What is the measurement for acromioclavicular (AC) joint separation in pediatric patients?

From the Guidelines

Acromioclavicular (AC) joint separation in pediatric patients should be measured using the Rockwood classification system, which categorizes the injury into six types based on the degree of displacement between the clavicle and acromion, as this system provides a standardized approach to assessing the severity of the injury 1. To measure AC joint separation in children, radiographic evaluation is essential, typically including anteroposterior views of both shoulders for comparison, axillary lateral views, and sometimes stress views with weights. The coracoclavicular (CC) distance is a key measurement, comparing the injured to the uninjured side.

• Normal CC distance in children varies by age but is generally 20-40% smaller than in adults.
• When interpreting measurements, it's crucial to consider that children's growth plates are still open, which can affect the appearance and measurement of the joint.
• Ultrasound can be a useful adjunct to avoid radiation exposure, as mentioned in the context of traumatic shoulder pain evaluation 1. Some key points to consider in the measurement and management of AC joint separation in pediatric patients include:
• The importance of clinical examination and radiography in determining the etiology of traumatic shoulder pain, as noted in the study on traumatic shoulder pain 1.
• The need for regular follow-up imaging to ensure proper healing and to monitor for potential growth disturbances.
• Treatment decisions should be based on the classification, with Types I-II typically managed conservatively with rest, ice, and a sling, while Types III-VI may require surgical intervention depending on the child's age, activity level, and degree of displacement.

From the Research

Measurement of AC Joint Separation in Pediatric Patients

• There is limited information available on the measurement of AC joint separation specifically in pediatric patients.
• The provided studies focus on the management and treatment of AC joint separations in general, without specific reference to pediatric patients 2, 3, 4, 5, 6.

Classification and Treatment of AC Joint Separations

• AC joint separations are typically classified using the Rockwood classification system, which grades the severity of the injury from type I to type VI 3, 4.
• The treatment of AC joint separations depends on the severity of the injury, with type I and II injuries often being treated non-operatively, and type IV, V, and VI injuries typically requiring operative intervention 3.
• Type III injuries are often treated conservatively, although some studies suggest that surgical management may be necessary in certain cases 3, 4.

Non-Operative Treatment of AC Joint Separations

• Non-operative treatment of AC joint separations may involve the use of a sling, physical therapy, and pain management 2, 3.
• A study by 5 reported a case of a high-grade AC joint separation being reduced and stabilized without surgery using an AC joint brace.
• Another study by 4 found that non-operative treatment of grade III or higher AC joint injuries resulted in similar functional outcomes and patient satisfaction compared to surgical treatment.

Surgical Treatment of AC Joint Separations

• Surgical treatment of AC joint separations may involve various techniques, including soft-tissue repair, trans-articular AC joint fixation, and coracoclavicular fixation 6.
• A study by 4 found that surgical treatment of grade III or higher AC joint injuries resulted in a higher rate of complications compared to non-operative treatment.