Bipolar Dislocation of the Clavicle: A Report of Two Cases with Different Injury Patterns and a Literature Review

Abstract

Bipolar dislocation of the clavicle is a rare injury that is defined as a concomitant dislocation of the ipsilateral acromioclavicular joint and sternoclavicular joint. This injury is also described as a floating clavicle. Although this injury has been known for nearly two centuries, knowledge about it is limited and the treatment strategy remains controversial. Bipolar dislocation includes several combinations of both joints' injury types. We reported two patients with bipolar dislocation of the clavicle: one with an anterior dislocation and the other with a posterior dislocation of the sternoclavicular joint. After reviewing the currently available literature, we discussed these cases to highlight the necessity of a specific treatment approach that is modified based on the pattern of each joint's lesion.

Figure 1

Case 1: images at the first presentation. A radiograph shows type III ACJ dislocation.

Figure 2

Case 1: a computed tomography scan shows anterior SCJ dislocation (arrow).

Figure 3

Case 2: images at the first presentation. (a) A radiograph shows type III ACJ dislocation. (b) A computed tomography (CT) scan shows posterior SCJ dislocation (arrow) as well as massive subcutaneous emphysema. (c) and (d) Three-dimensional reconstructed CT images of the left clavicle, which were made after the diagnosis was confirmed, clearly show ACJ dislocation (arrowhead) and posterior SCJ dislocation (arrow).

Figure 4

Case 2: a radiograph taken after ACJ surgery.

Figure 5

Case 2: intraoperative photographs of open reduction and augmentation of the SCJ. (a) Before reduction, the clavicle (arrow) was located behind the manubrium (arrowhead). (b) After reduction, the clavicle could maintain its position but was easily redislocated. (c) Three FiberWires were passed through a hole in the clavicle. (d) Sutures were also passed through holes in the manubrium and fastened to the surrounding soft tissue.

Figure 6

Case 2: a three-dimensional reconstructed CT scan of the SCJ at 12 months' follow-up shows a reduced ACJ (arrowhead) and SCJ (arrow) with remaining 2.5 mm superior displacement of the clavicle (line).