PMC10134166_01
(a-e) Case 1: Triple disruption of the SSSC: (a) the acromioclavicular and coracoclavicular ligaments tear and a CP fracture. (b) In the panorama view, we can see a widening of the AC joint and (c) in the MRI, a CP fracture and coracoclavicular ligaments rupture. (d) Intraoperative fluoroscopy showing the CP fixation with a cannulated screw and the AC-joint fixation with a nice-loop and a hook plate. (e) The panorama view after 6 months shows good reduction of the AC-joint after removal of the hook plate.. SSSC: superior shoulder suspensory complex; CP: coracoid process; AC: acromioclavicular.
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He had visited another hospital and was diagnosed to have an AC-joint subluxation and a CP fracture on shoulder radiographs (AP/Neer/axillary/AP (panorama) and stress views) (Figure 2(a) and (b)). Magnetic resonance imaging (MRI) was performed and he was finally diagnosed with Rockwood type III AC dislocation with a CP fracture (Figure 2(c)). The definitive plate was appropriately placed under the acromion and secured to the clavicular shaft with three cortical screws (Figure 2(d)). The plate was removed 4 months postoperatively (Figure 2(e)).
Active range of motion 1 year after surgery. Flexion, abduction, and external rotation were measured in degrees. For internal rotation, the highest vertebral level that the thumb can reach is recorded.. IR: internal rotation; ER: external rotation.
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AC joint was reduced and preliminarily fixed with a K-wire. An AC-joint augmentation with a non-absorbable braided suture (Niceloop, Wright Medical Group N.V., Memphis, Tennessee, USA) was performed in (Figure 8) between the acromion and lateral clavicle for horizontal stability.
PMC10134166_02
(a-e) Case 2: Quadruple disruption of the SSSC: (a) AC and CC ligaments, clavicle, and CP. (b, c) In the radiograph and the initial CT, we can see the lateral clavicle and CP fracture. (d) Postoperative radiographs after fixation of the CP and the AC joint and (e) 6 months postoperatively after removal of the k-wires show good reduction.. SSSC: superior shoulder suspensory complex; CP: coracoid process; AC: acromioclavicular; CC: coracoclavicular.
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Other radiograph views were obtained, and we found a CP fracture in addition to an extremely lateral clavicle fracture and AC-joint disruption (Figure 3(a) and (b)). The injuries were confirmed using a computed tomography (CT) scan that showed no additional shoulder lesions (Figure 3(c)). To avoid stress on the CP osteosynthesis, the AC-joint was transfixed with two K-wires (Figure 3(d)). The K-wires were removed 1 month postoperatively (Figure 3(e)).
PMC10134166_03
(a-e) Case 3: (a) Quadruple disruption of the SSSC. (b) The first radiograph showed the midshaft clavicle fracture. (c) In the following CT-scan, a CP fracture was detected additionally. (d) The intraoperative fluoroscopy shows the plate fixation of the clavicle and the screw fixation of the CP. (e) The 6-month follow-up shows good reduction with fracture union.. SSSC: superior shoulder suspensory complex; CP: coracoid process; AC: acromioclavicular.
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We additionally detected a CP fracture near the base extending to the upper part of the glenoid cavity and a Rockwood type II AC-joint dislocation (Figure 4(a)-(c)). Subsequently, open reduction and internal fixation of the clavicle fracture was performed with an isolated 2.0 mm bicortical screw and an eight-hole plate (Figure 4(d) and (e)).
PMC10134166_04
(a-g) Case 4: (a) Triple disruption of the SSSC is shown in the graphic. (b, c) The first radiographs and (d) the following CT show the CP fracture. (e) Intraoperative fluoroscopy showed good reduction of the CP fracture and the AC joint. (f) A CT performed 5 months postoperative, showed good consolidation of the CP. (g) A panorama view 1-year after surgery showed an AC-joint symmetric to the contralateral side.. SSSC: superior shoulder suspensory complex; CP: coracoid process; AC: acromioclavicular.
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AP/tangential and shoulder AP/Neer/axial/panorama with and without weight views) revealed a CP fracture and an associated Rockwood type III AC-joint dislocation (Figure 5(a)-(c)). A CT scan did not reveal any further injuries (Figure 5(d)). In addition, the AC ligaments were repaired using a suture anchor and fixation with a hook plate, the suture anchors were passed through the AC ligaments and tied with multiple knots (Figure 5(e) and (f)). The hook plate was removed 5 months after surgery (Figure 5(g)).
PMC10134166_05
(a-f) Case 5: (a) Triple disruption of the SSSC shown in the graphic, (b) could be detected on a panorama view by the widening of the AC joint. (c) The CP fracture was diagnosed on CT. (d) After screw fixation of the CP and transfixion of the AC-joint with a hook plate, anatomical reduction was confirmed with a panorama view. (e) After removal of the hook plate the AC joints were symmetric. (f) Because of capsulitis an MRI was performed 2 years postoperatively that showed good alignment of the CP.. SSSC: superior shoulder suspensory complex; CP: coracoid process; AC: acromioclavicular.
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The left shoulder showed a Rockwood type IV AC-joint dislocation and CP fracture (Figure 6(a)-(c)). Three days later, with the patient under general anesthesia and in a beach-chair position, open reduction and fixation of the AC joint with a hook plate and fixation of the CP with a cannulated screw were performed (Figure 6(d)). The rehabilitation process was difficult because of the combined injuries; 5 months postoperatively, the hook plate was removed (Figure 6(e)). In the MRI, the fracture was consolidated (Figure 6(f)).