Luxation bipolaire de la clavicule ou clavicule flottante. À propos de trois cas

The term "floating" used in traumatic orthopedics

BACKGROUND

The term "floating" is used in orthopedic literature to describe certain patterns of skeletal injuries that share one common character which is disruption and discontinuity of bones above and below a joint. The first time used in orthopedic literature being in late 1970 to describe a type of elbow injury. Later the word was used increasingly and applied to a variety of injuries affecting the knee, shoulder, hip, forearm, hand, and ankle. Currently, there are about 12 different skeletal injuries described as floating.

OBJECTIVES

The aim of this article was to define the term "floating" used in traumatic orthopedics and to discuss its history, mechanism of injury in each region, treatment and outcomes based on the currently available literature. As there were many separate articles describing different sites of floating injuries, this review aimed to summarize all floating injuries into 1 article.

Bipolar Dislocation of the Arm (Shoulder And Elbow): About One Case in an African Teaching Hospital

We report an exceptional clinical case of an ipsilateral dislocation fracture of the shoulder and right elbow, realizing a “swinging arm”. Following a violent road accident, patient S.I, a 43-year-old left-handed sports educator, presented with an antero-medial shoulder dislocation fracture and a posterolateral ipsilateral elbow fracture-dislocation. The reduction in urgency, followed by the orthopedic compression by Mayo Clinic and functional rehabilitation, allowed obtaining a good result after seven months. The ipsilateral bipolar dislocation of the shoulder and elbow is an exceptional lesional entity. Its adequate care in emergency makes it possible to obtain good anatomical and functional results.

[Post-traumatic bipolar dislocation of the clavicle: is operative treatment reasonable?]

Bipolar dislocation of the clavicle ("floating clavicle") is extremely rare. It exists no standardised treatment for this trauma and the treatment is often conservative. This is mainly an anterior displacement of the sternoclavicular joint (type III according to Allman) and a posterior dislocation of the acromioclavicular joint (type IV according to Rockwood).We report on a 60 year old male who fell onto the right shoulder. He sustained a 'floating clavicle' and had a massive dislocation, impairment of range of motion and pain. Venous congestion was observable. We stabilised the dislocated acromioclavicular joint with a Balser's plate, the sternoclavicular joint was fixed with PDS cord tension band technique around the first rip and the sternum. In addition we resected the anterior part of the distal clavicle to get a better cosmetic result. Post-operatively the patient had an excellent range of motion without any further symptoms after six weeks and one year. Venous congestion was not more observable.In most of the cases dislocations of both ends of the clavicle are treated conservatively. We recommend an operative treatment especially in young and active patients to avoid re-dislocation and to archive better cosmetic results.

Case report: Floating-clavicle from the 17th century: the oldest case?

BACKGROUND

Dislocation of both ends of the clavicle is a rare traumatic lesion and the mechanism of the lesion is usually related to major trauma. The first case was described in 1831.

CASE DESCRIPTION

We present the oldest referenced case of this alteration. The skeleton studied belonged to an old woman buried inside the Sant Pere de Madrona Church in Berga (Barcelona/Spain) and its dating indicated it corresponded to the end of the 17th century. There was a pseudarthrosis between the clavicle and coracoid ligament; when the bones were reconstructed by pseudarthrosis both ends of the clavicle appeared dislocated.

LITERATURE REVIEW

Bipolar dislocation of both ends of the clavicle, or "floating-clavicle", is a rare injury. Since 1831 when this type of injury was first reported, approximately 40 cases have been published. No archaeological case has been published.

CLINICAL RELEVANCE

Despite experiencing bipolar dislocation of both ends of the clavicle, or floating-clavicle, it is possible to have acceptable function of the arm as suggested by the anthropologic parameters analyzed here. The head of the humerus of the affected shoulder shows no abnormalities and the contralateral glenoid cavity shows severe osteochondritis of the anteroinferior side.

Bipolar dislocation of the clavicle

Bipolar dislocation of the clavicle at acromioclavicular and sternoclavicular joint is an uncommon traumatic injury. The conservative treatments adopted in the past is associated with redislocation dysfunction and deformity. A 41 years old lady with bipolar dislocation of right shoulder is treated surgically by open reduction and internal fixation by oblique T-plate at sternoclavicular joint and Kirschner wire stabilization at acromioclavicular joint. The patient showed satisfactory recovery with full range of motion of the right shoulder and normal muscular strength. The case reported in view of rarity and at 2 years followup.