Quadruple Disruption of the Superior Shoulder Suspensory Complex (SSSC) and Outcome after One Year of Conservative Treatment: A Case Report

The Superior Shoulder Suspensory Complex (SSSC) comprises a bony and soft tissue ring including the clavicle, acromioclavicular (AC) joint, acromial process, glenoid fossa and process, coracoid process and coracoclavicular ligaments [1]. This complex is believed to have important biomechanical functions concerning shoulder stability and overall shoulder function, and connects the upper extremity via the clavicle with the axial skeleton [2]. Disruption of the SSSC at a single location due to a clavicle fracture, acromion fracture, or ACjoint dislocation with intact coracoclavicular (CC) ligaments, is a common injury often treated conservatively as the stability of the SSSC is still warranted, if no other indication for operative therapy exists. Double disruption of the SSSC is a rare injury thought to destabilize the construct, and therefore operative repair of one or both of the involved structures is recommended [3-8]. Triple and quadruple SSSC disruptions have been reported, although they are even rarer. They most often result from high energy trauma events, which are very often accompanied by associated injuries of the ribs, spine, nerves and head [9-18]. The more parts of the SSSC are injured, the greater the instability of the shoulder girdle. Thus, almost all of these injury types are treated surgically. We report on the radiological and functional outcome of a quadruple SSSC disruption, which was successfully treated in a conservative manner and followed up for one year posttrauma.