Classification of Injury

The classification of acromioclavicular joint injuries classically describes three types of injuries. Rockwood describes three others ( Fig 263:4). Types I, II, and III are common; types IV, V, and VI are rare. The anatomic injury, radiographic findings, and physical findings are summarized in T§Me.,..2.63-1.

FIG. 263-4. Classification of acromioclavicular joint injuries. (From Rockwood CA, Green DP, Bucholz RW: Rockwood & Green's Fractures in Adults, 3d ed. Philadelphia, Lippincott, 1991, with permission.)

TABLE 263-1 Classification and Physical Findings in Acromioclavicular Joint Injuries

Treatment

Treatment of type I injuries consists of rest, ice, analgesics, and immobilization, followed by early range-of-motion exercises. Most agree that type II injuries should be similarly treated. Various straps and braces have been used to reduce the dislocation, but none has proven successful. A simple sling remains the most convenient and effective. Prognosis for type I and II injuries is excellent, with only a small percentage who develop late symptoms requiring excision of the distal clavicle.

Treatment of type III injuries (Fig 2.6.3.-5.) is controversial, with proponents for both conservative and operative philosophies. A recent trend among directors of orthopedic residency programs, however, reveals a shift to conservative treatment with sling immobilization. Both strategies have yielded good results in selected patients, with the specific management operator dependent. Treatment decisions are based on such factors as age, occupation, and activity level. Types IV, V, and VI are severe injuries, and most authors recommend surgical repair. Because other injuries are associated with these more severe forms of acromioclavicular joint injuries (especially type VI), a careful clinical and radiographic examination must be performed.

FIG. 263-5. Type III acromioclavicular dislocation. Note the dislocation of the acromioclavicular joint ( white arrow) and increased coracoclavicular interspace (black arrow).

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