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Abstract: Fractures of the acromion end of the clavicle can occur directly in adults who fall during sports in daily life, or in high-energy traffic trauma. In this case, the patient fell during sports one hour before the visit, resulting in a fracture of the acromion end of the right clavicle, which was confirmed by radiographic examination. In order to restore the function of the shoulder joint as soon as possible and to be able to continue to exercise, surgical repositioning and fixation treatment was considered, through which the patient’s fracture was repositioned and fixed, shoulder pain was relieved, and the range of motion of the shoulder joint was restored.
Basic information】Male, 41 years old
Disease Type】Fracture of the acromion of the clavicle
Hospital】Harbin First Hospital
Date of Consultation】May 2022
Treatment plan】Surgery (internal fixation with incision screw) + medication (calcium carbonate tablets) + rehabilitation (passive movement of shoulder joint)
Treatment period】7 days of inpatient treatment, 8-10 weeks of outpatient follow-up, 1 year after removal of the internal fixation screws
Results】Fracture repositioning and fixation, shoulder pain relief, shoulder joint range of motion restored
I. Initial consultation
The patient lost her balance and fell while playing basketball, and the palm of her hand supported the ground, causing a fracture of the acromion of the clavicle through force transmission, resulting in shoulder swelling, pain and impaired movement. After an orthogonal X-ray examination of the shoulder joint, the results showed that the clavicle was fractured at the acromion. Considering that the fracture alignment was acceptable, the patient was recommended to be treated conservatively with suspension fixation, but due to the patient’s high demand for movement and inability to adhere to long-term sling fixation, the patient requested to be considered for surgical treatment. The patient was informed in detail that the fracture of the acromion of the clavicle could produce heavy bone and soft tissue damage, and that the local bone healing and shaping ability would be significantly reduced, which could also affect the smooth healing of the fracture. The patient was informed and consented to the surgical treatment.
(Preoperative x-ray)
II. Treatment history
During the surgical incision and repositioning of the patient, soft tissue was found to be embedded in the fracture end, so the soft tissue was removed and the hematoma at the fracture end was cleared, the fracture end was repositioned, and the fracture surface was fixed vertically using two screws. After fixation, the shoulder joint was moved passively and no movement of the fracture end was detected. The entire procedure was performed with minimal surgical trauma and stripping of the periosteum. Due to the good alignment of the fracture, no autogenous cancellous bone graft was used, and the operation was smooth. Postoperatively, the patient was given oral calcium carbonate tablets to increase nutrition to promote bone scab formation at the fracture end, and the patient was given early passive movement of the shoulder joint by the rehabilitation physician to ensure the range of motion of the shoulder joint.
(Postoperative X-ray)
III. Treatment effect
The surgical treatment enabled the patient to resume shoulder joint movement early, effectively preventing shoulder stiffness and avoiding the possibility of blood clots in the upper extremity. The patient reported that the pain symptoms were completely relieved 3-5 days after surgery; the pain disappeared completely after 1 week, and with the help of the rehabilitation doctor, he could passively elevate the shoulder joint and actively contract the deltoid muscle, which effectively promoted the decreasing of swelling and absorption of bruising in the operated area of the shoulder, and he slept well at night with no pain symptoms in the left lateral and supine positions. The patient was discharged after 7 days of hospitalization and was instructed to come back to the hospital for a review in 8-10 weeks.
IV. Precautions
We are glad that the patient’s symptoms were relieved after the surgical treatment. However, the patient still needs to be protected with a tricot for 6 weeks after surgery and to review the radiographs at 8-10 weeks after surgery. In addition, nutrition needs to be increased and no weight-bearing on the right upper extremity should be used until the fracture heals, and calcium carbonate tablets should be taken to facilitate fracture healing at the acromion of the clavicle. The internal fixation screw should be taken out in a timely manner 1 year after surgery to avoid foreign body reaction and breakage of the internal fixation screw. Before the removal of the internal fixation screw, the patient should not play confrontational sports, such as basketball, rugby, wrestling, etc., to avoid local osteoporosis of the clavicle, which may lead to another fracture of the acromion of the clavicle.
V. Personal insight
The fracture of the acromion of the clavicle occurred mainly because the patient participated in a confrontational sport and fell. Since the acromion of the clavicle is located under the skin, it is the part of the upper limb that connects the bone to the trunk and is susceptible to fracture by external forces. Therefore, the patient should be seen immediately after the injury and treated with surgical incision and internal fixation to ensure that the fracture end is accurately repositioned and fixed, and the range of motion of the shoulder joint is fully protected after surgery. In daily life, care should be taken to protect the acromion of the clavicle and to prevent fracture of the acromion of the clavicle by not using the upper limb to support the ground when performing confrontational sports and falling.