simultaneous bipolar dislocation of the clavicle is uncommon and unusual , although it has been documented as panclavicular dislocation , floating clavicle , and complete dislocation of the clavicle .
a review of the recent literature indicated that most bipolar clavicular dislocations have been treated non - operatively .
we report the case of a 23 year polytrauma patient with bipolar dislocation of the right clavicle .
patient presented to us 2 weeks post injury and had an unstable corao - clavicular joint .
on radiographic assessment a simultaneous dislocation of the coraco - clavicular and sterno - clavicular joints of right side was diagnosed . in view of the unstable condition of the right clavicle , young age of the patient , requirement of high physical activity a decision for operative treatment for clavicle dislocation
although bipolar dislocation of the clavicle are rare a high index of suspicion will avoid missed diagnosis .
open reduction and internal fixation is a good option in young patients and gives good short term result .
simultaneous bipolar dislocation of the clavicle is uncommon and unusual , although it has been documented as panclavicular dislocation , floating clavicle , and complete dislocation of the clavicle [ 1 - 13 ] .
porral reported the first case of a dislocation of both ends of the clavicle in 1831 . a review of the recent literature indicated that most bipolar clavicular dislocations have been treated non - operatively .
we report the case of a 23 year old polytrauma patient with bipolar dislocation of the right clavicle treated surgically .
he sustained contusion of both lungs , multiple fractures of the 1st to 6th ribs left hand , and of the 3rd to 6th ribs right hand , fracture of the transverse processus of the 1st and of the 8th to 10th dorsal vertebrae , a fracture of the sacrum left hand , and a bipolar dislocation of the right clavicle .
first aid was performed at a primary center and patient was transferred to our hospital after 2 weeks .
the anteriorly dislocated sternoclavicular joint could be reduced passively , but was unstable , and the protruding anterior deformity quickly recurred . on physical examination
the lateral end of the clavicle was tender and was palpable in a posteriorly displaced position . on the radiograph of the right shoulder and of the thorax a type four dislocation of the right acromioclavicular joint according to rockwood   and an anterior dislocation of the right sternoclavicular joint
fractures of the spine and the sacrum were treaded conservatively , the patient was mobilized using analgesics and physiotherapy . in view of the unstable condition of the right clavicle , young age of the patient , requirement of high physical activity a decision for operative treatment for clavicle dislocation was taken . at 3 weeks after the accident ,
open reduction of both the acromioclavicular and the sternoclavicular joint and internal fixation by cerclage wires was performed ( fig.2 ) .
18 months after injury , the patient was referred to the senior one of us ( t.s . ) for evaluation .
the patient had no complaints of pain or discomfort and both shoulders had a full range of motion .
the patient could perform all activities of daily living and had returned to his former work .
a - anteroposterior view of the right shoulder shows a dislocation of the acromioclavicular joint .
b- anteroposterior view of both sternoclvicular joints shows a widening of the joint space of the right sternoclavicular joint .
c - ct scan of the thorax and both sternoclavicular joints confirms widening of the joint space of the right sternoclavicular joint .
simultaneous bipolar dislocation of the clavicle is uncommon and unusual [ 1 - 13 ] .
the predominant mechanism of injury causing acromioclavicular separation is a downward blow to the acromion , which tears the coracoclavicular and acromioclavicular ligaments and leads to a superior displacement of the distal pole of the clavicle .
the least common mechanism is a direct blow on the anterior aspect of the medial end of the clavicle , causing it to dislocate posterior to the manubrium .
a medially directed force on the lateral aspect of the shoulder can result in the more common anterior or superior dislocation of the medial end of the clavicle .
however , the treatment of an isolated dislocation of the acromioclavicubar or sternoclavicular joint is still controversial .
slings , braces , shoulder spicas , and ligament repair or reconstruction , as well as internal fixation .
because of the rarity of simultaneous dislocation of both poles of the clavicle , little is known about the treatment of this injury .
a review of the recent literature indicated that most bipolar clavicular dislocations have been treated non - operatively .
gearen et al .   treated bipolar clavicular dislocation in a young patient with a shoulder - spica cast in order to maintain the reduction of the clavicle at the acromioclavicular joint that had been obtained by manipulation .
cook and horowitz   reported the case of a patient who had a bipolar clavicular dislocation with a grade ii acromioclavicular separation whom they treated non - operatively with closed reduction .
several days after treatment , the clavicle redislocated , but this went unreported . at follow - up
beckman   reviewed 16 cases of patients who had biterminal dislocation of the clavicle that was treated by closed manipulation .
ten patient 's obtained a good functional result . in one shoulder that could not be manipulated because of the patient s poor general condition , symptoms involving the brachial plexus developed ; a total claviculectomy provided a good functional result .
the reasons for the remaining poor results were not stated . the acromioclavicular joint has been well described .
the conoid ligament medially and the trapezoid laterally connect the clavicle to the coracoid process and are strong stabilizers of the acromioclavicuhar joint .
a posterior dislocation of the acromioclavicular joint can be detected clinically by palpation of the end of the clavicle posterior to the acromion and within the substance of the trapezius .
the displacement ( that is , the widening of the acromioclavicular joint space ) may be seen on an anteroposterior radiograph like in our case .
an axillary lateral radiograph or a computed ct scan can confirm the diagnosis by showing the posterior displacement of the clavicle from the acromion .
the sternoclavicular joint connects the large medial end of the clavicle with a small sternal site of articulation .
the joint is stabilized by a dense fibrocartilaginous disc , as well as by the rhomboid ligament between the clavicle and the first rib , the capsular ligaments anteriorly and posteriorly between the clavicle and the manubrium , and the interclavicuhar ligament superiorly .
the injuries may be classified as type i- sprain with ligaments intact and no instability , type ii - persistent subluxation , and type iii- dislocation with gross disruption of the ligament [ 12 , 15 ) . in the current case a 23 year old polytrauma patient suffered biterminal dislocation of the right clavicle .
the sternoclavicular joint showed an anterior dislocation , the acromioclavicular joint showed a grade iv dislocation according to rockwood . in our case
there were several additional injuries especially serial fractures of the ribs . in respect to the young age of the patient with high physical demands and the polytrauama condition we performed open reduction of both joints with internal stabilization .
review of the literature did not show satisfying results with conservative treatment of this rare injury and we believe conservative treatment should be reserved for elderly and multimorbid patients .
a - postoperative radiograph of the right coraco - clavicular joint shows stabilization with a k - wire and cerclage wire .
bipolar clavicular dislocations are rare and a high index of suspicion should be excercised in polytrauma patients with unipolar clavicle dislocations to avoid missed diagnosis .
although a conservative treatment is reported we believe operative treatment should be offered to young patients especially in cases with high physical demands .
 introduction : simultaneous bipolar dislocation of the clavicle is uncommon and unusual , although it has been documented as panclavicular dislocation , floating clavicle , and complete dislocation of the clavicle . 
 a review of the recent literature indicated that most bipolar clavicular dislocations have been treated non-operatively.case report : we report the case of a 23 year polytrauma patient with bipolar dislocation of the right clavicle . 
 patient presented to us 2 weeks post injury and had an unstable corao - clavicular joint . 
 on radiographic assessment a simultaneous dislocation of the coraco - clavicular and sterno - clavicular joints of right side was diagnosed . in view of the unstable condition of the right clavicle , young age of the patient , requirement of high physical activity a decision for operative treatment for clavicle dislocation 
 was taken . 
 patient was treated surgically with open reduction and tension band wiring with good result.conclusion:although bipolar dislocation of the clavicle are rare a high index of suspicion will avoid missed diagnosis . 
 open reduction and internal fixation is a good option in young patients and gives good short term result . 
Introduction:
Case Report:
Conclusion:
Introduction
Case Report
Discussion
Conclusion