Soft tissue reconstruction on the very late presenting neglected acromioclavicular dislocation Rockwood type IV. A case report. (June 2022)

• Record Type: Journal Article
• Authors: Prasetia, Renaldi; Kristian, Hans; Rahim, Agus Hadian; Ismiarto, Yoyos Dias; Rasyid, Hermawan Nagar
• Is Part Of: International journal of surgery case reports. Volume 95(2022)
• Publication Date: 2022-06
• Subjects: Acromioclavicular joint -- Acromioclavicular dislocation -- Rockwood type IV -- Soft tissue reconstruction -- AC and CC reconstruction -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2022.107171
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction and importance: Acromioclavicular (AC) joint dislocation Rockwood type IV is a rare condition characterized by the posterior displacement of the distal clavicle and soft tissue damage. The rate of soft tissue healing markedly decreases as time from injury increases. In this case report, we had a very late presenting neglected AC joint dislocation Rockwood type IV successfully treated by AC and coracoclavicular (CC) reconstruction. Case presentation: A 24-year-old female presented with pain around her right shoulder since a motorcycle accident four years prior to current presentation. She was diagnosed with a posterior AC joint dislocation and suggested undergoing surgery, but she refused and chose to seek an alternative treatment. The patient felt pain chronically and could not elevate her shoulder, and she decided to come to our hospital. We performed a physical and radiograph examination that showed an AC joint dislocation Rockwood type IV. The management, suggested to the patient, was AC and CC soft tissue reconstruction. Clinical discussion: The advantages of using this procedure were to restore effective anatomy and avoid bone-to-bone contact between the clavicle and acromion. The disadvantages were increased cost and needed to be evaluated for long-term results. We considered the idea of maintaining AC joint reduction by biologic soft tissue healing of the graft and augmentation fixation to replace the CC ligaments. We could not rely on biological soft tissues healing themselves due to the chronicity. Conclusion: AC and CC reconstruction can be an option of treatment in neglected AC joint dislocation Rockwood type IV with excellent clinical and radiographic results. Highlights: Acromioclavicular (AC) joint dislocation Rockwood type IV is a rare condition. Soft tissue reconstruction on the neglected acromioclavicular dislocation Rockwood type IV gives excellent clinical and radiographic results. The advantages of using these procedures were restoring effective alignment between the clavicle and acromion and reconstructing the acromioclavicular (AC) ligament and coracoclavicular (CC) ligament.