Type IV acromioclavicular joint dislocation associated with a mid-shaft clavicle malunion

Ipsilateral Rockwood type IV acromioclavicular joint dislocation and midshaft clavicle fracture: a case report and review of the literature

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.

Monopolar and Bipolar Combination Injuries of the Clavicle: Retrospective Incidence Analysis and Proposal of a New Classification System

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.