PMC4900064_01
48-year-old male with complex acromioclavicular separation. Rockwood Type IV clavicle fracture with severe comminution of the distal fracture fragment and associated acromioclavicular and coracoclavicular joint separation. There is also a displaced fracture of the 3rd rib.
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He sustained a right AC and coracoclavicular (CC) joint separation with posterior displacement of the proximal clavicle fracture fragment (Rockwood Type IV) (Fig. 1).
48-year-old male with complex acromioclavicular separation. Intra-operative reduction with temporizing Steinmann pin.
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The distal clavicle fracture was reduced and maintained in place by a temporizing Steinmann pin (Fig. 2A). A drill guide was used to place a hole through the central third of the clavicle into the base of the coracoid, a pin was placed through the clavicle and coracoid to check positioning, and this was over-reamed with a cannulated 4mm drill bit (Fig. 2B). The fracture of the distal third of the clavicle was treated by suture fixation (Fig. 2C).
48-year-old male with complex acromioclavicular separation. A tunnel for the TightRope is prepared with a cannulated drill bit passing through the clavicle and the coracoid process
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Followup images six weeks later showed continued improved anatomic alignment of the clavicle post tightrope fixation with persistent widening of the AC joint (Fig. 3).