A Distal Clavicle Fracture With Unusual Displacement of the Medial Part: A Case Report

Abstract

Introduction: A 22-year-old man came to the emergency department after a fall on right shoulder. The radiographs showed a distal clavicle fracture with apparent disruption of the acromio clavicular joint (AC-joint). The CT-scan however showed an intact AC-joint with a Neer type IIb fracture pattern, except for a dislocation of the medial fragment to dorsocaudal.
Intervention: Ten days after trauma the patient was treated with open reduction and internal fixation using a hook plate.
Outcome: Six weeks after surgery the patient had no pain and full range of motion of the arm.
Discussion: There are two ways to classify a distal clavicle fracture; the Craig’s classification or the Neer classification. In both classifications there is the medial part of the clavicle is elevated in a type IIb distal clavicle fracture. The X-ray in this case was misleading, appearing as a disruption of the AC-joint. In this case there probably was a blow to the shoulder and the medial part of the clavicle was pushed caudally and got captured under the distal fragment of the clavicle. There are two systematic reviews and one meta-analysis about the treatment of a distal clavicle fracture. They all state that a hook plate is the most frequently used fixation technique, although it seems to have the highest complication rate.