A-C Joint Dislocations
The ac-joint dislocation is a common injury in contact sports such as hockey, football, and even snowboarding.
Classification - Rockwood
- Type 1 sprain
- Type 2 partial subluxation tear of ac joint ligaments only
- Type 3 complete tear of ac joint ligaments and coraco-clavicular ligaments
- Type 4 - posterior dislocation
- Type 5 - marked superior dislocation
- Type 6 - anterior dislocation under coracoid
Case Report
What is the best management in a 22 y/o right handed football quarter back with type 3 ac dislocation on right side?
The type 3 ac joint dislocation.
conservative should you brace or not? Does it make any difference in the long term?
The conservative management can be entertained when you can reduce the dislocation. You can appreciate from this picture that we have not completely reduced this dislocation. More pressure has to be applied on the clavicle to reduce the dislocation. The standing x-ray will confirm the reduction.
conservative should you brace or not? Does it make any difference in the long term?
The conservative management can be entertained when you can reduce the dislocation. You can appreciate from this picture that we have not completely reduced this dislocation. More pressure has to be applied on the clavicle to reduce the dislocation. The standing x-ray will confirm the reduction.
If you can reduce the clavicle with your hand, then the conservative treatment with the brace may be more effective than treatment with a sling. The result will not be perfect, but in my experience is better than treatment with a sling.
You must monitor this treatment with weekly xrays. The strap will usually have to be tightened weekly. The course of treatment is 4-6 weeks.
- operative what technique?
The current treatment at our clinic for the acute dislocation is transarticular fixation with a malleolar screw. This will have to be removed by 3 months, or the screw may break.
The decision to return to play depends on the side involved, the position played and the rehab. Usually it will take 3 months of healing and rehab before return to play. A quarterback who injures his throwing arm may be out for the entire season. In some situations, it may be more expedient to treat the dislocation conservatively, allow early return to play, and at the end of the season, reconstruct the a-c joint.
- What is the best treatment for the untreated type 3 dislocation of the ac joint?
The Neviasser procedure is probably the best. This is resection of the end of the clavicle, and bringing up the coraco-acromial ligament to the end of the clavicle. A trans-fixtion pin is also used to hold the end of the clavicle down until the soft tissues are healed. Some authors, such as Rockwood, use a Bosworth screw to hold the end of the clavicle down.
The Neviasser procedure. (from Campbells Operative Orthopedics)
