Overview
Fracture dislocation of the acromioclavicular (AC) joint involves disruption of the joint with associated fractures, often classified by severity (grades 1-6). Grade 3 dislocations typically involve significant ligamentous disruption and often coexist with other shoulder pathologies requiring additional treatment 1.Diagnosis
Key Diagnostic Criteria: Radiographic evaluation, including axillary lateral views, to identify AC joint disruption and associated fractures such as coracoid process fractures 2.
Recommended Tests: X-rays are primary; MRI or CT may be needed for detailed assessment of soft tissue injuries and associated lesions 1.
Grading: Classification systems (e.g., Rockwood classification) help stratify severity, guiding management decisions 1.Management
First-Line Treatments: Non-surgical management with immobilization for less severe cases (grades 1-2) 1.
Adjunctive Treatments: Surgical intervention often required for grade 3 and higher dislocations, addressing both AC joint stabilization and associated lesions like SLAP tears 1.
Specific Interventions: Arthroscopic evaluation and treatment of associated shoulder pathologies during surgery can improve outcomes 1.Special Populations
Younger Patients: Higher incidence of associated lesions requiring surgical intervention compared to older patients 1.
Acute vs Chronic: Younger acute patients show significantly different rates of needing additional surgical treatments compared to older acute patients 1.Key Recommendations
Concomitant arthroscopic evaluation is recommended for grade 3 AC joint dislocations to identify and treat associated shoulder lesions (Evidence: Moderate 1).
Suspect coracoid process fractures in AC dislocations occurring in younger patients (first three decades) and consider axillary lateral imaging (Evidence: Weak 2).
Surgical intervention may be necessary for optimal outcomes in grade 3 AC joint dislocations, especially in younger patients with acute injuries (Evidence: Moderate 1).References
1 Arrigoni P, Brady PC, Zottarelli L, Barth J, Narbona P, Huberty D et al.. Associated lesions requiring additional surgical treatment in grade 3 acromioclavicular joint dislocations. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2014. link
2 Bernard TN, Brunet ME, Haddad RJ. Fractured coracoid process in acromioclavicular dislocations. Report of four cases and review of the literature. Clinical orthopaedics and related research 1983. link