Mistake in diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Unexpected drug reaction , Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Ruyi Zou, Min Wu, Jianzhong Guan
Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China (mainland)
Am J Case Rep 2020; 21:e924889
Available online: 2020-09-02
Bipolar dislocation of the clavicle is a rare disease that is often associated with some high-energy injuries. It refers to concomitant dislocation of the ipsilateral acromioclavicular joint and sternoclavicular joint. Because of its rarity, the diagnosis of bipolar dislocation of the clavicle is often difficult. Additionally, few reports are available on its treatment. Here, we describe a case of bipolar dislocation of the clavicle in which a secondary operation was needed because of a missed diagnosis. However, after surgery for bipolar dislocation of the clavicle, the clavicle shaft had a fracture that required reoperation.
CASE REPORT: A 58-year-old woman presented at our hospital with left shoulder pain. The patient had a history of sternoclavicular joint (SCJ) reconstruction and had a plate for left SCJ dislocation inserted 1 month ago at another hospital. Plain radiography images revealed that the left acromioclavicular joint (ACJ) was dislocated. We performed ACJ reconstruction with a hook plate. However, 4 weeks after the operation, the patient fell and visited to our hospital with left shoulder pain again. Plain radiography images revealed a left clavicle shaft fracture. We removed the plates from both ends of the clavicle and performed an open reduction and internal fixation using the long clavicular plate for clavicle shaft fracture.
CONCLUSIONS: Bipolar dislocation of the clavicle is frequently missed at the first diagnostic imaging examination; therefore, careful attention is required when SCJ or ACJ dislocation is observed. This case suggested that clavicle shaft fracture can occur after reconstruction of the SCJ and ACJ for bipolar dislocation of the clavicle. We conducted a literature review of this related case, highlighting the treatment of such cases.
Keywords: Bipolar Disorder, Clavicle, Fracture Fixation