Stress fracture of the clavicle secondary to coracoclavicular fixation using a multistrand titanium cable: a case report

Acromioclavicular (AC) dislocations are common shoulder injuries. The classic mechanism of injury to AC joint is direct trauma caused by falls or blows to acromion with the arm abducted. According to Tossy et al,(1) the degrees of AC dislocations are classified into types I, H, and III. Tossy I and II are incomplete dislocations. Tossy III is a complete dislocation with complete disruption of the AC and coracoclavicular (CC) ligaments, accompanied by marked upward migration of the lateral end of the clavicle. Typically, surgical treatment is needed for patients with Tossy III. It is the best solution to restore the anatomy of AC joint. There are many surgical techniques that had been described in the preceding articles. Every surgical method has its limitations. Loss of reduction, implants failure or migration, and chronic pain are among the common postoperative complications. Relatively, clavicle fracture after surgery of AC dislocation is uncommon. Only few case reports were encountered by us in literature reviews.(2-5) It appears that the fractures reported were usually secondary to a new trauma. Clavicle fracture could be a problematic complication and deserves particular attention. We report a stress fracture of the clavicle after CC fixation with multistrand titanium cable. The case seems to be unique in that the clavicle fracture is directly secondary to the procedure in which a multistrand titanium cable was used for fixation of CC joint.