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06 June 2023 : Case report  Taiwan

Optimizing Treatment for Combined Midshaft Clavicle Fracture and Acromioclavicular Joint Injury: A Case Study Highlighting the Efficacy of Knowles Pin Fixation

Unusual or unexpected effect of treatment

Yu-Jen Shih12BDEF, Hui-Chin Chang ORCID logo3CDF, Chih-Lung Wu ORCID logo24ABDEF*

DOI: 10.12659/AJCR.939325

Am J Case Rep 2023; 24:e939325



BACKGROUND: An ipsilateral fracture of the midshaft clavicle with dislocation of the acromioclavicular joint (ACJ) is a rare combination injury and almost always occurs following high-energy trauma. Currently, there is no optimal surgical approach for this kind of rare injury. We present a 60-year-old man with a traumatic combined linear midshaft clavicle fracture and ACJ injury simultaneously treated with Knowles pin fixation.

CASE REPORT: A 60-year-old male patient presented a linear midshaft clavicle fracture in the emergency room (ER) due to a road traffic accident. A linear fracture progressed to a displaced fracture at followup in the outpatient orthopedic department 3 days later. After open reduction with Knowles pin fixation for displaced clavicle fracture, postoperative followup radiographs revealed unexpected ipsilateral type V ACJ dislocation according to Rockwood classification. The next day, a closed reduction with percutaneous Knowles pin fixation was performed for ACJ dislocation. At the 1-year followup, radiographic and clinical results demonstrated complete union of the clavicle fracture and anatomic reduction of the ACJ with painless and full range of motion.

CONCLUSIONS: This report highlights that even a linear midshaft clavicle fracture can be combined with ipsilateral ACJ dislocation if the traumatic injury was caused by a high-energy road traffic accident. Therefore, an intraoperative stress view of the injured shoulder is recommended to recheck the stability of the ACJ after the clavicle fracture fixation to prevent a missed ACJ injury. In our case, an excellent outcome was achieved by using Knowles pin fixation simultaneously to treat the dual shoulder injury.

Keywords: Acromioclavicular Joint, Clavicle, Cost Savings, Fracture Fixation, Internal

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923