ELSEVIER

PII: SOO20-1383(97)00009-O

Injury Vol. 28, No. 4, pp. 319-320, 1997 0 1997 Elsevier Science Ltd. All rights reserved

Printed in Great Britain 0020-1383/97 $17.00 + 0.00

Floating clavicle - simultaneous dislocation of both ends of the clavicle

D. 0. Eni-Olotu and N. J. Hobbs St Mary’s Hospital, Newport, Isle of Wight, UK

Injury, Vol. 28, No. 4, 319-320, 1997

Introduction shoulder against the stairs as she fell. She complained of a

Simultaneous dislocation or subluxation of both ends of the clavicle is rare. The first reported case was published by Porral in 1831’. Beckman” described the sixteenth case in the literature. Severe injury from the side was the cause in the 16 cases. In all these cases, the medial end displaced anteriorly while the lateral end displaced posteriorly. They were mostly managed by ‘skilful neglect’. However, two cases have been published recently in the English litera- ture. One followed a minor injury3 and the other required surgical intervention.

headache and neck pain. Past history included manic depression, high blood pressure and non-insulin depend- ent diabetes mellitus. She was on several drugs.

On examination there was a satisfactory range of move- ment in her neck and no signs of concussion. She exhibited

Case report A 63-year-old lady presented in the Accident and Emer- gency department with right shoulder pain following a fall down 12 steps at home. She remembered hitting her right

Figure 1. Inferior dislocation of the lateral clavicle. Figure 2. Superior migration of the medial clavicle

320 Injury: International Journal of the Care of the Injured Vol. 28, No. 4,1997

an intention tremor which was usual for her. There was swelling, bruising and tenderness over the lateral end of the clavicle. There was reduced range of movement of the shoulder due to pain but no neurovascular deficit.

X-rays of the right shoulder revealed an inferior disloca- tion of the clavicle at the acromioclavicular joint (Figure 1). She was treated non-operatively with a sling and oral analgesia as required.

clavicle. Although simultaneous displacement of both ends of the clavicle is rare, there is a danger of mis-diagnosis if both ends are not examined and investigated whenever pathology at one end is suspected. The authors’ recommend that in cases of shoulder pathology (especially where clavicle fracture is suspected), the whole clavicle, including the sternoclavicular joint, should at least be examined.

She attended the follow-up clinic a week later and complained of neck pain and a feeling of ‘pressure on the wind pipe’. Examination then revealed swelling over the right sternoclavicular joint. Superior dislocation of the medial end of clavicle was seen on X-ray (Figure 2). A diagnosis of simultaneous dislocation of both ends of the right clavicle, ‘floating clavicle’, was made.

References

Non-operative management was continued. She became asymptomatic at the medial end after 6 weeks, but con- tinued to have pain at the lateral end, with difficulty in lying on that side. Although she has a satisfactory range of movement she has some weakness of the shoulder. She is currently awaiting excision of the lateral end of the clavicle.

1 Rockwood CA Jr and Green DP (eds). Fractures in Adults. Vol. 1, Philadelphia: Lippincott, 1984, p. 948.

2 Beckman T. A case of simultaneous luxation of both ends of the clavicle. Acta Chir Stand 1923; 56: 156.

3 Jain AS. Traumatic floating clavicle. A case report. J Bone SurgfBr] 1984;66: 560.

4 Echo BS, Donati RB and Powell CE. Bipolar clavicular dislocation treated surgically: A case report. J Belle Joint Surg [Am] 1988; 70: 1251.

Discussion Paper accepted 30 January 1997.

To the authors’ knowledge, this is the first reported Requests for reprints should be addressed to: Mr N. I. Hobbs, case of inferior displacement of lateral end and Department of Orthopaedics, St Mary’s Hospital NHS superior displacement of the medial end of the same Trust, Newport, Isle of Wight PO30 5TG, UK.