Bipolar Dislocation of the Clavicle: A Report of Two Cases with Different Injury Patterns and a Literature Review

Treatment of bipolar clavicle injury with internal plating: a case series and literature review

BACKGROUND

Bipolar clavicle injury is a rare injury involving any combination of dislocation and/or fracture at both ends of the clavicle. Most reports of bipolar clavicle injury have been based on a single case, and treatment of this injury remains controversial. The present study was performed to evaluate the efficacy of surgical management with internal plating for bipolar clavicle injuries.

METHODS

We performed internal plating to treat seven consecutive bipolar clavicle injuries with different injury patterns from May 2013 to June 2021. A clavicle hook plate was used for five sternoclavicular joint injuries (including a revision surgery) and three acromioclavicular joint dislocations, a T plate was used for one sternoclavicular joint injury, and an anatomic plate was used for one distal clavicle fracture. At follow-up, radiographs were assessed for bone alignment, joint congruity, fracture union or malunion, and implant failure or migration. Clinical evaluation included determination of the Disability of the Arm, Shoulder, and Hand (DASH) score; Constant-Murley score; visual analog scale (VAS) score; and complications.

RESULTS

The patients were regularly followed up after the operation, and functional parameters were assessed over time. At a mean follow-up of 28.1 ± 22.0 months, each fracture had solid bone union, and each dislocation showed no sign of recurrent instability. The mean shoulder forward flexion was 159.3° ± 7.9°, and the mean DASH score was 8.8 ± 5.1. The mean Constant-Murley score was 88.9 ± 7.9, with six cases assessed as excellent and one case assessed as good. The mean VAS score was 1.0 ± 1.5, and the mean patient satisfaction score was 9.3 ± 0.8. No complications occurred, and each patient was able to resume their preinjury daily activity and was highly satisfied with their treatment.

CONCLUSIONS

In the present study, internal plating for bipolar clavicle injury allowed early mobilization and resulted in good joint function. We recommend fixation of the more severely affected side first because the other side may be passively reduced and acquire stability once the more severely affected side has been fixed. Internal fixation of the other end may therefore be unnecessary unless residual instability exists.

Lateral subtalar dislocation associated with a lateral malleolus and a nutcracker cuboid fracture: Case report of a rare pattern of lesion

Introduction and importance

Combined fracture of the lateral malleolus and cuboid due to a lateral subtalar dislocation is an uncommon injury. Literature is scarce on this trauma association. To the best of our knowledge, this represents a new lesion pattern. Hereby we describe its mechanism, management and outcomes.

Case presentation

We report a case of a 58-year-old woman, who fell from the stairs and presented with pain and an acute deformity of the left foot and ankle. Plain radiographs and CT scan revealed a lateral subtalar dislocation with a lateral malleolus and cuboid fractures. After a failed closed reduction, the patient underwent an open reduction and fixation of the talonavicular joint. An external fixator was applied to address the cuboid fracture. The lateral malleolus was treated conservatively with 5.5 weeks of immobilization. At 38 months of follow-up, the patient scored 87% on the AOFAS ankle-hindfoot scale and returned to normal daily activity. Radiographs demonstrate signs of posttraumatic arthritis at the subtalar and talonavicular joints.

Clinical discussion

After reduction of the lateral subtalar dislocation, addressing the nutcracker cuboid fracture was essential, since it can contribute to a flatfoot deformity. Although the patient progressed to posttraumatic arthritis, the sequelae are usually well tolerated and a good outcome was achieved.

Conclusion

The rarity of this pattern of lesion is related to the necessary multidirectional forces. Correct management of the associated fractures is essential.

Our study demonstrates a new lesion pattern of lateral subtalar dislocations, its mechanism, management and outcomes.

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Lateral subtalar dislocation with lateral malleolus and cuboid fractures are rare.

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Combined eversion and lateral foot column compression result in this pattern.

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Both lateral dislocations and cuboid fractures may result in a flatfoot deformity.

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CT scan is vital for fracture identification and proper surgical planning.

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Adequate treatment of the associated fractures is essential to a successful outcome.

The Unique Bipolar Clavicle Dislocation: A Novel Reconstruction Technique and Case Report

A bipolar clavicle separation is defined as a simultaneous dislocation of the ipsilateral sternoclavicular joint (SCJ) and acromioclavicular joint (ACJ). This rare injury pattern is usually the result of a high-energy mechanism, such as a motor vehicle collision or fall from height. While there are several treatment options such as screw fixation, sutures, or plate fixations, there is no single standard approach for this infrequent injury. We describe a unique case of bipolar clavicle dislocation, specifically an anteriorly displaced SCJ and posteriorly displaced ACJ, treated with a novel surgical technique-a TightRope technique (Arthex®) and semitendinosus allograft.

Traumatic Floating Clavicle: Is This a Rare Injury?

Bipolar clavicle dislocation is thought to be a rare injury pattern. Even experienced orthopaedic surgeons may have not come across this entity during their careers. We report a misdiagnosed case of a 65-year-old male who underwent a motorcycle accident and was surgically treated six months post-injury. This case has been the ground for research since then. We have come to the conclusion that this type of injury is probably not so uncommon as previously thought. Careful evaluation is of immense importance during diagnosis protocol, and practitioners should be aware of this injury pattern in order to avoid misdiagnosis.

Bipolar clavicular fracture on ipsilateral reverse shoulder prosthesis: Case report

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Rare case of traumatic bipolar clavicular over an ipsilateral reverse shoulder prosthesis.

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Open reduction and internal fixation showed satisfactory bony alignement with intact reverse shoulder prosthesis.

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Post operative rehabilitation is of great importance, taking into consideration the deltoid musculature wish should be addressed for shoulder strengthening over prosthesis.

Background

Bipolar clavicular fractures are extremely rare with no consensus on management. No previous cases of bipolar clavicular fracture on an ipsilateral reverse shoulder prosthesis have been reported.

Case presentation

We report a case of a 78y.o female patient with left bipolar clavicular fracture on ipsilateral reverse shoulder prosthesis, associated with multiple ribs fracture, that was treated with open reduction and internal fixation using k-wires and endobutton for the lateral part, while as the medial part was fixed with plate and screws.

Conclusions

Any patient with a clavicle fracture, with a history of sequential forces to the clavicle, a bipolar injury should always be suspected. Attention should be given if any implants are present on the ipsilateral side of the injury, which could affect surgical planning and outcome.