Subcoracoid acromioclavicular joint dislocation (Rockwood type VI) sustained in motorcycle crash: A case report

We present the case of a young male who sustained a rare acromioclavicular joint (ACJ) injury during a road traffic accident. A left-sided ACJ injury was identified on plain radiographs fourteen days following a motorcycling accident during which significant distracting injuries were sustained. Owing to persistent shoulder pain during awake tertiary surveillance, repeat shoulder plain radiographs were obtained, along with re-examination of the patient's index computed tomography (CT) shoulder imaging, indicating a grade VI left-sided acromioclavicular subluxation. The patient underwent operative management of the above injury at three weeks, with initial examination under anesthetic revealing a stiff shoulder joint significantly limited external rotation requiring extensive release of fibrosis. The left ACJ was reduced under anesthesia, being temporarily secured with Kirschner wire insertion. A Synthes locking distal tibial "L" plate was contoured and applied across the AC joint, and secured with locking screws. Intensive post-operative physiotherapy resulted in an significantly improved post-operative range of motion in the patient's left shoulder. Acromioclavicular joint injuries, commonly shortened to ACJ injuries, are most regularly traumatic in etiology, ranging in severity from mild sprain to complete joint disruption. ACJ injuries are classified according to the position of the clavicle with respect to the acromion and coracoid. The above case highlights the requirement for comprehensive tertiary surveillance of trauma patients both pre and postextubation, in order to identify such injuries that may require prompt surgical management in order to restore range of motion and function in affected joints.