Pediatric emergency medicine trisk 3438 3438

Infections
Osteomyelitis
TABLE 111.4
ROCKWOOD CLASSIFICATION OF ACROMIOCLAVICULAR JOINT
INJURIES
Type
Type I
Type II
Type III
Type IV
Type V

Type VI

Description
Acromioclavicular (AC) joint sprain; ligaments intact.
AC ligament torn; coracoclavicular (CC) ligament intact.
Lateral end of the clavicle may be mildly elevated.
AC and CC ligaments torn resulting in complete dislocation of
the joint; >5-mm elevation of the clavicle.
Complete dislocation of the joint with the distal clavicle
displaced posteriorly into or through the trapezius muscle.
Complete dislocation with superior elevation of the clavicle one
to three times above its normal position. Complete disruption
of deltoid and trapezius attachments from the distal clavicle.
Complete dislocation with the clavicle displaced inferior to the
acromion and coracoid process.

In skeletally mature patients presenting with lateral clavicular pain following
blunt trauma (such as contact sports), the emergency clinician should also
consider AC joint injuries rather than physeal injuries. These injuries, classified

by the Rockwood modified classification system range from low-grade AC joint
sprains (Rockwood I and II) to high grade (Rockwood III, IV, V, and VI) from
progressive increases in force, which result in AC ligament rupture, and then
sprain and rupture of the coracoclavicular ligaments ( Table 111.4 ).
Triage considerations. Infrequent, but serious, complications of clavicle fractures
include brachial plexus injury, pneumothorax, vascular injury, and tracheal
compression. Any patient with evidence of respiratory distress or neurovascular
compromise requires immediate treatment and consultation. Most patients with
suspected clavicle fracture require a sling and pain medication for symptom
control. With severe AC joint injuries or a forceful mechanism, examination for
related cervical spine injuries or secondary neurovascular compromise should be
assessed upon presentation.