Simultaneous open fracture of the acromion and distal of the clavicle: a case report

Introduction : The simultaneous occurrence of an open fracture of the acromion and distal clavicle represents a rare pattern of shoulder trauma. The anatomical complexity of the scapular girdle and the functional role of the acromioclavicular (AC) joint make this injury a particular diagnostic and therapeutic challenge. Case presentation : In this case, we report a 30-year-old male, a construction worker, who sustained a high-energy trauma to the left shoulder in a motorcycle-vehicle collision. The clinical assessment revealed an open wound at the posterosuperior aspect of the shoulder. The radiographic evaluation (anteroposterior and lateral views) showed an open acromion fracture (Kuhn type III) and a distal clavicle fracture (Neer type IIb). These findings indicate a triple disruption of the superior shoulder suspensory complex (SSSC).During surgery, after thorough irrigation with normal saline, the acromion fracture was anatomically reduced and fixed using a 3.5 mm locking compression plate (LCP). Next, the distal clavicle fracture was stabilized with a 3.5 mm clavicular hook plate. The acromioclavicular (AC) ligament was also repaired during the operation. Outcome : A rehabilitation plan was started after surgery. By the end of week eight, complete active pain-free motions were achieved. Radiological imaging confirmed complete bone union, and the patient returned to occupational activities and normal daily function by the fifth postoperative month. The DASH score improved from 88 to 22 over twelve weeks. Conclusion : This report highlights that prompt surgical intervention combined with targeted rehabilitation programs can lead to favorable functional and clinical outcomes in complex shoulder girdle injuries involving the SSSC.