Reduction Technique in a Rockwood Grade VI Acromioclavicular Separation

Hypothesis and Purpose: Rockwood Grade VI acromioclavicular separations (AC) are extremely rare injuries and pose a challenge because the surgeon must reduce the clavicle to its appropriate anatomical position from the subcoracoid or subacromial space. After searching the literature, there is scant information of the appropriate reduction technique. This report aims to describe the reduction technique as well as the appropriate ligament reconstruction technique. Materials and Methods: A 35 year old female was involved in a rollover motor vehicle crash with ejection. The patient presented to the ED with multiple facial lacerations, closed nasal fracture, a closed displaced left scapula fracture, a closed right ulna fracture, and a Rockwood Grade VI AC separation. She presented with severe left shoulder pain as well as numbness over the medial aspect of her forearm. We present our case of distal clavicle excision, reduction, and reconstruction of the coracoclavicular ligaments. Results: The reduction was performed by placing a lobster claw clamp around the clavicular shaft to control the clavicle. A cobb elevator was used in a lever-like fashion to free the clavicle from the inferior coracoid. Soft tissue adhesion from the pectoralis minor and the anterior deltoid insertion were free with bovie electrocautery. A curette was used to sweep the pectoralis minor and the conjoined tendon off the clavicle as well as to cup the posterior inferior edge of the clavicle. Anterior and superior force was exerted on the clavicle until the clavicle was reduced into anatomic position. The distal clavicle was excised and the coracoclavicular ligament was reconstructed with a semitendinosis allograft. The patient's pain was improved post-operatively compared to pre-operatively and her pre-operative numbness was immediately resolved post-operatively. Conclusions: Rockwood grade VI AC separation is a rare injury without a clear reduction technique. We present a reduction and fixation technique that was successful in improving our patients pain and her pre-operative numbness.