Dislocation of the clavicle: causes, symptoms, diagnosis, treatment

ICD-10 code

• 543.1. Dislocation of the acromioclavicular joint.
• 543.2. Dislocation of the sternoclavicular joint.

Dislocation of the clavicle accounts for 3-5% of all dislocations.

What causes dislocation of the clavicle?

They arise mainly as a result of an indirect mechanism of injury : a fall on the forearm or a withdrawn arm, a sharp contraction of the shoulder-blades in the frontal plane.

Dislocation of clavicle (acromial end)

ICD-10 code

S43.1. Dislocation of the acromioclavicular joint.

Anatomy

On the outside, the clavicle retains the acromioclavicular and coracoid-clavicular ligament.

Classification of dislocation of the clavicle (acromial end)

Depending on the severance of which ligament has occurred, distinguish between complete and incomplete dislocations. When a single acromioclavicular ligament is broken, the dislocation is considered incomplete, with a break of both - complete.

Symptoms of clavicle dislocation (acromial end)

Complaints of pain in the acromial joint zone, moderately limiting movements in the shoulder joint.

Diagnosis of clavicle dislocation (acromial end)

A characteristic mechanism of injury in history. The place of damage is marked by edema and deformity. Her severity depends on how dislocated: full or incomplete - we are dealing. At full dislocations the acromial end will stand out considerably, its external surface is probed under the skin, and when the scapula moves with the scapula it remains motionless. With incomplete dislocations, the clavicle retains its connection with the scapula through the coracoid-clavicular ligament and moves along with the scapula; the outer end of the clavicle can not be probed. Palpation in all cases is painful.

When pressing on the clavicle, the dislocation is quite easily eliminated, but it is necessary to stop the pressure - it reappears. This is the so-called "key symptom" - a reliable sign of the rupture of the acromioclavicular joint.

Laboratory and instrumental research

Radiography facilitates the diagnosis. When reading the radiographs, attention should be paid not so much to the width of the articulation gap (its magnitude is variable, especially with incorrect styling), but rather to the position of the lower edge of the clavicle and the acromial process. If they are on the same level, then the ligamentous apparatus is intact and there is no dislocation, and the displacement of the clavicle upward is a sign of pathology.

Treatment of dislocation of the clavicle (acromial end)

Distinguish conservative and operative ways of treatment of a dislocation of a clavicle (an acromial end).

Conservative treatment of clavicle dislocation (acromial end)

The direction of the dislocated acromial end of the clavicle presents no difficulties, however, it is rather difficult to keep it in the right position with conservative methods. For fixation use a variety of bandages, tires and apparatus, supplemented by a peloton, pressing on the acromial joint. Let's consider some of them.

Bandage of Volkowig. After anesthetic damage, 20-30 ml of a 1% procaine solution refills the clavicle. On the acromial-clavicular articulation area, a cotton-gauze peloton is applied, fixing it with a strip of sticky plaster from the acromial process through the forehead posteriorly and downwards, then along the back surface of the shoulder, around the elbow joint and return along the front surface of the shoulder to the starting point. The bandage is applied with the shoulder removed from the outside and back. In the axillary region, a small cushion is inserted, the arm is lowered and a kerchief is fixed.

Another way to fix the pelota is to apply a plaster bandage with the shoulder removed from the shoulder strap to the lower third of the shoulder along the outer surface. Fixation is supported by a second strip, running perpendicular to the first (crosswise). The arm is lowered, which increases the tension of the patch and the retention of the clavicle. And that and other plaster bandages it is expedient to reinforce the application of dezo bandages.

The cast is the most common method of fixation. Apply various modifications of thoracobrachial bandages, Deso's gypsum dressing and others, but with the obligatory use of peloids.

Term immobilization for all conservative methods is 4-6 weeks. In the future, rehabilitation treatment is shown.

Surgical treatment of clavicle dislocation (acromial end)

If the conservative treatment is unsuccessful and when chronic dislocations of the patients should be sent to a hospital for surgical treatment.

Its essence lies in the creation of an acromial-clavicular and beak-clavicular ligaments from autotkaines, allotkins or synthetic materials (silk, kapron, lavsan). The most frequently used operations are the method of Bohm, Bennel, Watkins-Kaplan.

After surgical intervention, a gypsum thoracobrachial bandage is applied for a period of 6 weeks.

Bringing down the simplicity of the operation of restoring the acromial-clavicular articulation with knitting needles, screws, by sewing and other similar methods without plasty of the coracoid-clavicular ligament should not be performed because of the large number of relapses. The biliary-clavicular ligament is the main ligament responsible for retaining the clavicle.

Estimated period of incapacity for work

Workability is restored in 6-8 weeks.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]

Dislocation of clavicle (sternal end)

ICD-10 code

S43.2. Dislocation of the sternoclavicular joint.

Classification of dislocation of the clavicle (sternal end)

Depending on the displacement of the inner end of the clavicle, there are pre-hereditary, supragradinous and retrosternal dislocations. The last two are extremely rare.

What causes dislocation of the clavicle (sternal end)?

Dislocation of the sternal end of the clavicle occurs as a result of an indirect mechanism of injury: excessive deviation of the shoulder and the forelegs posteriorly or anteriorly.

Symptoms of dislocation of the clavicle (sternal end)

The patient is concerned about pain in the sternoclavicular joint.

Diagnosis of dislocation of the clavicle (sternal end)

In the history - the corresponding injury. In the upper part of the sternum, protrusion is determined (excluding the retrosternal dislocation), which is displaced by the mixing and dilution of the shoulder and deep breathing. The tissues are edematous, painful on palpation. The forearm on the side of the injury is shortened.

Laboratory and instrumental research

Obligatory radiography of both sternoclavicular articulations in a strictly symmetrical arrangement. In the dislocation, the sternal end of the clavicle moves upward and toward the midline of the body. In the picture, his shadow covers the vertebral shadow and is projected higher compared to the healthy side.

Treatment of dislocation of the clavicle (sternal end)

Surgical treatment of clavicle dislocation (sternal end)

The best anatomical and functional results are achieved in the surgical treatment of this lesion.

The most commonly performed operation is the method of Marxer. Fix the clavicle to the sternum with a U-shaped trans-osal suture. Apply a diverting splint or a thoracobrachial gypsum bandage for 3-4 weeks.

Estimated period of incapacity for work

Workability is restored after 6 weeks.

[13], [14], [15], [16], [17], [18], [19], [20], [21]

Classification of clavicle dislocation

There are dislocations of the acromial and sternal ends of the clavicle, and the former are found five times more often. It is very rare to find a dislocation of both ends of the collarbone at the same time.

[22], [23], [24], [25]