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van de Voort JC, van Doesburg PG, Leijnen M. Ipsilateral Rockwood type IV acromioclavicular joint dislocation and midshaft clavicle fracture: a case report and review of the literature. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:236-241. [PMID: 37588430 PMCID: PMC10426522 DOI: 10.1016/j.xrrt.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The combination of ipsilateral acromioclavicular joint dislocation and midshaft clavicle fracture is rare. In the last 30 years, only 29 cases have been reported in literature. We present a case of a 55-year-old woman with this combined injury pattern on the right side after a fall from a bicycle. She underwent open reduction and plate fixation of the clavicle fracture and repair of both the acromioclavicular ligaments and the coracoclavicular joint with semi-rigid surgical implants. Six months of follow-up showed satisfactory results with full range of motion. In addition, we provide an overview of the literature regarding this rare injury pattern with treatment options and functional outcomes.
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Affiliation(s)
| | - Peter G. van Doesburg
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel Leijnen
- Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands
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Cosic F, Ernstbrunner L, Hoy GA, Ooi KS, Ek ET. Case Report: Midshaft clavicle fracture with concomitant high grade (Type V) acromioclavicular joint dislocation. Front Surg 2022; 9:885378. [PMID: 36017522 PMCID: PMC9395734 DOI: 10.3389/fsurg.2022.885378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Concomitant acromioclavicular joint dislocation and midshaft clavicle fracture are rare injuries, generally resulting from high energy trauma, with limited previous experience in management. Case A 30 year old male presented following a pushbike accident. He had suffered a head on collision with another cyclist. Radiographic examination demonstrated a displaced midshaft clavicle fracture with a Rockwood Type V acromioclavicular joint dislocation. Operative management was undertaken using a dual plating technique. At six month follow up the patient demonstrated full range of motion and had no pain. Conclusion Appropriate radiographic evaluation and careful intraoperative assessment are required using the principles of management for acromioclavicular joint injuries, along with stabilization of the mid-clavicular fracture to reduce the risk of non-union.
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Affiliation(s)
- Filip Cosic
- Department of Orthopaedic Surgery, Austin Health, Heidelberg, VIC, Australia
- Correspondence: Filip Cosic
| | - Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Austin Health, Heidelberg, VIC, Australia
- Melbourne Orthopaedic Group, Windsor, VIC, Australia
| | - Greg A. Hoy
- Department of Orthopaedic Surgery, Austin Health, Heidelberg, VIC, Australia
- Melbourne Orthopaedic Group, Windsor, VIC, Australia
| | - Keat S. Ooi
- Department of Orthopaedic Surgery, Austin Health, Heidelberg, VIC, Australia
| | - Eugene T. Ek
- Department of Orthopaedic Surgery, Austin Health, Heidelberg, VIC, Australia
- Melbourne Orthopaedic Group, Windsor, VIC, Australia
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Bakir MS, Carbon R, Ekkernkamp A, Schulz-Drost S. Monopolar and Bipolar Combination Injuries of the Clavicle: Retrospective Incidence Analysis and Proposal of a New Classification System. J Clin Med 2021; 10:jcm10245764. [PMID: 34945058 PMCID: PMC8706334 DOI: 10.3390/jcm10245764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/25/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
Clavicle injuries are common, but only few case reports describe combined clavicular injuries (CCI). CCI include combinations between clavicular fractures and acromioclavicular/sternoclavicular joint dislocations (SCJD). We present the first general therapeutic recommendations for CCI based on a new classification and their distribution. A retrospective, epidemiological, big data analysis was based on ICD-10 diagnoses from 2012 to 2014 provided by the German Federal Statistical Office. CCI represent 0.7% of all clavicle-related injuries (n = 814 out of 114,003). SCJD show by far the highest proportion of combination injuries (13.2% of all SCJD were part of CCI) while the proportion of CCI in relation to the other injury entities was significantly less (p < 0.023). CCIs were classified depending on (1) the polarity (monopolar type I, 92.2% versus bipolar type II, 7.8%). Monopolar type I was further differentiated depending on (2) the positional relationship between the combined injuries: Ia two injuries directly at the respective pole versus Ib with an injury at one end plus an additional midshaft clavicle fracture. Type II was further differentiated depending on (3) the injured structures: IIa ligamento-osseous, type IIb purely ligamentous (rarest with 0.6%). According to our classification, the CCI severity increases from type Ia to IIb. CCI are more important than previously believed and seen as an indication for surgery. The exclusion of further, contra-polar injuries in the event of a clavicle injury is clinically relevant and should be focused.
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Affiliation(s)
- Mustafa Sinan Bakir
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17471 Greifswald, Germany;
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683 Berlin, Germany;
- Correspondence:
| | - Roman Carbon
- Department of Pediatric Surgery, University Hospital Erlangen, Krankenhausstraße 12, 91054 Erlangen, Germany;
| | - Axel Ekkernkamp
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17471 Greifswald, Germany;
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683 Berlin, Germany;
| | - Stefan Schulz-Drost
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683 Berlin, Germany;
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Krankenhausstraße 12, 91054 Erlangen, Germany
- Department of Trauma Surgery, Helios Hospital Schwerin, Wismarsche Str. 393-397, 19049 Schwerin, Germany
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Gao Z, Cai P, Yao K, Long N, Liu L, Xiao C. Mid-clavicle fracture with dislocation of the ipsilateral acromioclavicular joint treated with Endobutton system: A case report and review of the literature. Medicine (Baltimore) 2021; 100:e27894. [PMID: 34964758 PMCID: PMC8615337 DOI: 10.1097/md.0000000000027894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Acromioclavicular joint (ACJ) dislocation combined with ipsilateral midclavicular fracture is extremely unusual and is a high-energy injury to the shoulder. A review of the literature divides the treatment of clavicular fractures is divided into nonsurgical treatment, plates, and intramedullary nailing, while the options for ACJ dislocation are elastic fixation and rigid fixation. However, there is still a lack of consensus about the most appropriate way to treat this shoulder injury. This case report involves a mid-clavicle fracture with dislocation of the ipsilateral ACJ, which was classified as type V according to Rockwood classification. PATIENT CONCERNS A 65-year-old man came to the emergency department after a traffic accident in which he was driving a motorcycle that collided with another motorcycle and his right shoulder collided directly with the ground. Digital radiography (DR) and computed tomography (CT) scans of the right shoulder joint showed mid-clavicle fracture with dislocation of the ipsilateral ACJ, which was classified as type V according to Rockwood classification. DIAGNOSES The diagnosis of mid-clavicle fracture with dislocation of the ipsilateral ACJ was confirmed by DR and CT. INTERVENTIONS The patient was treated with a clavicle plate combined with the double Endobutton technique. OUTCOMES After a 6-month follow up, the patient had excellent results for shoulder range of motion and functional. The patient's Constant-Murley score is 92. LESSONS Mid-clavicular fracture with a high-energy injury is highly suspicious and requires perfect shoulder CT or bilateral shoulder stress position DR to confirm whether there is a combined ACJ dislocation.
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López Palacios C, Sanchez-Munoz E, Pipa Muñiz I, Rodríguez García N, Maestro Fernández A. Simultaneous Clavicle Fracture and Acromioclavicular Joint Dislocation: Novel Surgical Technique: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00129. [PMID: 34161305 DOI: 10.2106/jbjs.cc.20.00775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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.
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Affiliation(s)
- Cristina López Palacios
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Toledo, Toledo, Spain
| | - Enrique Sanchez-Munoz
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Toledo, Toledo, Spain.,Knee Pathology and Sports Medicine Unit, HM IMI Clinic, Toledo, Spain
| | - Iván Pipa Muñiz
- Department of Orthopaedic Surgery, Begoña Hospital, Gijón, Spain
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Ottomeyer C, Taylor BC, Isaacson M, Martinez L, Ebaugh P, French BG. Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint dislocations: Incidence and risk factors. Injury 2017; 48:469-473. [PMID: 28062098 DOI: 10.1016/j.injury.2016.12.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 12/14/2016] [Accepted: 12/24/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Simultaneous ipsilateral clavicle and acromioclavicular (AC) joint injury have been infrequently reported in the literature at this time. The purpose of this study was to assess incidence as well as assess risk factors for this dual injury pattern. METHODS We performed a retrospective review of a prospectively collected database (Level III evidence), evaluating 383 adult patients without previous shoulder girdle injury or trauma with a minimum 1-year follow-up who sustained a displaced diaphyseal clavicle fracture. All patients in the study underwent either nonoperative management or surgical reduction and stabilization of a diaphyseal clavicle fracture with a plate and screw construct. Study subjects were followed with serial radiographs. Clavicle and shoulder radiographs, as well as chest radiographs and contralateral films in questionable cases, were used to assess for acromioclavicular joint injury in both operative and nonoperative groups. Additional data was collected on concurrent injuries, patient demographics, fracture characteristics, fixation techniques, surgical/post-operative data, and operative or nonoperative treatment. RESULTS We found that 13/183 (7.1%) of patients undergoing fixation of a diaphyseal clavicle fracture had an ipsilateral AC joint injury, while 13/200 (6.5%) of patients undergoing conservative management had an ipsilateral AC joint injury. Critical analysis of the data revealed that presence of ipsilateral scapular body fractures, and a likely incidental association with superior plating fixation, were associated with an increased rate of this injury pattern. CONCLUSIONS Ipsilateral clavicle fracture and AC joint injury is much more common than traditionally believed, with an incidence of 6.8% overall. It is unknown how the presence of an associated AC injury influences outcome, as AC injury was not universally symptomatic.
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Affiliation(s)
| | - Benjamin C Taylor
- Department of Orthopaedic Trauma, Grant Medical Center, Columbus, OH, USA
| | - Mark Isaacson
- Department of Orthopaedic Trauma, Grant Medical Center, Columbus, OH, USA
| | - Lara Martinez
- Department of Orthopaedic Trauma, Grant Medical Center, Columbus, OH, USA
| | - Pierce Ebaugh
- Department of Orthopaedic Surgery, Doctor's Hospital, Columbus, OH, USA
| | - Bruce G French
- Department of Orthopaedic Trauma, Grant Medical Center, Columbus, OH, USA
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Park CH, Shon OJ, Seo JS, Kim GB. Midshaft clavicle fracture with ipsilateral acromioclavicular joint separation found during serial follow-up. J Orthop Sci 2016; 21:399-402. [PMID: 26740446 DOI: 10.1016/j.jos.2015.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 12/04/2014] [Accepted: 12/11/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Chul Hyun Park
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, South Korea
| | - Oog Jin Shon
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, South Korea.
| | - Jae Sung Seo
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, South Korea
| | - Gi Beom Kim
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, South Korea
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Mohammed KD, Stachiw D, Malone AA. Type IV acromioclavicular joint dislocation associated with a mid-shaft clavicle malunion. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2016; 10:37-40. [PMID: 26980988 PMCID: PMC4772415 DOI: 10.4103/0973-6042.174518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This reports presents the case of a combined clavicle fracture malunion and chronic Type IV acromioclavicular (AC) joint dislocation. The patient was seen acutely in the emergency department following a mountain bike accident at which time the clavicle fracture was identified and managed conservatively however the AC dislocation was not diagnosed. The patient presented 25 months following the injury with persistent pain and disability and was treated with clavicle osteotomy and AC stabilization. We document the clinical details, surgical treatment and outcome.
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Affiliation(s)
- Khalid D Mohammed
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch Hospital, Christchurch, 8140, New Zealand
| | - Danielle Stachiw
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch Hospital, Christchurch, 8140, New Zealand
| | - Alex A Malone
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch Hospital, Christchurch, 8140, New Zealand
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Madi S, Pandey V, Khanna V, Acharya K. A dual injury of the shoulder: acromioclavicular joint dislocation (type IV) coupled with ipsilateral mid-shaft clavicle fracture. BMJ Case Rep 2015; 2015:bcr2015213254. [PMID: 26598529 PMCID: PMC4680282 DOI: 10.1136/bcr-2015-213254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2015] [Indexed: 11/04/2022] Open
Abstract
A direct blow to the shoulder, as may be sustained in a road traffic accident (RTA), can result in various combinations of fracture dislocations in the shoulder joint complex. Among these, a rare variety is an acromioclavicular joint (ACJ) dislocation coupled with ipsilateral mid-shaft clavicle fracture. Diverse treatment options have been described in the literature, ranging from non-operative and operative, to hybrid management. Treatment for this complex injury is predominantly dictated by the type of dislocation and displacement of the clavicle fracture, as well as age and demand of the patient. Acute high grades of ACJ dislocation require restoration of the coracoclavicular relationship (in place of torn coracoclavicular (CC) ligament) by some form of internal fixation, thereby maintaining the ACJ reduction. An arthroscopic reinstatement of the coracoclavicular relationship using a dog bone button and fibre tape implant for this composite injury pattern has not been previously described. Furthermore, a comprehensive review of the literature associated with this injury pattern is briefly described.
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Affiliation(s)
- Sandesh Madi
- Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India
| | - Vivek Pandey
- Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India
| | - Vikrant Khanna
- Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India
| | - Kiran Acharya
- Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India
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Kembhavi RS, James B. Ipsilateral Closed Clavicle and Scapular spine Fracture with Acromioclavicular Joint Disruption. J Orthop Case Rep 2015; 5:58-61. [PMID: 27299047 PMCID: PMC4722593 DOI: 10.13107/jocr.2250-0685.276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Injuries around shoulder and clavicle are quite common. Injuries involving lateral end of clavicle involving acromioclavicular joints are commoner injuries. In this rare injury, we report about a case involving clavicle and scapular spine fracture with acromioclavicular disruption which has never been described in English literature as per our knowledge. Case Report: A patient with closed clavicle and scapular spine fracture with acromioclavicular joint disruption was treated with open reduction and internal fixation of clavicle and scapular spine as a staged procedures. Six months post operatively, patient had excellent functional recovery with near full range of movements. Conclusion: Though rare complex injury, clavicle fracture with scapular spine fracture with acromioclavicular disruption, when managed properly with good physiotherapy protocol post operatively will result in good clinical and functional outcome.
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Affiliation(s)
- Raghavendra S Kembhavi
- Department of Orthopaedics, Sri Lakshmi Narayan Institute Of Medical Sciences. Pondicherry. India
| | - Boblee James
- Department of Orthopaedics, Sri Lakshmi Narayan Institute Of Medical Sciences. Pondicherry. India
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Beytemür O, Adanir O, Dinçel YM, Baran MA, Güleç MA. Clavicle diaphyseal fracture, ipsilateral type 3 acromioclavicular joint dislocation stabilized with double plate. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2014; 7:153-4. [PMID: 24403764 PMCID: PMC3883191 DOI: 10.4103/0973-6042.123536] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ozan Beytemür
- Department of Orthopedics and Traumatology, Bağcilar Training and Research Hospital, Mimar Sinan Cad, Bağcilar, İstanbul, Turkey
| | - Oktay Adanir
- Department of Orthopedics and Traumatology, Bağcilar Training and Research Hospital, Mimar Sinan Cad, Bağcilar, İstanbul, Turkey
| | - Yaşar Mahsut Dinçel
- Department of Orthopedics and Traumatology, Bağcilar Training and Research Hospital, Mimar Sinan Cad, Bağcilar, İstanbul, Turkey
| | - Mehmet Ali Baran
- Department of Orthopedics and Traumatology, Bağcilar Training and Research Hospital, Mimar Sinan Cad, Bağcilar, İstanbul, Turkey
| | - Mehmet Akif Güleç
- Department of Orthopedics and Traumatology, Bağcilar Training and Research Hospital, Mimar Sinan Cad, Bağcilar, İstanbul, Turkey
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12
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13
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Wijdicks CA, Anavian J, Ly TV, Spiridonov SI, Craig MR, Cole PA. Surgical management of a midshaft clavicle fracture with ipsilateral acromioclavicular dislocation: A report on 2 cases and review of the literature. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.injury.2012.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Psarakis SA, Savvidou OD, Voyaki SM, Beltsios M, Kouvaras JN. A rare injury of ipsilateral mid-third clavicle fracture with acromioclavicular joint dislocation. Hand (N Y) 2011; 6:228-32. [PMID: 22654711 PMCID: PMC3092883 DOI: 10.1007/s11552-011-9323-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Spyridon A. Psarakis
- Department of Orthopaedics, Thriassio General Hospital of Elefsis, Attica, Greece
| | - Olga D. Savvidou
- Department of Orthopaedics, Thriassio General Hospital of Elefsis, Attica, Greece
| | - Sofia M. Voyaki
- Department of Orthopaedics, Thriassio General Hospital of Elefsis, Attica, Greece
| | - Michail Beltsios
- Department of Orthopaedics, Thriassio General Hospital of Elefsis, Attica, Greece
| | - John N. Kouvaras
- Department of Orthopaedics, Thriassio General Hospital of Elefsis, Attica, Greece
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Midshaft clavicle fracture and acromioclavicular dislocation: a case report of a rare injury. J Shoulder Elbow Surg 2008; 18:e1-4. [PMID: 19046642 DOI: 10.1016/j.jse.2008.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2008] [Accepted: 09/15/2008] [Indexed: 02/01/2023]
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16
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Fraser-Moodie JA, Shortt NL, Robinson CM. Injuries to the acromioclavicular joint. ACTA ACUST UNITED AC 2008; 90:697-707. [DOI: 10.1302/0301-620x.90b6.20704] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Injuries to the acromioclavicular joint are common but underdiagnosed. Sprains and minor subluxations are best managed conservatively, but there is debate concerning the treatment of complete dislocations and the more complex combined injuries in which other elements of the shoulder girdle are damaged. Confusion has been caused by existing systems for classification of these injuries, the plethora of available operative techniques and the lack of well-designed clinical trials comparing alternative methods of management. Recent advances in arthroscopic surgery have produced an even greater variety of surgical options for which, as yet, there are no objective data on outcome of high quality. We review the current concepts of the treatment of these injuries.
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Affiliation(s)
- J. A. Fraser-Moodie
- Edinburgh Shoulder Clinic The Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SU, UK
| | - N. L. Shortt
- Edinburgh Shoulder Clinic The Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SU, UK
| | - C. M. Robinson
- Edinburgh Shoulder Clinic The Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SU, UK
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Andermahr J, Jubel A, Elsner A, Johann J, Prokop A, Rehm KE, Koebke J. Anatomy of the clavicle and the intramedullary nailing of midclavicular fractures. Clin Anat 2006; 20:48-56. [PMID: 16506232 DOI: 10.1002/ca.20269] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Intramedullary fixation is used increasingly to treat clavicular fractures. Anatomical variations in the clavicle of relevance to this procedure are analyzed. The length, diameters and curvature of the clavicle were measured in 196 specimens from the dissecting room. The calcium bone density was analyzed in 300 cross-sectional samples of 100 specimens. The thickness of cortical and medullary bone of 70 slices was analyzed from freshly plastinated clavicles with implants in place. The female clavicle was shorter, less curved, and had a lower concentration of calcium than the male clavicle. Measurement of cortical thickness showed a mean value of 1.05 +/- 0.23 mm at the most sternal measuring point, 2.05 +/- 0.29 mm at the midpoint of the clavicle, and 0.95 +/- 0.35 mm at the acromial end. The thinnest regions were the medial ventral cortex and the dorsal acromial cortex. These measurements explain clinical observations on nail perforation. The diameter of the medullary canal measured 6.7 +/- 2.6 mm at its narrowest part, so that reaming (i.e., predrilling the medullary canal) prior to 3.5 mm titanium nail insertion is not necessary. The main difficulties encountered when placing a nail are secondary to the S-curvature of the clavicle. In 80% of fractures, the break is located at the narrowest diameter of the medullary canal. Thus, the clavicle displays definite gender- and side-specific anatomical features in terms of length, diameter, curvature, and calcium concentration. These should be considered when performing intramedullary fixation.
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Affiliation(s)
- Jonas Andermahr
- Clinic of Trauma-, Hand- and Reconstructive Surgery, University of Cologne, Köln, Germany.
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