Prasetia Renaldi, Kristian Hans, Rahim Agus Hadian, Ismiarto Yoyos Dias, Rasyid Hermawan Nagar
Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia.
General Practitioner, Faculty of Medicine, Maranatha Christian University, Bandung, West Java, Indonesia.
Int J Surg Case Rep. 2022 Jun;95:107171. doi: 10.1016/j.ijscr.2022.107171. Epub 2022 May 6.
Acromioclavicular (AC) joint dislocation Rockwood type IV is a rare condition characterized by the posterior displacement of the distal clavicle and soft tissue damage. The rate of soft tissue healing markedly decreases as time from injury increases. In this case report, we had a very late presenting neglected AC joint dislocation Rockwood type IV successfully treated by AC and coracoclavicular (CC) reconstruction.
A 24-year-old female presented with pain around her right shoulder since a motorcycle accident four years prior to current presentation. She was diagnosed with a posterior AC joint dislocation and suggested undergoing surgery, but she refused and chose to seek an alternative treatment. The patient felt pain chronically and could not elevate her shoulder, and she decided to come to our hospital. We performed a physical and radiograph examination that showed an AC joint dislocation Rockwood type IV. The management, suggested to the patient, was AC and CC soft tissue reconstruction.
The advantages of using this procedure were to restore effective anatomy and avoid bone-to-bone contact between the clavicle and acromion. The disadvantages were increased cost and needed to be evaluated for long-term results. We considered the idea of maintaining AC joint reduction by biologic soft tissue healing of the graft and augmentation fixation to replace the CC ligaments. We could not rely on biological soft tissues healing themselves due to the chronicity.
AC and CC reconstruction can be an option of treatment in neglected AC joint dislocation Rockwood type IV with excellent clinical and radiographic results.
肩锁关节（AC）脱位Rockwood IV型是一种罕见情况，其特征为锁骨远端后移及软组织损伤。随着受伤时间增加，软组织愈合率显著下降。在本病例报告中，我们成功治疗了一例就诊非常晚的被忽视的肩锁关节脱位Rockwood IV型，采用了肩锁关节及喙锁（CC）重建术。
一名24岁女性，自当前就诊前四年发生摩托车事故后，一直存在右肩周围疼痛。她被诊断为肩锁关节后脱位，并建议接受手术，但她拒绝并选择寻求其他治疗方法。患者长期感到疼痛，无法抬起肩部，于是决定前来我院。我们进行了体格检查和X线检查，结果显示为肩锁关节脱位Rockwood IV型。向患者建议的治疗方法是肩锁关节及喙锁软组织重建术。
采用该手术方法的优点是恢复有效的解剖结构，避免锁骨与肩峰之间的骨对骨接触。缺点是费用增加，且需要对长期效果进行评估。我们考虑通过移植物的生物软组织愈合及增强固定来维持肩锁关节复位以替代喙锁韧带的想法。由于病程较长，我们不能依赖生物软组织自行愈合。
肩锁关节及喙锁重建术可作为治疗被忽视的肩锁关节脱位Rockwood IV型的一种选择，具有良好的临床和影像学效果。
