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Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

AC Joint Separation



- Discussion:
    - tears of AC & CC ligaments (from fall on tip of shoulder) allows upper limb to drop away from clavicle, producing separation of AC joint;
    - diff dx:
          - distal clavicular physeal separation:
                  - childhood equivolent of AC separation;
          - atraumatic AC joint laxity: (from ligamentous laxity)

                 

- Classification:
    - Rockwood Classification:
          - type I:
                   - sprain of joint with out a complete tear of either ligament
          - type II:
                   - tear of AC ligaments w/ coracoclavicular ligaments intact;
                   - will not show marked elevation of lateral end of clavicle;
          - type III:
                   - in this injury both AC & CC ligaments are torn;
                   - > 5 mm elevation of AC joint w/o weights is consistent w/ severe type II or a type III injury;
                   - need to distinguish this from type III clavicular fracture
          - type IV:
                   - distal clavicle impaled posteriorly into trapezial fascia;

          - type V:
    - Basamania Classification:  

          - essentially relies on whether the distal clavicle is stable or unstable;
          - w/ more than 50-75 % displacement on static films or more than 100% displacement on a cross arm AP, there will be disruption of not only the AC ligaments but also the CC ligaments;
          - clinically, an unstable AC separation will cause significant prominence of the distal end of the clavicle when the arm is distracted in adduction;

                   

- Radiograph:
    - Cross Body Adduction View:
          (from C.J. Basamania MD personal communication, 1997);

         
    - case example:
           

          - 20-year-old who fell on tip of right shoulder, but did not show radiographic signs of AC joint injury in the ER;
          - one month later the patient continued to have pain, and radiographs demonstrated greater than 100 percent displacement of AC joint on both AP and Cross Body AP (Cross Adduction View);



- Operative Treatment:
         - Distal Clavicle Excision
         - Modified Weaver Dunn Procedure



Surgical treatment of acute type-V acromioclavicular injuries in athletes.

Four-year outcome of operative treatment of acute acromioclavicular dislocation.

Acromioclavicular joint injuries.

A classification of acute acromioclavicular dislocation: a clinical, radiological and anatomical study.

Late reconstruction of the ligaments following acromioclavicular separation.

Acute, complete acromioclavicular separation.

Conservative treatment of grade III acromioclavicular dislocations.

Percutaneous cannulated screw coracoclavicular fixation for acute acromioclavicular dislocations.

Complete acromioclavicular separations. A comparison of operative methods.

Dislocation of the acromioclavicular joint. An end-result study.

Conservative or surgical treatment of acromioclavicular dislocation. A prospective, controlled, randomized study.

Year Book: Four-Year Outcome of Operative Treatment of Acute Acromioclavicular Dislocation.

Acute dislocation of the acromioclavicular joint. Traumatic anatomy and the importance of deltoid and trapezius.

Repair of complete acromioclavicular separations using the acromioclavicular-hook plate.

Surgical treatment of acute type-V acromioclavicular injuries in athletes.

Comprehensive functional analysis of shoulders following complete acromioclavicular separation.

Conservative or surgical treatment of acromioclavicular dislocation. A prospective, controlled, randomized study.

Surgical treatment of acute type-V acromioclavicular injuries in athletes.

Radiological evaluation of the acromioclavicular joint.

Biomechanical study of the ligamentous system of the acromioclavicular joint.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, January 3, 2013 4:35 pm