A 25-year-old rugby player lands on the point of his shoulder. There is a visible step over the acromioclavicular region, the clavicle is prominent upward, and stress radiographs show the coracoclavicular distance increased by more than twice the normal side with the coracoid process intact. The most appropriate definitive management in an adult manual worker is:

• A Surgical stabilisation of the acromioclavicular joint ✓
• B Closed reduction with figure-of-eight bandage for 6 weeks
• C Sling immobilisation alone, as function recovers fully
• D Excision of the lateral end of the clavicle

Explanation

The findings describe a Rockwood Type III injury: complete rupture of both the acromioclavicular and coracoclavicular ligaments with more than 100 percent increase in coracoclavicular distance. In heavy labourers and athletes, persistent weakness and fatigue pain justify surgical reconstruction. Types I and II are treated non-operatively with a sling. Closed reduction methods cannot hold this unstable joint. Lateral clavicle excision is a salvage procedure for painful post-traumatic arthritis of the joint, not primary treatment.

Reference: Miller's Review of Orthopaedics, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.