Shoulder: Trauma

Clavicular Fractures Following Coracoclavicular Ligament Reconstruction with Tendon Graft: A Report of Three Cases

Turman KA, Miller CD, Miller MD (Univ of Virginia Health System, Charlottesville) J Bone Joint Surg Am 92:1526-1532, 2010^§

Abstract

Background

Over 60 techniques have been developed to surgically manage severe acromioclavicular joint separations. An anatomic reconstruction of both the conoid and the trapezoid coracoclavicular ligament is especially appealing because these ligaments act synergistically to limit displacement of the acromioclavicular joint, improving the stability of the joint and enhancing clinical outcome. Few reports note the complications associated with newer techniques such as this. Seven patients had reconstruction of the coracoclavicular ligaments with an anatomic tendon graft technique, and three suffered complications related to the clavicular fixation.

Case Reports

Case 1: Man, 26, had a Rockwood type-V acromioclavicular separation after a bicycle accident. Tibialis anterior allograft reconstruction was done, including clavicular tunnels 7 mm in diameter to accommodate the graft. Two weeks later there was anatomic reduction of the acromioclavicular joint, but the patient did not return until 4 months postoperatively, when he had reinjured the shoulder while white-water rafting a month earlier. There was a healing clavicular fracture through the lateral bone tunnel with minimal displacement and visible callus formation. The acromioclavicular joint reduction was maintained. Conservative treatment was undertaken.

Case 2

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