Ribeiro Gustavo G, Figueiredo Elisa G, Souza Thiago A, Vilela José Carlos S
Orthopedics and Traumatology, Hospital Francisco José Neves - Unimed Belo Horizonte (BH), Belo Horizonte, BRA.
Cureus. 2024 Nov 30;16(11):e74828. doi: 10.7759/cureus.74828. eCollection 2024 Nov.
In this report, we present a case of a triple clavicle injury, acromioclavicular joint (ACJ) dislocation, a middle third clavicle fracture, and a sternoclavicular joint (SCJ) subluxation, and describe its successful surgical treatment. A 49-year-old female patient sustained a 3 m fall, resulting in direct trauma to her left shoulder. Initial radiographs and computed tomography (CT) scans revealed a displaced middle third clavicle fracture, a high-grade ACJ dislocation, and a posterior SCJ subluxation. Surgical intervention was proposed due to the severity of the ACJ dislocation. The patient underwent open reduction and internal fixation (ORIF) of the clavicle fracture with an anatomical locking plate (EVOS Clavicle Plate®; Smith & Nephew, Andover, MA) and ACJ stabilization using an Endobutton® (Smith & Nephew, Andover, MA) along with the transposition of the coracoacromial ligament. The SCJ subluxation was reduced indirectly. She returned to work after four weeks and, after six months, demonstrated excellent functional recovery achieving a full, pain-free range of motion. Outcome scores were favorable (Constant Shoulder Score: 73 bilaterally; University of California, Los Angeles {UCLA} Shoulder Rating Scale: 33). Follow-up radiographs at nine months demonstrated stable fixation with satisfactory anatomical alignment and fracture healing. Given the absence of specific guidelines for managing this combination, we based our method on established protocols for isolated injuries. Our patient's favorable outcome supports the effectiveness of this strategy and highlights the potential for successful functional recovery with careful management. This case underscores the importance of a high index of suspicion for concomitant ACJ and SCJ injuries in patients with midshaft clavicle fractures. This triad requires an individualized treatment plan for optimal outcomes, and future studies should focus on further documenting and evaluating treatment strategies for this rare injury pattern.
在本报告中，我们介绍了一例三联锁骨损伤病例，包括肩锁关节（ACJ）脱位、锁骨中1/3骨折和胸锁关节（SCJ）半脱位，并描述了其成功的手术治疗过程。一名49岁女性患者从3米高处坠落，导致左肩直接受伤。最初的X线片和计算机断层扫描（CT）显示锁骨中1/3骨折移位、肩锁关节高位脱位以及胸锁关节后脱位。由于肩锁关节脱位严重，建议进行手术干预。患者接受了锁骨骨折切开复位内固定（ORIF），使用解剖锁定钢板（EVOS锁骨钢板®；史赛克公司，安多弗，马萨诸塞州），并使用Endobutton®（史赛克公司，安多弗，马萨诸塞州）进行肩锁关节稳定，同时进行喙肩韧带转位。胸锁关节半脱位间接复位。四周后她重返工作岗位，六个月后功能恢复良好，达到了完全无痛的活动范围。结果评分良好（Constant肩关节评分：双侧均为73分；加利福尼亚大学洛杉矶分校{UCLA}肩关节评分量表：33分）。九个月后的随访X线片显示固定稳定，解剖对位满意，骨折愈合良好。鉴于缺乏针对这种联合损伤的具体指南，我们的方法基于已确立的孤立损伤治疗方案。我们患者的良好结果支持了该策略的有效性，并突出了通过精心管理实现成功功能恢复的潜力。该病例强调了对于中段锁骨骨折患者合并肩锁关节和胸锁关节损伤保持高度怀疑的重要性。这种三联损伤需要个体化的治疗方案以获得最佳结果，未来的研究应专注于进一步记录和评估这种罕见损伤模式的治疗策略。
