Skip to main content
SpringerLink
Log in

Concomitant intra-articular glenohumeral injuries in displaced fractures of the lateral clavicle

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To detect concomitant intra-articular glenohumeral injuries, in acute displaced fractures of the lateral clavicle, initially missed due to unfeasible clinical evaluation of the acutely injured shoulder.

Methods

All patients suffering from an acute displaced lateral clavicle fracture with indication to surgical treatment underwent diagnostic shoulder arthroscopy prior to open reduction and internal fixation. In case of therapy-relevant intra-articular glenohumeral injuries, subsequent surgical treatment was performed.

Results

Intra-articular injuries were found in 13 of 28 patients (46.4 %) with initially suspected isolated lateral clavicle fracture. Additional surgical treatment was performed in 8 of 28 cases (28.6 %). Superior labral anterior-posterior (SLAP) lesions were observed in 4 of 28 patients (14.3 %; SLAP II a: 1; II b: 1; III: 1; and IV: 1). Lesions of the pulley system were found in 3 of 28 patients (10.7 %; Habermeyer III°). One partial articular supraspinatus tendon avulsion lesion (3.6 %) and one lesion of the subscapularis tendon (3.6 %; Fox and Romeo II°) were observed.

Conclusions

Traumatic concomitant glenohumeral injuries in lateral clavicle fractures seem to be more frequent than expected in general. Subsequent surgical treatment of these formerly missed but therapy-relevant injuries may increase functional outcome and reduce complication rate.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Baumann B, Genning K, Bohm D, Rolf O, Gohlke F (2008) Arthroscopic prevalence of pulley lesions in 1007 consecutive patients. J Shoulder Elbow Surg 17:14–20

    Article  PubMed  Google Scholar 

  2. Beirer M, Siebenlist S, Cronlein M, Postl L, Huber-Wagner S, Biberthaler P, Kirchhoff C (2014) Clinical and radiological outcome following treatment of displaced lateral clavicle fractures using a locking compression plate with lateral extension: a prospective study. BMC Musculoskelet Disord 15:380

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bennett WF (2003) Arthroscopic repair of anterosuperior (supraspinatus/subscapularis) rotator cuff tears: a prospective cohort with 2- to 4-year follow-up. Classification of biceps subluxation/instability. Arthroscopy 19:21–33

    Article  PubMed  Google Scholar 

  4. Brady PC, Narbona P, Adams CR, Huberty D, Parten P, Hartzler RU, Arrigoni P, Burkhart SS (2014) Arthroscopic proximal biceps tenodesis at the articular margin: evaluation of outcomes, complications, and revision rate. Arthroscopy 3:470–476

    Google Scholar 

  5. Braun S, Horan MP, Elser F, Millett PJ (2011) Lesions of the biceps pulley. Am J Sports Med 39:790–795

    Article  PubMed  Google Scholar 

  6. Braun S, Minzlaff P, Imhoff AB (2012) Subpectoral tenodesis of the long head of the biceps tendon for pathologies of the long head of the biceps tendon and the biceps pulley. Oper Orthop Traumatol 24:479–485

    Article  CAS  PubMed  Google Scholar 

  7. Castagna A, Delle Rose G, Conti M, Snyder SJ, Borroni M, Garofalo R (2009) Predictive factors of subtle residual shoulder symptoms after transtendinous arthroscopic cuff repair: a clinical study. Am J Sports Med 37:103–108

    Article  PubMed  Google Scholar 

  8. Deutsch A, Altchek DW, Veltri DM, Potter HG, Warren RF (1997) Traumatic tears of the subscapularis tendon. Clinical diagnosis, magnetic resonance imaging findings, and operative treatment. Am J Sports Med 25:13–22

    Article  CAS  PubMed  Google Scholar 

  9. Ellman H (1990) Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res 254:64–74

    Google Scholar 

  10. Fox JAN, Mayo A, Romeo AA (2003) Arthroscopic subscapularis repair. Tech Should Elbow Surg 4:154–168

    Article  Google Scholar 

  11. Fukuda H (2003) The management of partial-thickness tears of the rotator cuff. J Bone Joint Surg Br 85:3–11

    Article  CAS  PubMed  Google Scholar 

  12. Gorantla K, Gill C, Wright RW (2010) The outcome of type II SLAP repair: a systematic review. Arthroscopy 26:537–545

    Article  PubMed  Google Scholar 

  13. Gottschalk MB, Karas SG, Ghattas TN, Burdette R (2014) Subpectoral biceps tenodesis for the treatment of type II and IV superior labral anterior and posterior lesions. Am J Sports Med 42:2128–2135

    Article  PubMed  Google Scholar 

  14. Habermeyer P, Magosch P, Pritsch M, Scheibel MT, Lichtenberg S (2004) Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Shoulder Elbow Surg 13:5–12

    Article  PubMed  Google Scholar 

  15. Hessmann M, Gotzen L, Kirchner R, Gehling H (1997) Therapy and outcome of lateral clavicular fractures. Unfallchirurg 100:17–23

    Article  CAS  PubMed  Google Scholar 

  16. Jager M, Breitner S (1984) Therapy related classification of lateral clavicular fracture. Unfallheilkunde 87:467–473

    CAS  PubMed  Google Scholar 

  17. Kim TK, Rauh PB, McFarland EG (2003) Partial tears of the subscapularis tendon found during arthroscopic procedures on the shoulder: a statistical analysis of sixty cases. Am J Sports Med 31:744–750

    Article  PubMed  Google Scholar 

  18. Kirchhoff C, Braunstein V, Paul J, Imhoff AB, Hinterwimmer S (2009) Septic arthritis as a severe complication of elective arthroscopy: clinical management strategies. Patient Saf Surg 3:6

    Article  PubMed  PubMed Central  Google Scholar 

  19. Koppe D, Reilmann H (2010) Fractures of the lateral clavicle. Unfallchirurg 113:45–52

    Article  CAS  PubMed  Google Scholar 

  20. Maffet MW, Gartsman GM, Moseley B (1995) Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med 23:93–98

    Article  CAS  PubMed  Google Scholar 

  21. Neer CS 2nd (1968) Fractures of the distal third of the clavicle. Clin Orthop Relat Res 58:43–50

    PubMed  Google Scholar 

  22. Oh JH, Kim SH, Lee JH, Shin SH, Gong HS (2011) Treatment of distal clavicle fracture: a systematic review of treatment modalities in 425 fractures. Arch Orthop Trauma Surg 131:525–533

    Article  PubMed  Google Scholar 

  23. Pagnani MJ, Deng XH, Warren RF, Torzilli PA, O’Brien SJ (1996) Role of the long head of the biceps brachii in glenohumeral stability: a biomechanical study in cadavera. J Shoulder Elbow Surg 5:255–262

    Article  CAS  PubMed  Google Scholar 

  24. Pauly S, Gerhardt C, Haas NP, Scheibel M (2009) Prevalence of concomitant intraarticular lesions in patients treated operatively for high-grade acromioclavicular joint separations. Knee Surg Sports Traumatol Arthrosc 17:513–517

    Article  PubMed  Google Scholar 

  25. Pauly S, Kraus N, Greiner S, Scheibel M (2012) Prevalence and pattern of glenohumeral injuries among acute high-grade acromioclavicular joint instabilities. J Shoulder Elbow Surg 22:760–766

    Article  PubMed  Google Scholar 

  26. Payne LZ, Altchek DW, Craig EV, Warren RF (1997) Arthroscopic treatment of partial rotator cuff tears in young athletes: a preliminary report. Am J Sports Med 25:299–305

    Article  CAS  PubMed  Google Scholar 

  27. Postacchini F, Gumina S, De Santis P, Albo F (2002) Epidemiology of clavicle fractures. J Shoulder Elbow Surg 11:452–456

    Article  PubMed  Google Scholar 

  28. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ (1990) SLAP lesions of the shoulder. Arthroscopy 6:274–279

    Article  CAS  PubMed  Google Scholar 

  29. Stanley D, Trowbridge EA, Norris SH (1988) The mechanism of clavicular fracture: a clinical and biomechanical analysis. J Bone Joint Surg Br 70:461–464

    Article  CAS  PubMed  Google Scholar 

  30. Stuart KD, Karzel RP, Ganjianpour M, Snyder SJ (2013) Long-term outcome for arthroscopic repair of partial articular-sided supraspinatus tendon avulsion. Arthroscopy 29:818–823

    Article  PubMed  Google Scholar 

  31. Szabo I, Boileau P, Walch G (2008) The proximal biceps as a pain generator and results of tenotomy. Sports Med Arthrosc 16:180–186

    Article  PubMed  Google Scholar 

  32. Tiren D, Vroemen JP (2013) Superior clavicle plate with lateral extension for displaced lateral clavicle fractures: a prospective study. J Orthop Traumatol 14:115–120

    Article  PubMed  PubMed Central  Google Scholar 

  33. Tischer T, Salzmann GM, El-Azab H, Vogt S, Imhoff AB (2009) Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med 37:136–139

    Article  PubMed  Google Scholar 

  34. Walch G, Nove-Josserand L, Levigne C, Renaud E (1994) Tears of the supraspinatus tendon associated with “hidden” lesions of the rotator interval. J Shoulder Elbow Surg 3:353–360

    Article  CAS  PubMed  Google Scholar 

  35. Weber SC, Abrams JS, Nottage WM (2002) Complications associated with arthroscopic shoulder surgery. Arthroscopy 18:88–95

    Article  PubMed  Google Scholar 

  36. Wellmann M, Smith T (2012) Epidemiology, anatomy, biomechanics and imaging of acromioclavicular joint injuries. Unfallchirurg 115:867–871

    Article  CAS  PubMed  Google Scholar 

  37. Yamanaka K, Matsumoto T (1994) The joint side tear of the rotator cuff: a followup study by arthrography. Clin Orthop Relat Res 468:68–73

    Google Scholar 

  38. Zhang AL, Kreulen C, Ngo SS, Hame SL, Wang JC, Gamradt SC (2012) Demographic trends in arthroscopic SLAP repair in the United States. Am J Sports Med 40:1144–1147

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675, Munich, Germany

    Marc Beirer, Michael Zyskowski, Moritz Crönlein, Dominik Pförringer, Gunther Sandmann, Stefan Huber-Wagner, Peter Biberthaler & Chlodwig Kirchhoff

  2. Medical Park Bernau Chiemsee, Bernau am Chiemsee, Germany

    Marcus Schmitt-Sody

Authors
  1. Marc Beirer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Zyskowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Moritz Crönlein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dominik Pförringer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marcus Schmitt-Sody
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gunther Sandmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stefan Huber-Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Peter Biberthaler
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Chlodwig Kirchhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marc Beirer.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Beirer, M., Zyskowski, M., Crönlein, M. et al. Concomitant intra-articular glenohumeral injuries in displaced fractures of the lateral clavicle. Knee Surg Sports Traumatol Arthrosc 25, 3237–3241 (2017). https://doi.org/10.1007/s00167-015-3875-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3875-2

Keywords

Search

Navigation