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Injuries of the shoulder and upper arm
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
While it is helpful to describe the position of the fracture, this does not describe any of the prognostic indicators such as comminution, shortening or displacement. Lateral-third fractures can be further sub-classified into Neer type I, those with the coracoclavicular ligaments intact, Neer type II, those where the coracoclavicular ligaments are torn or detached from the medial segment but the trapezoid ligament remains intact to the distal segment, and Neer type III factures, which are intra-articular. An even more detailed classification of midshaft fractures, proposed by Robinson, is useful for managing data and comparing clinical outcomes.
Injuries of the Shoulder, Upper Arm and Elbow
Published in Louis Solomon, David Warwick, Selvadurai Nayagam, Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
Louis Solomon, David Warwick, Selvadurai Nayagam
A fall on the shoulder tears the acromioclavicular ligaments, and upward subluxation of the clavicle may occur; more severe injury also tears the coracoclavicular (conoid and trapezoid) ligaments and results in complete dislocation of the joint.
Operative management of acromioclavicular joint injuries
Published in Andreas B. Imhoff, Jonathan B. Ticker, Augustus D. Mazzocca, Andreas Voss, Atlas of Advanced Shoulder Arthroscopy, 2017
Felix Dyrna, Brendan Comer, Augustus D. Mazzocca
Next, attention is turned to creating bone tunnels in the clavicle for fixation of the tendon graft. These tunnels are determined at locations that reflect the native anatomic insertion of the conoid and trapezoid ligaments. A guide pin is drilled approximately 45 mm medial from the distal end of the clavicle. Alternatively, the conoid tubercle, located on the inferior surface of the lateral third of the clavicle, can be used as an anatomical landmark during guide pin placement, as it marks the attachment of the conoid ligament. The guide pin should be placed as posterior as possible relative to the axis of the clavicle in order to recreate anatomy. However, care should be taken to avoid disruption of the posterior cortical rim during subsequent reaming. A 5 mm cannulated reamer (assuming a 5 mm tendon graft) is used on power over the guide pin to create the bone tunnel for the conoid graft limb. The reamer is removed from the bone tunnel by hand to ensure the tunnel remains a perfect circle and is not widened by eccentric reaming. After reaming, a hand powered tap 0.5 mm wider than the drill is introduced. The depth of the tunnel is measured for appropriate tenodesis screw length placement. The bone tunnel for the trapezoid ligament is then created using the same method, but by placing a guide pin approximately 15–20 mm lateral to the conoid tunnel. The placement of the pin should be centered along the axis of the clavicle, as this reflects the anatomic insertion site of the native trapezoid. If done correctly, the pin should subsequently be 25–30 mm medial to the AC joint, and the tunnel is drilled in an identical fashion to the conoid tunnel. Thus, efforts must be taken to accurately place bone tunnels in order to minimize risk of clavicular fracture and graft slippage (Figure 38.3).
Acromioclavicular joint injuries at a Colorado ski resort
Published in The Physician and Sportsmedicine, 2023
Naomi Kelley, Lauren Pierpoint, Jack Spittler, Morteza Khodaee
Acromioclavicular joint (ACJ) injuries (also known as separations or dislocations) are very common, accounting for up to forty percent of all shoulder injuries [1–4]. The AC joint is a diarthrodial joint where the clavicle can rotate and translate anteriorly, posteriorly and inferiorly in relation to its articulation with the acromion. The joint is composed of a meniscus-type structure of hyaline cartilage, surrounded by synovium [2]. Stability of the ACJ is provided horizontally by the acromioclavicular ligament, and vertically by the coracoacromial ligament. Although not directly attached to the acromion, two coracoclavicular ligaments (conoid and trapezoid ligaments) provide further vertical stability to the joint [5]. Overall, the anatomy of the ACJ provides resistance against significant forces.
The Tight-Rope Technique versus Clavicular Hook Plate for Treatment of Acute Acromioclavicular Joint Dislocation: A Systematic Review and Meta-Analysis
Published in Journal of Investigative Surgery, 2021
Weihui Qi, Yunyun Xu, Zijian Yan, Jingdi Zhan, Jian Lin, Xiaoyun Pan, Xinghe Xue
In the subgroup analyses, we found that the use of arthroscopy or a mini-incision in the TR group did not affect the results. This provides opportunities for surgeons who are unable to use arthroscopy. Anatomical reconstruction of the CC ligament contained conoid and trapezoid ligament reconstruction. As a result, some researchers are in favor of double bundle reconstruction, but no superiority with this technique was found in our subgroup analyses. The double bundle with triple Endobuttons increases the risk of coracoid fracture, economic cost, and operation time. Therefore, a single bundle with two Endobuttons may be sufficient.
Displaced isolated coronal shearing fracture of the trapezoid: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Yuya Otake, Koji Sukegawa, Kenji Onuma, Shuhei Machida, Riyo Iida, Masashi Takaso
Trapezoid fractures account for only 0.4% of all carpal bone fractures [1]. Anatomically, the trapezoid bone has a keystone shape, with the dorsal surface twice the size of its volar surface. It is stabilized and protected by its congruent articulations with the trapezium: the second metacarpal, the capitate, and the scaphoid. In addition, the stout second metacarpal-trapezoid ligament, trapezium-trapezoid ligament and trapezoid-capitate ligament [2] complex firmly anchors the trapezoid to these surrounding bones [3]. Hence, trapezoid fractures are rare, with 24 cases reported in the literature [4].