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