A special type of triple injury of superior shoulder suspensory complex—lateral segment floating clavicle_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Yu ¹ , ZHAO Hongsheng ² ^{共同第一作者} , YANG Mingxing ² ,  XU Shengming ¹ ,  CAI Yuwei ¹

1. Department of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200120, P. R. China;
2. Department of Orthopedics and Traumatology, Diqing Tibetan Autonomous Prefecture Tibetan Hospital, Diqing Yunnan, 674400, P. R. China;

Corresponding?author：

XU Shengming, Email: smmu2004@126.com; CAI Yuwei, Email: doctorcaiyw@163.com

Keywords：

Midclavicular fracture; acromioclavicular joint dislocation; acromioclavicular ligament rupture; coracoid process fracture; coracoclavicular ligament rupture; multiple injuries of the superior shoulder suspensory complex

DOI：

10.7507/1002-1892.202602022

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Objective To investigate the clinical characteristics and injury mechanisms of lateral segment floating clavicle (LSFC), and to establish a comprehensive classification system for this specific triple injury of the superior shoulder suspensory complex (SSSC), so as to provide a reference for clinical diagnosis and treatment. Methods A retrospective analysis was performed on 354 patients with midclavicular fractures who underwent surgical treatment between January 2021 and December 2024. Among them, 11 patients met the diagnostic criteria for LSFC, defined as a combination of midclavicular fracture, ipsilateral coracoid process fracture or coracoclavicular ligament rupture, and ipsilateral acromioclavicular ligament rupture, distal clavicular fracture, or acromial fracture. There were 9 males and 2 females, with an age range of 21-53 years (mean, 39.3 years). LSFC was classified into two main types: Type Ⅰ was characterized by coracoclavicular ligament rupture, and type Ⅱ by coracoid process fracture. According to the injury pattern at the acromioclavicular joint-distal clavicle complex, each type was further subdivided into three subtypes: subtype a (acromioclavicular ligament rupture or acromioclavicular joint dislocation), subtype b (distal clavicular fracture), and subtype c (acromial fracture). Of the 11 patients, 4 were classified as type Ⅰa, 5 as type Ⅱa, and 2 as type Ⅱb. All patients underwent open reduction and internal fixation. Missed diagnosis occurred in 3 cases (27.3%), intraoperative revision of the surgical plan was required in 1 case, and postoperative delayed diagnosis was found in 2 cases during follow-up, with 1 patient undergoing reoperation. Results All 11 LSFC patients were followed up 13-26 months (mean, 17.8 months). Bony union was achieved in all fractures at last follow-up. A total of 7 complications were noted: 3 cases of acromioclavicular joint subluxation, 3 cases of periprosthetic osteolysis around the clavicular hook plate, and 1 case of wire breakage. The incidence of ipsilateral multiple rib fractures in LSFC patients was 45.5% (5/11), which was significantly higher than that in patients with isolated midclavicular fractures (1.7%, 6/343) (P<0.001). Conclusion LSFC is mostly caused by high-energy trauma, with a high rate of missed diagnosis and frequent associated injuries. In particular, ipsilateral multiple rib fractures are a highly suggestive sign of LSFC. The classification system proposed in this study summarizes the characteristics of this triple injury of SSSC, which is conducive to improving clinicians’ understanding of the injury and reducing the rate of missed diagnosis.

Citation： CHEN Yu, ZHAO Hongsheng, YANG Mingxing, XU Shengming, CAI Yuwei. A special type of triple injury of superior shoulder suspensory complex—lateral segment floating clavicle. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(7): 1080-1087. doi: 10.7507/1002-1892.202602022 Copy

1.	Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma, 1993, 7(2): 99-106.
2.	Ja?n M, Sayer L, Fornaciari P. Triple disruption of the superior shoulder suspensory complex—review and surgical technique. J Orthop Case Rep, 2023, 13(6): 121-126.
3.	Shakya S, Wen Y, Wen X, et al. Minimally invasive plate osteosynthesis (MIPO) with mini-open technique versus open reduction and internal fixation (ORIF) in the treatment of displaced midclavicular fracture: a retrospective study. J Orthop Traumatol, 2025, 26(1): 51. doi: 10.1186/s10195-025-00865-8.
4.	von Rüden C, Rehme-R?hrl J, Augat P, et al. Evidence on treatment of clavicle fractures. Injury, 2023, 54 Suppl 5: 110818. doi: 10.1016/j.injury.2023.05.049.
5.	曾勇濤, 鄭宏程, 那次克道爾吉, 等. 肩關節鏡下喙突單隧道固定與無隧道懸吊固定治療急性Ⅲ-Ⅴ型肩鎖關節脫位. 中國組織工程研究, 2025, 29(5): 1036-1042.
6.	蔣棟, 呂書軍, 洪曄, 等. 鎖骨鉤鋼板與三Endobutton鋼板治療新鮮肩鎖關節脫位療效比較. 中國修復重建外科雜志, 2012, 26(9): 1025-1028.
7.	Ingoe H, Maharaj J, Singh N, et al. Superior suspensory complex of the shoulder reconstruction for acute and chronic acromioclavicular joint dislocations: the Queensland Unit for Advanced Shoulder Research 3-tunnel technique. JSES Int, 2024, 9(1): 31-39.
8.	Nguyen MK, Nguyen VH, Le HGK, et al. Multiple disruptions of superior suspensory shoulder complex: A case report. Int J Surg Case Rep, 2024, 124: 110385. doi: 10.1016/j.ijscr.2024.110385.
9.	Korkoman AJ, Alhamodi A, Alrusayni S, et al. Ipsilateral Rockwood type Ⅴ acromioclavicular joint dislocation and midshaft clavicle fracture: A case report. World J Orthop, 2024, 15(12): 1208-1213.
10.	Lancourt JE. Acromioclavicular dislocation with adjacent clavicular fracture in a horseback rider. A case report. Am J Sports Med, 1990, 18(3): 321-322.
11.	Meignanaguru M, Dhakshinamurthi Y, Srinivasan D, et al. Mid-shaft clavicle fracture with disguised ipsilateral type Ⅳ acromioclavicular joint dislocation—A rare case report. J Orthop Case Rep, 2024, 14(9): 19-23.
12.	葉春曉, 張細祥, 郭穎彬. 肩上部懸吊復合體2處損傷并亞急性肩鎖關節脫位2例. 中國骨與關節損傷雜志, 2024, 39(5): 556-558.
13.	蔣澤輝, 張開華, 許春濤, 等. 肩上方懸吊復合體多處損傷的切開復位內固定. 中國矯形外科雜志, 2025, 33(13): 1215-1218.
14.	Bakir MS, Carbon R, Ekkernkamp A, et al. Monopolar and bipolar combination injuries of the clavicle: Retrospective incidence analysis and proposal of a new classification system. J Clin Med, 2021, 10(24): 5764. doi: 10.3390/jcm10245764.
15.	董文偉, 連偉杰, 毛海蛟, 等. 鎖定鋼板微創內固定治療鎖骨中段骨折的療效研究. 中國修復重建外科雜志, 2024, 38(8): 947-953.
16.	Allman FL Jr. Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg (Am), 1967, 49(4): 774-784.
17.	Sanders JO, Lyons FA, Rockwood CA Jr. Management of dislocations of both ends of the clavicle. J Bone Joint Surg (Am), 1990, 72(3): 399-402.
18.	Eyres KS, Brooks A, Stanley D. Fractures of the coracoid process. J Bone Joint Surg (Br), 1995, 77(3): 425-428.
19.	Frege S, Lacheta L, Karpinski K, et al. Influence of tilt and rotation on coracoclavicular distance measurements and rockwood classification in panorama view radiographs in the diagnosis of acromioclavicular dislocations. Orthop J Sports Med, 2025, 13(4): 23259671251329344. doi: 10.1177/23259671251329344.
20.	Madi S, Pandey V, Khanna V, et al. A dual injury of the shoulder: acromioclavicular joint dislocation (type Ⅳ) coupled with ipsilateral mid-shaft clavicle fracture. BMJ Case Rep, 2015, 2015: bcr2015213254. doi: 10.1136/bcr-2015-213254.
21.	Paryavi E, Christian MW, Belin EJ, et al. Floating clavicular injury: Treatment of combined midshaft fracture and acromioclavicular separation with a dual plating technique. Current Orthopaedic Practice, 2013, 24(3): 349-352.
22.	姜天淇, 周艷妮, 郇顏強, 等. 外傷性漂浮鎖骨1例報道. 中國矯形外科雜志, 2024, 32(2): 190-192.
23.	Jiamton C, Taweekitikul P, Leelasestaporn T, et al. Traumatic floating clavicle: A case report and updated literature review. Cureus, 2024, 16(8): e67630. doi: 10.7759/cureus.67630.
24.	于雷剛, 嚴正, 姜硯劼, 等. 鎖定鋼板聯合克氏針張力帶固定治療漂浮鎖骨. 中國骨科臨床與基礎研究雜志, 2025, 15(1): 14-18.
25.	高培剛, 王興存, 鮑紅剛. 切開復位內固定治療鎖骨雙極脫位四例. 中國修復重建外科雜志, 2024, 38(2): 151-154.
26.	孫遠林, 申云周, 陽運康. 新型解剖鎖定鋼板內固定治療鎖骨雙極骨折脫位伴胸骨體骨折一例. 中國修復重建外科雜志, 2025, 39(11): 1498-1500.
27.	Wang C, Li X, Dong S, et al. Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a systematic review. BMC Surg, 2025, 25(1): 87. doi: 10.1186/s12893-025-02815-x.
28.	劉宏智, 邱長茂, 劉兆杰, 等. 喙突Eyres Ⅴ型骨折合并肩關節上方懸吊復合體損傷的特點及手術療效分析. 中國修復重建外科雜志, 2014, 28(12): 1469-1473.
29.	Ottomeyer C, Taylor BC, Isaacson M, et al. Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint dislocations: Incidence and risk factors. Injury, 2017, 48(2): 469-473.
30.	Wijdicks C , Anavian J , Ly TV, et al. Surgical management of a midshaft clavicle fracture with ipsilateral acromioclavicular dislocation: A report on 2 cases and review of the literature. Injury Extra, 2013, 44: 9-12.
31.	Davies EJ, Fagg JA, Stanley D. Subacromial, supracoracoid dislocation of the acromioclavicular joint with ipsilateral clavicle fracture: a case report with review of the literature and classification. JRSM Open, 2014, 5(7): 2054270414527281. doi: 10.1177/2054270414527281.
32.	Sharma N, Mandloi A, Agrawal A, et al. Acromioclavicular joint dislocation with ipsilateral mid third clavicle, mid shaft humerus and coracoid process fracture—A case report. J Orthop Case Rep, 2016, 6(2): 24-27.
33.	吳勝凱, 劉潔函, 魏鴻翔, 等. 鎖骨鉤鋼板治療肩鎖關節脫位與鎖骨肩峰端骨折的療效比較研究. 中國修復重建外科雜志, 2025, 39(8): 1037-1044.

1. Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma, 1993, 7(2): 99-106.
2. Ja?n M, Sayer L, Fornaciari P. Triple disruption of the superior shoulder suspensory complex—review and surgical technique. J Orthop Case Rep, 2023, 13(6): 121-126.
3. Shakya S, Wen Y, Wen X, et al. Minimally invasive plate osteosynthesis (MIPO) with mini-open technique versus open reduction and internal fixation (ORIF) in the treatment of displaced midclavicular fracture: a retrospective study. J Orthop Traumatol, 2025, 26(1): 51. doi: 10.1186/s10195-025-00865-8.
4. von Rüden C, Rehme-R?hrl J, Augat P, et al. Evidence on treatment of clavicle fractures. Injury, 2023, 54 Suppl 5: 110818. doi: 10.1016/j.injury.2023.05.049.
5. 曾勇濤, 鄭宏程, 那次克道爾吉, 等. 肩關節鏡下喙突單隧道固定與無隧道懸吊固定治療急性Ⅲ-Ⅴ型肩鎖關節脫位. 中國組織工程研究, 2025, 29(5): 1036-1042.
6. 蔣棟, 呂書軍, 洪曄, 等. 鎖骨鉤鋼板與三Endobutton鋼板治療新鮮肩鎖關節脫位療效比較. 中國修復重建外科雜志, 2012, 26(9): 1025-1028.
7. Ingoe H, Maharaj J, Singh N, et al. Superior suspensory complex of the shoulder reconstruction for acute and chronic acromioclavicular joint dislocations: the Queensland Unit for Advanced Shoulder Research 3-tunnel technique. JSES Int, 2024, 9(1): 31-39.
8. Nguyen MK, Nguyen VH, Le HGK, et al. Multiple disruptions of superior suspensory shoulder complex: A case report. Int J Surg Case Rep, 2024, 124: 110385. doi: 10.1016/j.ijscr.2024.110385.
9. Korkoman AJ, Alhamodi A, Alrusayni S, et al. Ipsilateral Rockwood type Ⅴ acromioclavicular joint dislocation and midshaft clavicle fracture: A case report. World J Orthop, 2024, 15(12): 1208-1213.
10. Lancourt JE. Acromioclavicular dislocation with adjacent clavicular fracture in a horseback rider. A case report. Am J Sports Med, 1990, 18(3): 321-322.
11. Meignanaguru M, Dhakshinamurthi Y, Srinivasan D, et al. Mid-shaft clavicle fracture with disguised ipsilateral type Ⅳ acromioclavicular joint dislocation—A rare case report. J Orthop Case Rep, 2024, 14(9): 19-23.
12. 葉春曉, 張細祥, 郭穎彬. 肩上部懸吊復合體2處損傷并亞急性肩鎖關節脫位2例. 中國骨與關節損傷雜志, 2024, 39(5): 556-558.
13. 蔣澤輝, 張開華, 許春濤, 等. 肩上方懸吊復合體多處損傷的切開復位內固定. 中國矯形外科雜志, 2025, 33(13): 1215-1218.
14. Bakir MS, Carbon R, Ekkernkamp A, et al. Monopolar and bipolar combination injuries of the clavicle: Retrospective incidence analysis and proposal of a new classification system. J Clin Med, 2021, 10(24): 5764. doi: 10.3390/jcm10245764.
15. 董文偉, 連偉杰, 毛海蛟, 等. 鎖定鋼板微創內固定治療鎖骨中段骨折的療效研究. 中國修復重建外科雜志, 2024, 38(8): 947-953.
16. Allman FL Jr. Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg (Am), 1967, 49(4): 774-784.
17. Sanders JO, Lyons FA, Rockwood CA Jr. Management of dislocations of both ends of the clavicle. J Bone Joint Surg (Am), 1990, 72(3): 399-402.
18. Eyres KS, Brooks A, Stanley D. Fractures of the coracoid process. J Bone Joint Surg (Br), 1995, 77(3): 425-428.
19. Frege S, Lacheta L, Karpinski K, et al. Influence of tilt and rotation on coracoclavicular distance measurements and rockwood classification in panorama view radiographs in the diagnosis of acromioclavicular dislocations. Orthop J Sports Med, 2025, 13(4): 23259671251329344. doi: 10.1177/23259671251329344.
20. Madi S, Pandey V, Khanna V, et al. A dual injury of the shoulder: acromioclavicular joint dislocation (type Ⅳ) coupled with ipsilateral mid-shaft clavicle fracture. BMJ Case Rep, 2015, 2015: bcr2015213254. doi: 10.1136/bcr-2015-213254.
21. Paryavi E, Christian MW, Belin EJ, et al. Floating clavicular injury: Treatment of combined midshaft fracture and acromioclavicular separation with a dual plating technique. Current Orthopaedic Practice, 2013, 24(3): 349-352.
22. 姜天淇, 周艷妮, 郇顏強, 等. 外傷性漂浮鎖骨1例報道. 中國矯形外科雜志, 2024, 32(2): 190-192.
23. Jiamton C, Taweekitikul P, Leelasestaporn T, et al. Traumatic floating clavicle: A case report and updated literature review. Cureus, 2024, 16(8): e67630. doi: 10.7759/cureus.67630.
24. 于雷剛, 嚴正, 姜硯劼, 等. 鎖定鋼板聯合克氏針張力帶固定治療漂浮鎖骨. 中國骨科臨床與基礎研究雜志, 2025, 15(1): 14-18.
25. 高培剛, 王興存, 鮑紅剛. 切開復位內固定治療鎖骨雙極脫位四例. 中國修復重建外科雜志, 2024, 38(2): 151-154.
26. 孫遠林, 申云周, 陽運康. 新型解剖鎖定鋼板內固定治療鎖骨雙極骨折脫位伴胸骨體骨折一例. 中國修復重建外科雜志, 2025, 39(11): 1498-1500.
27. Wang C, Li X, Dong S, et al. Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a systematic review. BMC Surg, 2025, 25(1): 87. doi: 10.1186/s12893-025-02815-x.
28. 劉宏智, 邱長茂, 劉兆杰, 等. 喙突Eyres Ⅴ型骨折合并肩關節上方懸吊復合體損傷的特點及手術療效分析. 中國修復重建外科雜志, 2014, 28(12): 1469-1473.
29. Ottomeyer C, Taylor BC, Isaacson M, et al. Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint dislocations: Incidence and risk factors. Injury, 2017, 48(2): 469-473.
30. Wijdicks C , Anavian J , Ly TV, et al. Surgical management of a midshaft clavicle fracture with ipsilateral acromioclavicular dislocation: A report on 2 cases and review of the literature. Injury Extra, 2013, 44: 9-12.
31. Davies EJ, Fagg JA, Stanley D. Subacromial, supracoracoid dislocation of the acromioclavicular joint with ipsilateral clavicle fracture: a case report with review of the literature and classification. JRSM Open, 2014, 5(7): 2054270414527281. doi: 10.1177/2054270414527281.
32. Sharma N, Mandloi A, Agrawal A, et al. Acromioclavicular joint dislocation with ipsilateral mid third clavicle, mid shaft humerus and coracoid process fracture—A case report. J Orthop Case Rep, 2016, 6(2): 24-27.
33. 吳勝凱, 劉潔函, 魏鴻翔, 等. 鎖骨鉤鋼板治療肩鎖關節脫位與鎖骨肩峰端骨折的療效比較研究. 中國修復重建外科雜志, 2025, 39(8): 1037-1044.

Chinese Journal of Reparative and Reconstructive Surgery

A special type of triple injury of superior shoulder suspensory complex—lateral segment floating clavicle

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