Bipolar clavicular dislocation

Bipolar clavicular dislocation rarely occurs. Although referred to by several different names (panclavicular dislocation, bifocal clavicle dislocation, traumatic floating clavicle, and periarticular clavicle dislocation), knowledge regarding appropriate treatment of this condition is limited. Conservative therapy remains the gold standard in asymptomatic individuals. In younger individuals with higher functional demands, or individuals with persistent pain or instability, open reduction with internal fixation of the acromioclavicular joint has also proven successful. In situations with continued medial instability, internal fixation can be used at both the acromioclavicular joint and sternoclavicular joint.Chronic bipolar dislocation may require total claviculectomy, especially when chronic dislocation has led to nonviable acromioclavicular and sternoclavicular joint viability. This article presents a chronic case of bipolar dislocation treated by complete claviculectomy.     

Posttraumatische bipolare Luxation der Klavikula

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.     

切降性胸锁关节成形术治疗胸锁关节脱位

目的：探讨切除性胸锁关节成形术治疗胸锁关节脱位的临床应用可行性。方法：采用切除性胸锁关节成形术和修复或重建肋锁韧带治疗5例胸锁关节脱位的病例,并对结果进行平均1．8年随访、评价。结果：全部病例均随访平均1．8年,所有病人均获优秀效果,无感染、疼痛、畸形。结论：我们认为切除性胸锁关节成形术,保留或重建肋锁韧带是治疗胸锁关节脱位疗效可靠的方法。     

胸锁钩钢板治疗胸锁关节脱位的临床观察

目的:观察应用胸锁钩钢板治疗胸锁关节脱位患者的临床治疗效果。方法:2010年6月至2012年6月对7例胸锁关节脱位患者行胸锁钩钢板复位固定术治疗,其中男5例,女2例;年龄38～54岁,平均42.3岁;病程1～4周。术前患者均有外伤史,患侧胸锁关节肿胀、疼痛明显,患侧肩关节活动明显受限。术前X线片及CT证实为胸锁关节脱位,根据Rockwood评分法对术后疗效进行评价。结果:本组7例胸锁关节脱位患者按Rockwood评分法进行评价,优6例,良1例。术后未出现内固定松动、断裂,未出现再次脱位,肩关节功能良好,胸锁关节无疼痛,外观无畸形,患肢活动自如无疼痛。结论:胸锁钩钢板治疗胸锁关节脱位,手术操作简单,固定可靠,疗效肯定,值得临床推广。     

Dislocation of the acromioclavicular joint. An end-result study

The cases of 127 patients who had an acute dislocation of the acromioclavicular joint were studied. Fifty-two patients, with an average follow-up of 10.8 years, were managed operatively, and seventy-five patients, with an average follow-up of 9.5 years, were managed non-operatively. Using a rating system that included subjective, objective, and roentgenographic criteria, it did not appear that reduction of the acromioclavicular joint was necessary to obtain consistently good results. Operative management, using either coracoclavicular or acromioclavicular fixation, was associated with a higher rate of complications than non-operative treatment. The use of a sling for four weeks without reduction of the joint, followed by a graduated exercise program, led to acceptable clinical results. In patients who had persistent pain and stiffness of the acromioclavicular joint, or in whom symptomatic post-traumatic arthritis developed, resection of the distal part of the clavicle reliably produced significant improvement.     

Posterior sternoclavicular dislocations--a diagnosis easily missed.

Posterior dislocation of the sternoclavicular joint is a relatively rare injury and can be difficult to diagnose acutely. We report 3 cases of posterior dislocation of the sternoclavicular joint who presented to the Accident & Emergency Department within a 3 month period. All 3 patients had sustained a significant injury to the shoulder region and complained of pain around the medial clavicle. Two patients had also complained of dysphagia following the injury. Plain X-rays of the shoulder and chest were reported as normal by junior and senior medical staff. The diagnosis was delayed until CT scans were performed, and once this was established, open reduction and stabilisation was performed.     

Bipolar dislocation of the clavicle or floating clavicle. A report of 3 cases

Bipolar clavicular dislocation is uncommon. It associates an acromioclavicular and sternoclavicular dislocation. The authors review the mechanism of this injury and discuss the treatment. Three patients presented after a trauma of the shoulder a floating clavicle. In 2 patients management was surgical. Abstention was decided for the fourth patient. The pathology of floating clavicle is not completely understood. Two hypothesis were made: 1) two dislocations occur simultaneously; 2) two dislocations occur one after another. Management still difficult. Indications must take into considerations the severity of the injury and the functional consequences in the acromioclavicular joint.     

Superior sternoclavicular joint dislocation presented with shoulder motion limitation: A case report and literature review

Introduction and importanceSternoclavicular joint dislocation accounts for 1 percent of the human joint dislocations. Sternoclavicular joint dislocation most commonly occurs in anterior or posterior dislocation. To the best of the authors knowledge, only six cases of superior sternoclavicular joint dislocation are reported in the literature. The injury is commonly missed.Case presentationWe present a 28-year-old athlete with upper chest pain and right shoulder range of motion limitation. On imaging, it was revealed that he had a superior sternoclavicular dislocation. He was managed with arm sling, analgesics and physiotherapy. After 3 months, he was asymptomatic and returned to his sport activity successfully.Clinical discussionWe searched the published related studies and summarized the signs and symptoms of patients presented with sternoclavicular dislocation. Chest pain is one of the most common symptom while sternoclavicular tenderness and restriction of shoulder movement are among the most common signs of sternoclavicular dislocations. Conservative, close reduction, and open reduction and internal fixation with fiber wire have been applied for cases with superior sternoclavicular dislocation with acceptable results.ConclusionA high index of suspicion is needed in order not to miss sternoclavicular dislocation. In cases with no evidence of mediastinal structure compression it may be managed conservatively successfully. However, some degree of cosmetic deformity may remain at the sternoclavicular joint in those treated with conservative therapy.     

关节镜下喙锁和肩锁韧带重建治疗陈旧性Rockwood III型肩锁关节脱位

目的探讨关节镜下喙锁+肩锁韧带重建治疗陈旧性Rockwood III型肩锁关节脱位的疗效。 方法选取2016年1月至2020年12月北京大学人民医院收治的14例确诊为陈旧性肩锁关节脱位患者,其中男8例、女6例,平均年龄（37.2±10.1）岁,平均受伤时间（13.4±3.5）个月,累及优势侧肩关节7例,均行关节镜下喙锁+肩锁韧带重建手术。术后所有患者分别于不同时间点随访（术后1、3、6、12个月）,进行视觉模拟评分（visual analogue scale,VAS）和美国加州大学洛杉矶分校（University of California, Los Angeles,UCLA）评分。 结果14例确诊为陈旧性肩锁关节脱位患者（均为Rockwood III型）进入研究并完成手术,12例获得完全随访,平均随访（26.3±8.6）个月（12~36个月）。患者术前和术后1个月、3个月、6个月、12个月VAS评分分别为（5.667±0.414）分、（5.583±0.288）分、（4.583±0.229）分、（2.833±0.271）分、（0.538±0.193）分,与术前相比,所有患者在术后3个月、6个月和12个月随访时均显示疼痛减轻,术后6个月和12个月疼痛减轻的程度与术前相比（VAS评分变化）差异有统计学意义（P<0.001）。患者术前和术后1个月、3个月、6个月、12个月UCLA评分分别为（19.083±0.468）分、（18.583±0.434）分、（21.000±0.628）分、（25.750±0.579）分、（32.750±0.509）分,与术前相比,所有患者在术后3个月、6个月和12个月随访时UCLA评分与术前相比均有提高,术后6个月、12个月随访时UCLA评分改善的程度与术前相比,差异有统计学意义（P<0.001）。 结论关节镜下喙锁+肩锁韧带重建可以用较小的创伤达到帮助陈旧性肩锁关节脱位患者减轻疼痛和改善肩关节功能的目的。     

Ipsilateral sternoclavicular joint anterior dislocation with fracture of the mid shaft of the clavicle

Even though fractures of the clavicle are very common but fracture of the shaft of clavicle associated with sternoclavicular joint dislocation is extremely rare. This is a case report of a 50-year old woman who met with a road accident. Radiographs revealed right mid shaft clavicle fracture with inferior angulation of fracture fragments, anterior dislocation of sternoclavicular joint. The sternoclavicular joint was stabilized with sutures whereas the midshaft fracture was managed non-operatively. In postoperative period the sternoclavicular joint was found stable whereas the shaft clavicle united completely after 6 months.     

新型胸锁钩钢板治疗胸锁关节周围不稳定性骨折脱位的疗效观察

目的:探讨新型胸锁钩钢板治疗胸锁关节周围不稳定性骨折脱位的临床疗效。方法 :自2011年6月至2013年12月,应用胸锁钩钢板对32例成年胸锁关节骨折脱位患者进行手术治疗。其中男24例,女8例;年龄25~76岁,平均42岁;胸锁关节前脱位12例,胸锁关节后脱位5例,锁骨内侧端骨折10例,骨折合并脱位5例。胸锁关节前骨折脱位采用标准胸锁钩钢板,后脱位则在钢板钩的远端,即胸骨柄前方加用螺母和垫片,预防术后再脱位。根据Rockwood评分法评定疗效。结果 :患者手术过程中无并发症发生。术后复查X线片及CT显示胸锁关节解剖位置正常,内固定位置良好。32例均获得随访,时间6~24个月,平均10个月。术后3~6个月骨折达Ⅰ期愈合,胸锁关节无再脱位,锁骨内侧端解剖结构均恢复,功能满意,其中9例患者胸锁关节周围存在肿胀,但无疼痛等症状。Rockwood评分结果12.78±1.43;疗效优24例,良8例。结论:使用该新型胸锁钩钢板治疗胸锁关节周围不稳定性骨折,内植物固定确实可靠,安全性高,操作简便,为治疗此类创伤提供了一种可靠的方法。     

自体双股掌长肌腱联合人工韧带重建喙锁韧带治疗肩锁关节脱位

目的:探讨应用自体双股掌长肌腱联合人工韧带重建喙锁韧带治疗肩锁关节脱位的手术方法及临床疗效。方法:2006年4月至2009年6月采用自体双股掌长肌腱联合人工韧带重建喙锁韧带治疗肩锁关节脱位31例,男18例,女13例;年龄18～60岁,平均35岁;急性损伤26例,慢性损伤5例。术前患者主要表现为不同程度肩部疼痛、活动受限、肩锁不稳,X线提示肩锁关节脱位。结果:术后切口愈合好,无一例血管及臂丛神经损伤。全部病例获得随访,平均时间23个月,JOA评分术前(38.8±1.5)分,术后1个月(73.2±1.1)分,末次随访(93.5±0.8)分。本组优28例,良2例,一般1例。结论:应用自体双股掌长肌腱联合人工韧带重建喙锁韧带同时行锁骨远端部分切除是治疗肩锁关节脱位的有效方法。     

Akute AC-Gelenksprengung – operative oder konservative Therapie?

42 patients with complete acromioclavicular dislocation treated operatively and 38 patients managed non-operatively were examined retrospectively with a mean follow-up of 6.3 +/- 2.5 years. The dislocations in both groups included type III and type V injuries according to the Rockwood-classification. The operative technique was suturing of the tom ligaments and stabilization of the acromioclavicular joint using resorbable coracoclavicular PDS-banding. In non-operative treatment, early physiotherapy accepting the deformity was performed in most of the patients. The clinical results using the UCLA- and the Constant-Murley score as well as evaluation of pain, function and strength were similar in both groups. Those patients suffering from a more severe dislocation type Rockwood V who were treated non-operatively had as good results as those patients with grade III dislocation. Posttraumatic osteoarthritis developed mainly in those patients whose acromioclavicular joint healed in partial dislocation. Non-operative treatment was equal even in less severe dislocations in the subgroup of type Rockwood V injuries. The persisting deformity which must be expected in non-operative treatment did not affect the patient's outcome regarding pain, function and strength of the shoulder.     

Origin, diagnosis and treatment of sternoclavicular joint dislocation

Traumatic dislocation of the sternoclavicular joint is very uncommon (1,5% of all dislocation, 10% of all dislocations in clavicular joints; ratio acromioclavicular dislocations: sternoclavicular dislocations = 5-10:1). The functional importance of this joint requires open reduction with reconstruction of its ruptured ligaments and the disc. The sternoclavicular joint can be dislocated in association with congential, developmental, degenerative and inflammatory processes (M. Friedrich, rheumatoid arthritis). Epiphyseal separations or fractures of the medial end of the clavicle can usually be treated conservatively, but interposition of the joint capsule between the fragments may cause the dislocation to be irreducible. In addition to clinical examination and anteroposterior of oblique posteroanterior X-rays, tomography, computed tomography and arthrography can be of help in diagnosis. Additional special X-ray pictures as suggested by Heinig, Hobbs and Kattan are very helpful in determining the degree of dislocation (Allman). If open reduction is necessary, the functional importance of the disc and the angle of inclination of the joint socket must be taken into consideration.     

Resection of the acromial and sternal end of the clavicle

The causes of complaints in the acromioclavicular joint include arthrosis after dislocation of the joint, metastases, polyarthritis, tuberculosis, or hyperparathyroidism. Some causes have not yet been identified. If conservative therapy is unsuccessful the condition may be treated by resection of the acromial end of the clavicular, as first described by Gurd and Mumford. The present paper reports the results obtained in 22 patients who were followed up. Complete freedom from pain was achieved in 59% of the cases and improvement in 23.7%, while in 13.6% the results had to be classified as unchanged or poor. An analysis of these results admits the conclusion that with restricted indication and in particular in post-traumatic conditions, it is certainly possible to achieve results which make this technically simple procedure the treatment of choice in arthrosis of the acromioclavicular joint; this is borne out by the literature. In much rarer cases, changes in the sternoclavicular joint have to be surgically treated. Here also, the majority of cases are post-traumatic changes, and here again most of them are conditions following anterior luxation. Analogously to resection at the acromial end of the clavicula, a resection at its sternal end may also produce successful results. With reference to three of the authors' own cases, the clinical picture is considered and the results are presented and discussed; however, since the various surgical techniques cannot be compared, a final evaluation is only possible to a limited extent.     

Complete dislocation of the acromioclavicular joint: operative versus conservative treatment

Abstract The preferred treatment for complete acromioclavicular separation is still controversial. The purpose of this study was to compare conservative and operative treatment on the basis of a long follow- up period, including subjective and objective clinical assessments as well as radiological evaluation. Forty-two patients with complete acromioclavicular dislocation treated operatively and 38 patients treated conservatively were examined at a mean follow-up of 6.3 years (SD=2.5). Assessment included the UCLA and the Constant-Murley scores as well as evaluation of pain, function and satisfaction. Shoulder strength was measured objectively using a cable tensiometer in four planes. The operative technique was suturing of the torn ligaments and stabilization of the acromioclavicular joint using resorbable coracoclavicular PDS banding. In conservative treatment, early physiotherapy accepting the deformity was performed in most patients. Clinical results according to the UCLA and Constant-Murley Scores as well as evaluation of pain, function and strength were similar in both groups. Three months postoperatively, the conservatively treated patients had less pain, a better range of motion and a significantly earlier return to work. Post-traumatic osteoarthritis developed only in those patients whose acromioclavicular joint healed in partial dislocation. The persisting deformity, which must be expected in conservative treatment, did not affect the patient’s outcome regarding pain or function and especially not regarding shoulder strength. With respect to the time for recovery, conservative treatment is superior to operative management. Therefore, most patients can be treated conservatively, even those patients who are heavy overhead workers or overhead athletes.     

创伤性胸锁关节损伤的诊断及治疗方法的选择（附69例报道）

目的：通过对创伤性胸锁关节损伤解剖结构的改变、致伤机理,诊断及不同治疗方法的研究。而寻求一种简便、有效的治疗方法,方法：69例71个创伤性胸锁关节,其中半脱位14个,新鲜脱位36个,陈旧性脱位13个,骨骺骨折8个,应用非手术治疗和手术治疗。随访6-18个月。结果：非手术治疗48个关节。47个关节功能正常,不伴疼痛等不适;手术治疗23个关节。17个关节功能正常,6个关节功能受限伴或不伴疼痛等不适。结论：非手术治疗是创伤性胸锁关节损伤首选治疗方法。且新鲜损伤优于陈旧性损伤,因此对创伤性胸锁关节损伤要求尽早诊断及治疗,以提高治疗效果。     

Evaluation of arthroscopic stabilization of acute acromioclavicular joint dislocation using the TightRope system

The purpose of this study was to evaluate the results of the arthroscopic treatment of acute acromioclavicular dislocation using the TightRope system (Arthrex, Naples, Florida). Between January 2006 and May 2007, ten shoulders in 10 patients with acute acromioclavicular joint dislocation (Rockwood types IV and V) underwent arthroscopic acromioclavicular joint stabilization using the TightRope. Average patient age was 30 years (range, 22-42 years), and mean follow-up was 24 months (range, 18-30 months). Follow-up occurred at 2 and 6 weeks, 3 months, and then every 6 months postoperatively. The shoulders were evaluated radiologically by comparing the acromioclavicular joint with the normal side and clinically by assessing the pain, function, and range of joint motion using the Constant score.Ten patients returned to work without pain 10 to 12 weeks postoperatively. Average Constant score was 96.3 (range, 94-99) at last follow-up. Because of technical error, 1 patient experienced TightRope fixation failure on the coracoid side, and the acromioclavicular joint was redislocated, which was treated by an open technique. The 10 patients were satisfied with their functional results and cosmetic appearance.The arthroscopic treatment of acute acromioclavicular dislocation using the TightRope is a minimally invasive surgical technique that has been proven effective for the treatment of these lesions. It is characterized by less morbidity, less hospitalization, excellent cosmoses, and early rehabilitation.     

Midterm results of arthroscopic co-planing of the acromioclavicular joint

BACKGROUND: There has been recent concern about long-term morbidity associated with arthroscopic co-planing of the acromioclavicular joint in the treatment of impingement syndrome. OBJECTIVE: The purpose of this study was to assess the results of the co-planing procedure, special attention being paid to acromioclavicular joint morbidity. METHODS: The study included 56 patients who were operated on by the senior author. Outcomes were evaluated both objectively and subjectively through physical examinations and telephone surveying. Each patient had subacromial decompression at the time of the index surgery. Other concomitant arthroscopic procedures included rotator cuff repair and labral debridement or repair. RESULTS: Average follow-up was 4 years (range, 2-7 years). Thirty-five (95%) of 37 patients had no subjective pain and no objective tenderness to direct palpation or compression of the acromioclavicular joint. The joint was not clinically hypermobile in comparison with that on the opposite side in any patient. In all, 95% of patients had good or excellent results in terms of the University of California at Los Angeles Shoulder Score. Of the 2 patients who did have pain and tenderness at the acromioclavicular joint, both had had multiple operations on their shoulders before the index procedure. Nineteen patients were not examined clinically but did complete a telephone survey; these 19 patients were not symptomatic at the acromioclavicular joint. CONCLUSIONS: To fully treat impingement syndrome, the surgeon should remove osteophytes under the lateral clavicle and medial acromion. With good technique, the surgeon can leave the anterior, posterior, and superior acromioclavicular joint capsule intact. We conclude that for appropriate clinical indications, beveling the inferior 20% to 25% of the clavicle to make it co-planar with the decompressed acromion is safe and is not an etiologic factor in acromioclavicular joint pain or instability.     

Triple-Endobutton钢板置入治疗Rochwood Ⅲ-Ⅴ型肩锁关节脱位

目的：探讨Triple-Endobutton 钢板置入治疗Rochwood分型Ⅲ-Ⅴ型肩锁关节脱位的临床疗效。方法：2008年3月至2010年6月,对28例Rochwood Ⅲ-Ⅴ型肩锁关节脱位的患者进行Triple-Endobutton 钢板置入治疗,男18例,女10例;年龄20～60岁,平均38岁;左侧20例,右侧8例;均为闭合性损伤。肩关节功能按Constant标准进行疗效分析。结果：28例获随访,时间18～24个月,平均20个月。所有患者肩关节活动良好,未出现再脱位及疼痛等症状。X线检查肩锁关节均完全复位。肩关节功能按Constant标准,术前评分25.4±2.0,术后1个月65.9±3.0,术后3个月87.2±3.2,术后6个月95.7±1.6.结论：利用Triple-Endobutton 钢板置入治疗Rochwood Ⅲ-Ⅴ型肩锁关节脱位固定牢靠,操作简单,并发症少,无须二次取出,术后可早期进行功能锻炼,疗效满意。