Acromioclavicular lesions in children

Abstract

This study reports on the followup of 25 children who were thought to have complete acromioclavicular joint dislocations. The patients were from 5 to 16 years old at the time of injury. Followup ranged between one and nine years. All were treated surgically. Various methods of stabilization were used, including transfixing the acromioclavicular joint with pins or a Bosworth screw and Mersilene (Ethicon, Somerville, NJ) taping of the clavicle to the coracoid. Good or excellent results, including return to full, asymptomatic activity and essentially normal clinical and roentgenographic appearance, were seen in over 90% of the cases. None of the children developed growth disturbances. Two of the 25 developed asymptomatic acromioclavicular joint arthritis, and both were cross-pinned. Children below the age of 13 years rarely sustain a complete acromioclavicular joint dislocation, but usually sustain a fracture of the distal clavicle with an intact acromioclavicular joint. Five (20%) of 25 patients below age 13 were erroneously diagnosed as having an acromioclavicular joint lesion. These children had only a fracture of the distal clavicle with rupture of the coracoclavicular ligament complex. Children of 13 years and older usually sustained complete dislocations of the acromioclavicular joint similar to adults. In children below age 13, conservative treatment should produce good or excellent results. Patients above age 13 all had adult-type acromioclavicular joint dislocations and were, accordingly, treated as adults.