Anatomic Restoration of Triple Disruption of the Superior Shoulder Suspensory Complex: A Case Report and Review of the Literature

• Published in: Orthopaedic surgery Vol. 12; no. 5; pp. 1526 - 1530
• Main Authors: Wu, Kai, Wu, Xiao‐ming, Zha, Xiao‐long, Wang, Qiu‐gen
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.10.2020; John Wiley & Sons, Inc; Wiley
• Subjects: Case Report; Case Reports; Disruption; Fractures; Ligaments; Range of motion; Restoration; Superior shoulder suspensory complex; Triple; China
• ISSN: 1757-7853; 1757-7861
• DOI: 10.1111/os.12764

Background Multiple disruptions of the superior shoulder suspensory complex (SSSC) involving more than two components are extremely rare. In some extreme situations, three components of the SSSC structure can be involved. The ideal treatment for this type of injury is debatable. Case presentation A 21‐year‐old woman was referred to our emergency center following a traffic accident. A three‐dimensional CT scan showed triple disruption of the SSSC involving concomitant ipsilateral fractures of the coracoid, the acromion, and the distal clavicle. The connection between the upper limber and the axial skeleton was destroyed. There was no evidence of associated injury and the neurovascular examination of the injured upper limb was normal. The patient underwent an open reduction and internal fixation to restore the anatomic integrity of the SSSC. The arm was supported in a broad arm sling for 2 weeks after surgery. Gentle passive range of motion activity under analgesic was encouraged from the second day postoperatively. One year and half after the operation, the patient had regained pain free and unrestricted shoulder stability and mobility. Conclusion The manifestations of multiple disruptions of the SSSC may be variable. This case illustrated the challenges of treating the multiple disruption of the SSSC structure. It also showed that surgical intervention for this rare combination injury yields an excellent functional result. The good outcome achieved in this patient demonstrates that surgical intervention might be an optional resolution for multiple disruptions of the SSSC. The SSSC is a ring of bone and soft tissue, which is composed of the coracoclavicular ligament, the distal clavicle, the AC joint, the coracoacromial ligament and the acromion, the coracoid process, and the glenoid. We presented a case of a triple bone break of this ring.