Acromioclavicular Joint Injury Pathway Posted: 5/15/2020 ID: (C101461)

Acromioclavicular Joint Separation in 55M

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PRESENTATION
2
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POLLS
18,298
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OUTCOMES
2
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VIDEOS
3
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EVIDENCE
39
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Comments
22
CASE DESCRIPTION
AGE 55 / Male
CC Right shoulder pain and deformity
HPI A 55-year-old male presents with severe right shoulder pain and deformity following a high-speed motorcycle collision. He was initially treated with 6 weeks of conservative management with physical therapy. His pain persisted and remained severe.
PMH Otherwise healthy
PE His right shoulder shows a profound prominence, mobility, and tenderness over the distal clavicle. His range of motion is limited in all planes. He has reduced strength. His neurovascular status is intact.
Pre-procedure IMAGES:
https://upload.orthobullets.com/cases/101461/affd15f9-c171-457c-8a6c-f1d45e0f68cf_2.jpg https://upload.orthobullets.com/cases/101461/b3f3b42e-fc5a-49c7-86b9-d6447a8ef4e6_3.jpg
POLLS
OB Community
1) Would you obtain additional imaging studies to guide management?
Other
2) How would you classify this injury?
Other
3) Considering that the patient has failed 6 weeks of physical therapy, how would you manage this injury?
Other
4) If you choose Operative management, what surgical method would you perform?
Other
5) It you choose Fixation across AC joint only, what fixation technique would you use?
Other
6) If you choose Fixation to the Coracoid (+/- fixation across AC joint), what type would you use?
Other
7) If you choose Fixation to the Coracoid with a Synthetic implant, what fixation type would you use on the Coracoid?
Other
8) If you choose Ligament reconstruction, what surgical approach would you use?
Other
9) If you choose Ligament reconstruction, what type of graft would you use?
Other
10) If you choose Ligament reconstruction, what fixation techniques would you use on the Coracoid and Clavicle?
Other
11) If you choose Ligament reconstruction, in addition to graft fixation on the coracoid and clavicle, would you extend fixation of the graft to the acromium?
Other
12) If you choose Ligament reconstruction, would you include a distal clavicle resection?
Other
13) If you choose Ligament reconstruction, and obtained the fixation seen below, when would you start active ROM?
Other
CASE OUTCOMES
PROCEDURE 1: Diagnostic arthroscopy of the R shoulder; Open AC/CC reconstruction with allograft; Distal clavicle resection
Intra-procedure P1
https://upload.orthobullets.com/cases/101461/cc8fb72f-d4e4-409e-b9d1-985e6e94d185_1.jpg
Post-procedure P1
https://upload.orthobullets.com/cases/101461/98aec420-8c75-4716-894f-4d98167d8aa4_1.jpg
VIDEOS & PODCASTS (3)
EVIDENCE (39)
EXPERT COMMENTS