Gurd, Ann Surg 1941 - The Treatment of Complete Dislocation of the Outer End of the Clavicle: An Hitherto Undescribed Operation

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The Treatment of Complete Dislocation of the Outer End of the Clavicle: An Hitherto Undescribed Operation

Gurd·Ann Surg·1941·204 citations·Case series

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Gurd describes an operation for complete dislocation of the lateral end of the clavicle: resection of the outer third of the bone. He challenges the textbook claim that the clavicle is a structural strut, arguing instead that it serves mainly as a point of muscle attachment. The report covers three patients, including one total clavicle resection for tumor and two distal resections for AC dislocation.

Key Findings

Total resection of the entire clavicle for a childhood sarcoma left the patient with full range of motion and no shoulder deformity 13 years later. Gurd uses this as his core proof that the clavicle is not a load-bearing strut supporting the shoulder.
At operation for complete AC dislocation, the coracoclavicular ligament was intact in both cases. This directly contradicts the classic teaching that the CC ligament always ruptures alongside the AC ligaments in complete dislocation.
The intact coracoclavicular ligament was used as an anatomic marker for the resection level, cutting the bone just lateral to it with Bethune rib shears. This gives a reproducible landmark for how much lateral clavicle to remove.
Both AC dislocation patients returned to heavy manual labor (steam shovel operator and locomotive mechanic) with no shoulder disability. Loss of the outer clavicle did not compromise strength or function.
No AC joint surface or ligament remained that could be used for repair, and the lateral clavicle overrode ~2 cm onto the superior surface of the acromion. This is why Gurd argued resection made more sense than attempting reconstruction of a destroyed joint.
Gurd frames resection as faster and lower-risk than fascial reconstruction (suturing clavicle to coracoid and acromion to clavicle), shortening operative time, infection risk, and the period of disability.

Board PearlResecting the outer end of the clavicle treats complete AC dislocation without deformity — the clavicle is a muscle anchor, not a load-bearing strut.

The Treatment of Complete Dislocation of the Outer End of the Clavicle: An Hitherto Undescribed Operation.

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|

The Treatment of Complete Dislocation of the Outer End of the Clavicle: An Hitherto Undescribed Operation

Gurd·Ann Surg·1941·204 citations·Case series

|

Gurd describes an operation for complete dislocation of the lateral end of the clavicle: resection of the outer third of the bone. He challenges the textbook claim that the clavicle is a structural strut, arguing instead that it serves mainly as a point of muscle attachment. The report covers three patients, including one total clavicle resection for tumor and two distal resections for AC dislocation.

Key Findings

Total resection of the entire clavicle for a childhood sarcoma left the patient with full range of motion and no shoulder deformity 13 years later. Gurd uses this as his core proof that the clavicle is not a load-bearing strut supporting the shoulder.
At operation for complete AC dislocation, the coracoclavicular ligament was intact in both cases. This directly contradicts the classic teaching that the CC ligament always ruptures alongside the AC ligaments in complete dislocation.
The intact coracoclavicular ligament was used as an anatomic marker for the resection level, cutting the bone just lateral to it with Bethune rib shears. This gives a reproducible landmark for how much lateral clavicle to remove.
Both AC dislocation patients returned to heavy manual labor (steam shovel operator and locomotive mechanic) with no shoulder disability. Loss of the outer clavicle did not compromise strength or function.
No AC joint surface or ligament remained that could be used for repair, and the lateral clavicle overrode ~2 cm onto the superior surface of the acromion. This is why Gurd argued resection made more sense than attempting reconstruction of a destroyed joint.
Gurd frames resection as faster and lower-risk than fascial reconstruction (suturing clavicle to coracoid and acromion to clavicle), shortening operative time, infection risk, and the period of disability.

Board PearlResecting the outer end of the clavicle treats complete AC dislocation without deformity — the clavicle is a muscle anchor, not a load-bearing strut.

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