Distal Clavicle Fracture Mimicking Type IV Acromioclavicular Joint Injury in the Skeletally Immature Athlete

Introduction: Lateral end clavicle fractures are rare injuries in pediatric and adolescent population. Most of these injuries can be managed conservatively. However, in patients with acromioclavicular joint (ACJ) “pseudo-dislocations” associated with significant clinical deformity, some patients will benefit from operative intervention. Case Report:Our reported case is a young adolescent with a Type IV Dameron and Rockwood distal clavicle fracture and ACJ pseudo-dislocation, who underwent surgical fixation for this injury. We propose a novel technique of fixation with a suture anchor and endo button with temporary K wire stabilization. These are rare injuries and there are no standardized techniques for reconstruction and fixation. Stabilization with a suture anchor can provide a minimally invasive method of fixation for such injuries without the traditional plating and can lead to excellent final outcomes. Conclusion:ACJ pseudo-dislocations are rare injuries. There is limited evidence in guiding the management of such injuries. Our proposed technique of fixation with suture anchor, endo button and temporary stabilisation with K-wire can provide promising results. Keywords:Clavicle fracture, paediatrics, suture anchors, acromioclavicular joint, trauma.

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Os acromiale may be a contraindication of the clavicle hook plate: case reports and literature review

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04841-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Qi Sun ◽

Ming Cai ◽

Xiaoming Wu

Keyword(s):

Acromioclavicular Joint ◽

Case Reports ◽

Clavicle Fracture ◽

Hook Plate ◽

Acromioclavicular Joint Dislocation ◽

Distal Clavicle ◽

Distal Clavicle Fracture ◽

Joint Dislocation ◽

Os Acromiale ◽

Clavicle Hook Plate

Abstract Background Os acromiale can be potentially missed or misdiagnosed as acromion fracture, and this can affect treatment determination if it is complicated with an ipsilateral shoulder injury. The clavicle hook plate is a widely used technique for distal clavicle injuries, leading to transacromial erosion, particularly when in the presence of os acromiale. Case presentation A 70-year-old man and a 78-year-old man who had limited mobility and severe pain in their right shoulders following falls attended the emergency center. Both patients were diagnosed with os acromiale with CT or MRI and acute distal clavicle fracture or acromioclavicular joint dislocation. Following a comprehensive evaluation, os acromiale may limit the application of a clavicle hook plate due to potential transacromial erosion. The distal clavicle fracture with ipsilateral os acromiale received treatment with a volar radius locking T plate, and the acromioclavicular joint dislocation with ipsilateral os acromiale was reconstructed using suture anchors. Both yielded satisfactory outcomes and voided transacromial erosion. Conclusions Ipsilateral os acromiale may be a relative contraindication to the clavicle hook plate. An axillary lateral radiograph is recommended to detect potential os acromiale in patients using a hook plate.

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Neglected Type IV Acromioclavicular Joint Injury - 2 Cases Report -

Clinics in Shoulder and Elbow ◽

10.5397/cise.2008.11.2.185 ◽

2008 ◽

Vol 11 (2) ◽

pp. 185-188

Author(s):

Do-Young Kim ◽

Sung-Ryong Shin ◽

Yon-Sik Yoo ◽

Sang-Soo Lee ◽

Un-Seob Jeong ◽

...

Keyword(s):

Acromioclavicular Joint ◽

Joint Injury ◽

Type Iv ◽

Acromioclavicular Joint Injury

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Response to Van Tongel and De Wilde regarding: “A biomechanical comparison of a novel technique for distal clavicle fracture repair versus locked plating”

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2019.09.046 ◽

2020 ◽

Vol 29 (3) ◽

pp. e97

Author(s):

David A. Porter ◽

Gautam P. Yagnik

Keyword(s):

Clavicle Fracture ◽

Fracture Repair ◽

Distal Clavicle ◽

Distal Clavicle Fracture ◽

Locked Plating ◽

Novel Technique ◽

Biomechanical Comparison

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Results of minimal invasive coracoclavicular fixation by double button lift-up system in Neer type II distal clavicle fractures

Journal of Orthopaedic Surgery ◽

10.1177/2309499016684722 ◽

2017 ◽

Vol 25 (1) ◽

pp. 230949901668472 ◽

Cited By ~ 5

Author(s):

Süleyman Semih Dedeoğlu ◽

Yunus İmren ◽

Haluk Çabuk ◽

Murat Çakar ◽

Samet Murat Arslan ◽

...

Keyword(s):

Functional Outcomes ◽

Clavicle Fracture ◽

Rehabilitation Program ◽

Minimal Invasive ◽

X Rays ◽

Distal Clavicle ◽

Distal Clavicle Fracture ◽

Shoulder Scores ◽

Coracoclavicular Fixation

Aim: We aimed to evaluate clinical and functional outcomes of indirect fracture reduction performed by coracoclavicular fixation with minimal invasive double button lift-up system in Neer type IIa unstable fractures of distal clavicle. Material and methods: 22 patients with Neer type 2 distal clavicle fracture were enrolled in that prospective study. All patients underwent indirect reduction and osteosynthesis performed by coracoclavicular fixation with minimal invasive double button lift-up system. Postoperative follow-up was carried out clinically and radiologically with plain X-rays and utilization of Constant and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) shoulder scores. Mean follow-up time was 15 months. A standard sling was applied for 2 weeks, postoperatively. Rehabilitation program was started on postoperative day 1. Results: Mean age was 39 (range: 21–60), 18 of the patients were male. Right dominant extremity was affected in 14 patients. Mean duration of the surgical intervention was 40 min (range: 30–55 min). Mean union time was found to be 14 weeks (range: 7–21 weeks). Mean postoperative ASES and Constant scores were 79.9 (66.9–88.3) and 82.2 (71–100), respectively. The duration of return to normal daily activities were found to be 4.5 months. Any loss of reduction, AC joint arthrosis, and clavicular shortening were not detected in X-rays. Conclusion: This study has demonstrated that indirect osteosynthesis performed by coracoclavicular fixation with double button lift-up system in the treatment of unstable Neer type IIa fractures of the distal clavicle had successful clinical, radiological, and functional outcomes.

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