusionNon-operative reduction and stabilization of high-grade AC joint separations seems to be a valuable treatment option. A “closed reduction and external fixation” approach with the aid of a dedicated AC joint brace can reduce the AC joint and keep it in place until ligamentous consolidation occurs, thus improving AC joint stability and cosmetic appearance without surgical intervention.

Highlights

While the management of Rockwood type III injuries is still a topic of debate, high-grade Rockwood type V injuries are mostly treated surgically, to anatomically reduce the acromioclavicular (AC) joint and to restore functionality
We present a method for non-operative reduction and stabilization of a high-grade AC joint injury, using an AC joint brace for six weeks in combination with a restrictive physiotherapy program
At the six-month follow-up, weighted X-ray views (10 kg) showed an AC joint that had healed in a Rockwood type II position with a slightly elevated clavicle compared to the uninjured contralateral side (Fig. 2e)

Summary

Introduction

AC joint separations account for 4–12% of all shoulder injuries and mainly affect male athletes that sustain a direct impact trauma to the shoulder [1]. At the six-month follow-up, weighted X-ray views (10 kg) showed an AC joint that had healed in a Rockwood type II position with a slightly elevated clavicle compared to the uninjured contralateral side (Fig. 2e). Six weeks after conservative treatment the patient showed no remaining radiographic signs of clavicle elevation, and six months post injury the patient’s clavicle had healed in a mildly elevated Rockwood type II position. This shows that a dynamic development of the injury is possible. The proposed rehab protocol, including a six-week immobilization is similar to the one suggested for surgically treated patients [9, 26]

Discussion

Compliance with ethical standards