Current concepts in the diagnosis and management of acromioclavicular dislocations

Not all complete dislocations of the acromioclavicular joint should be treated by one method alone. A classification of acromioclavicular dislocation is presented and is based upon the pathology of the injury. Grade I sprain results from a mild force that causes tearing of only a few fibers of the acromioclavicular joint. Grade II sprains are caused by a moderate force with a rupture of the capsule and acromioclavicular ligament. Grade III sprains result from a severe force that ruptures both the acromioclavicular and coracoclavicular ligaments and causes a dislocation of the joint. Grade IV dislocation may be associated with an avulsion fracture of the coracoclavicular ligament from the inferior lateral clavicle, severe tearing or other injury to the soft-tissue envelope about the lateral clavicle, or a buttonhole injury of the lateral clavicle. Grade V dislocation refers to a posterior displacement of the lateral clavicle from any cause, while Grade VI relates to an inferior lateral clavicle displacement. Grades I, II, and most Grade III injuries can be treated conservatively. The indications for open treatment of Grade III injuries are reviewed. It is recommended that Grade IV and most Grade V and VI dislocations be managed with open methods.