Surgical management of a midshaft clavicle fracture with ipsilateral acromioclavicular dislocation: a report on 2 cases and review of the literature [review]
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The clavicle articulates with the acromion at the acromioclavicular (AC) joint and is tethered to the scapula’s coracoid process by the coracoclavicular ligaments. Injuries to the clavicle are very common as they constitute 4% of all fractures in adults and comprise up to 44% of all shoulder girdle trauma [1–3]. Fractures of the clavicle have been reported to be 12 times more common than dislocations of the AC joint [4,5]. The location of the AC joint on the superolateral aspect of the shoulder and the bony anatomy of the shoulder girdle make it susceptible to dislocation injury. Nearly one-fifth of shoulder girdle injuries involve the AC joint. Even partial disruption of the AC joint may lead to subluxation [6,7]. While both clavicle and AC joint injuries are common, it is a rare event for both to occur concomitantly in the same shoulder [2,5,8–10]. Review of the literature produced one case series which described four fractures to the middle third of the clavicle (classified as an Allman Group)  associated with three Rockwood Type IV and one Type II AC disruptions . A separate case report described a Group I clavicle fracture associated with a Type VI AC joint separation in an ice hockey player . Another case report described a midshaft clavicle fracture associated with a Type III AC joint disruption in a cyclist . In all cases, however, there was no report of operative technique since all patients were managed nonoperatively. The purpose of this report is to describe two cases of this unique injury and the operative strategy utilized by the surgeon. In both cases, a dual plating technique with independent fixation was used to achieve fracture reduction and joint relocation.
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