Value of Upright X-Rays in Diagnosis ofACJoint Injuries in Polytrauma Patients

Acromioclavicular (AC)jointinjury is a common orthopaedic problem that can occur following trauma, but may be underdiagnosed in patients with multiple injuries. In the polytrauma patient, X-rays are commonly done in the supine position, which leads to an underestimation of the amount of displacement of the AC joint. When suspecting an AC joint separation, upright or standing images are needed, without support of the injured arm, in order to classify the injury and guide further management. If initial films are nongravity weight- ed images, they are not adequate and further follow-up is necessary. This manuscript outlines a standard protocol for obtaining upright radiographs to evaluate the AC joint, and describes the clinical course of three polytrauma patients who initially had under-diagnosed AC joint injuries. Only after their injuries were stabilized and the patients underwent upright radiographs were their high-degree injuries demonstrated and treatment recommendations changed from nonoperative to operative intervention.