Inferior acromio-clavicular disjunction stage VI with clavicular shaft fracture: Very rare case report and review of the literature

Yassine El Qadiri 1, 2, *, Vinh Le Thai 2, Charaf Eddine Berouag 1, Yassir El Andaloussi 1, Maroun Raad 2, Constantin Balasoiu 2, Michel Brax 2 and Mustapha Fadili 1

1 Department of Orthopaedic, Traumatology A4 university hospital Ibn Rochd Casablanca, Morocco.
2 Department of Orthopaedics, HAGUENAU hospital HNA group, France.
 
Research Article
International Journal of Science and Research Archive, 2024, 11(01), 2575–2578.
Article DOI: 10.30574/ijsra.2024.11.1.0346
Publication history: 
Received on 14 January 2024; revised on 23 February 2024; accepted on 26 February 2024
 
Abstract: 
Introduction and importance: Acromioclavicular dislocations are relatively common in the young, athletic population. We report a rare case of a rockwood stage VI acromioclavicular dislocation associated with one of the clavicle. This is the case of a patient who presented with an inferior right acromioclavicular dislocation associated with a well-engaged mediodiaphyseal fracture of the right clavicle, treated surgically with a good functional result. Our work will be based on the study of this case, with a review of the clinical and therapeutic literature.
Case report: This is a 41-year-old female patient who presented to the emergency department with closed trauma of the right shoulder following a fall from a horse, with direct landing on the right shoulder. She complained of pain with total functional impotence of her right upper limb, with no downstream vascular-nervous disorders or other associated lesions. X-rays of the right shoulder face and profile with lamy and a right accromioclavicular defilement were consistent with Rockwood stage VI inferior right acromioclavicular dislocation associated with a well-engaged medio-diaphyseal fracture of the right clavicle.
Treatment was surgical, with osteosynthesis of the right clavicle and reduction of the acromioclavicular joint, with satisfactory stability control, supplemented by immobilization in an elbow-to-body brace for 3 weeks and free mobilization beyond 3 weeks, as well as muscle strengthening from the 6th postoperative week.
Discussion: Very few cases of type VI acromioclavicular dislocation have been found in the literature. These dislocations are observed very rarely and are difficult to diagnose in the early clinical findings, or may simply be overlooked due to the association of multiple traumas, as well as being associated with fractures of the acromion, clavicle, scapula and/or ribs.
The therapeutic attitude is controversial, although surgical techniques differ, and conservative treatment with therapeutic abstention takes its place.
Acromioclavicular dislocations must be classified into subtype VI-A for the subacromial and subtype VI-B for the subcoracoid, in order to codify the therapeutic attitude.
Surgical treatment of this type of dislocation guarantees a satisfactory functional outcome, and our work supports this observation and is in line with the literature.
Conclusion: Rockwood stage VI acromioclavicular dislocations, with its 2 subtypes, remain rare lesions requiring adequate surgical treatment with early and appropriate rehabilitation to ensure satisfactory functional results.
 
Keywords: 
Acromioclavicular joint; Surgery; Dislocation; Clavicle
 
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