Acromio-clavicular joint injuries - Chinmay Gupte 20/2/2001
Overview
Incidence:
3-4/1000
Anatomy: joint stabilised by:
acromioclavicular-horizontal stabilitycoraco-clavicular- vertical stability
Mechanism: fall on adducted arm driving scapula inferiorly; clavicle maintains position due to strong sternoclavicular ligaments.
Radiology: stress views and transaxillary lateral
Classification: three systems: Allman; Tossy; Rockwood.
All assess coracoclavicular distance and infer damage to AC and CC ligaments.
Rockwood classification:
Type I
AC ligament sprain
Type II
Complete ACL rupture and CCL sprain
Type III
Complete ACL and CCL rupture
Type IV
Posterior translation of clavicle (axillary view)
Type V
similar to type III but with grossly increased CC distance
Type VI
distal clavicle driven beneath coracoid or acromion
Treatment:
Type I and II
broad arm sling 10 days
Type III
controversial
Type IV, V, VI
coraco- or acromioclavicular fixation.
Surgery:
Over 40 techniques described!!
[1] ACJ fixation
)
Threaded pins or
[2] CCJ fixation
)
screws
[3] Dynamic muscle transfer- transfer of coracoid process to under surface of clavicle.
Muscle origin acts as dynamic depressor of lateral clavicle.
Excellent review: Richards-RR; Instr-Course-Lect. 1993; 42: 259-69: Acromioclavicular joint injuries;
ACJ dislocation type III
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