A rare case of a middle-third clavicle fracture concurrent with ipsilateral acromioclavicular dislocation in a 46-year-old women who had fallen off her bicycle is presented. The clavicular fracture was managed by locking plate osteosynthesis. The acromioclavicular joint was stabilised by traction osteorrhaphy that was removed at 7 weeks after the procedure. Both the radiographic and clinical outcomes were very good. The epidemiology, aetiology, diagnosis and therapy of this injury are discussed.

• MeSH
• akromioklavikulární kloub diagnostické zobrazování   zranění   MeSH
• fraktury kostí diagnostické zobrazování   chirurgie   MeSH
• klíční kost diagnostické zobrazování   zranění   MeSH
• kostní destičky MeSH
• lidé středního věku MeSH
• lidé MeSH
• luxace ramenního kloubu diagnostické zobrazování   chirurgie   MeSH
• radiografie MeSH
• trakce MeSH
• úrazy pádem MeSH
• vnitřní fixace fraktury MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE OF THE STUDY: To present the TightRope (Arthrex, Naples, FL) technique and its results in the arthroscopic stabilisation of acute acromioclavicular joint (ACJ) dislocation carried out at our department. MATERIAL AND METHODS: From July 2009 till December 2010, arthroscopic stabilisation of acute ACJ dislocation was performed in 22 patients. The group consisted of 18 men and four women with an average age of 37.4 years. The Rockwood type III to type V ACJ dislocations (III, 16; IV, 1; V, 5) were indicated for surgery. The average interval between injury and surgery was 5.4 days. In all cases, a second-generation TightRope implant was inserted by the EndoButton technique joining the distal end of the clavicle and the coracoid process. The results were evaluated using the UCLA Shoulder Scale at 6 months after surgery. RESULTS: All 22 patients returned to their pre-operative activities without any restriction of shoulder motion within 5 months of surgery. The average post-operative UCLA score was 31.2 points (range, 28 to 35). Radiographic evidence of the loss of full reduction, with no effect on the clinical outcome, was recorded in four patients (18%) during post-operative rehabilitation. Of these, one had Rockwood type III, two had type IV and one had type V dislocations. One patient suffered post-operative pull-out of the implant from the coracoid; three patients showed skin wound healing by second intention above the lateral clavicle, with one requiring surgical repair under local anaesthesia. There was no neurovascular complication, intra- or postoperative fracture of the coracoid process or lateral clavicle, or deep wound infection. DISCUSSION: Arthroscopic stabilisation of acute ACJ dislocation is a minimally invasive procedure providing the coracoclavicular ligament complex with dynamic stability. In comparison with open procedures, it is less painful post-operatively, allows the patients to return early to daily activities and has a better cosmetic effect. It eliminates the necessity of removing the osteosynthetic material, as is the case in commonly used techniques such as Bosworth's method, K-wiring, osteorrhaphy or hook plate insertion. The loss of full reduction in four patients, as observed on radiographs during their rehabilitation, was not accompanied by any clinical problems and is in agreement with the findings of other authors. In our group, it occurred in Rockwood grade IV and grade V dislocations. For these, there is a possibility of using two implants in order to increase stability and prevent the loss of full reduction but this involves a higher risk of coracoid fracture, extension of operative time and higher costs. However, a loss of reduction in some patients has also been reported by the authors who have used two implants. Therefore we prefer using a single TightRope implant, particularly in acute grade III ACJ dislocations requiring surgical treatment in patients engaged in repetitive overhead activities related to sports or occupation. CONCLUSIONS: Arthroscopic stabilisation of acute ACJ dislocations using a single TightRope implant is an elegant minimally invasive method with good results in indicated cases. It proves efficient particularly in Rockwood type III injuries in patients who have to do repetitive overhead activities. Acute type IV and type V ACJ dislocations treated by this technique show a loss of full reduction on radiographs more frequently, although no effect on the clinical outcome is evident.

• MeSH
• akromioklavikulární kloub diagnostické zobrazování   zranění   patofyziologie   MeSH
• artroskopie * škodlivé účinky   přístrojové vybavení   metody   MeSH
• čas zasáhnout při rozvinutí nemoci MeSH
• dospělí MeSH
• interní fixátory MeSH
• lidé MeSH
• luxace ramenního kloubu diagnóza   patofyziologie   chirurgie   MeSH
• obnova funkce MeSH
• pooperační komplikace diagnóza   MeSH
• pooperační období MeSH
• radiografie MeSH
• retence protézy škodlivé účinky   metody   MeSH
• retrospektivní studie MeSH
• rozsah kloubních pohybů MeSH
• selhání protézy etiologie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Complex injuries of the shoulder are comparatively rare. Within the field of complex shoulder injuries this article particularly deals with the diagnosis and therapy of the "floating shoulder injury" as a review article. This term describes a discontinuation of the osseus and soft tissue suspension of the upper extremity from the axial skeleton. By literature review and involvement of recent biomechanical studies this article will show the injury patterns that lead to instability of the shoulder girdle and the therapeutic to be employed in respective cases. Key words: shoulder, floating shoulder, clavicle fracture, scapula fracture.

• MeSH
• akromioklavikulární kloub diagnostické zobrazování   zranění   MeSH
• dislokace kloubu komplikace   diagnostické zobrazování   chirurgie   MeSH
• fraktury kostí komplikace   diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• lopatka diagnostické zobrazování   zranění   MeSH
• radiografie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

We report ten patients (all boys) with distal clavicular physeal injuries. Eighty percent of the injuries occurred on the right side. Nine boys were treated conservatively, but one required operation. Kirschner wire osteosynthesis was performed. Regardless of the type of treatment, all patients healed without functional sequelae. In seven of the nine treated conservatively, however, a deformity of the injured shoulder resulted. I suggest that in cases of great displacement of the central metaphyseal fragment resulting in shortening of the clavicle an open reduction with internal fixation is indicated for cosmetic reasons.

• MeSH
• akromioklavikulární kloub diagnostické zobrazování   zranění   MeSH
• dislokace kloubu diagnostické zobrazování   terapie   MeSH
• dítě MeSH
• klíční kost diagnostické zobrazování   zranění   MeSH
• lidé MeSH
• mladiství MeSH
• radiografie MeSH
• sportovní úrazy diagnostické zobrazování   terapie   MeSH
• trakce MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH