Middle-Third Clavicle Fracture With Associated Type IV Acromioclavicular Separation: Case Report and Literature Review


Review of available English literature suggests that combined injuries involving a clavicle shaft fracture and an acromioclavicular (AC) separation are rare. The force dissipation after the occurrence of either a midshaft clavicle fracture or an AC separation typically renders the injuries mutually exclusive. This article presents a review of literature on this combined injury pattern. A variety of treatment approaches have been put forth, including nonoperative, operative, and hybrid management of the two distinct injuries. The most appropriate treatment rendered depends on the degree of AC joint instability. This case report involves a midshaft clavicle fracture associated with a type IV AC separation in a patient ejected during a high-speed motor vehicle collision. Internal fixation of each injury was chosen and the patient had a successful final result. Other reported treatment options and recommendations are reviewed. (Journal of Surgical Orthopaedic Advances 22(2):183–186, 2013)

Shane K. Woolf, MD; Brandon J. Valentine, MD; William R. Barfield, PhD;
and Langdon A. Hartsock, MD