Rockwood grade for acj injuries

The Rockwood Grading for AcromioClavicular Joint injuries is from 1 to 6.(1)

In Grade 1 to 3 there is a varying degree of injury to the AcromioClavicular Ligaments (AC) and the CoracoClavicular ligaments (CC). Radiographically this translates into a 25-100% CoracoClavicular (CC) distance. 

For Grade 4-6 the disruption of the AC and CC ligaments and the Deltopectoral Fascia is more severe. For Grade 5 the CC distance is >100% of normal. (2)

Grade 1-3 Injuries can be managed conservatively with a Broad Arm Sling, Analgesia, an Advice Sheet and discharge. 

The orthopaedic referral chart (Accessed Oct 2020) states between 0830-2200 Grade 4-6 Injuries should be discussed with the Orthopaedic team on call and between 2200-0830 discussion is not indicated but a fracture clinic triage should be completed. Please ensure Senior ED discussion for all Grade 4-6 Injuries and especially if there is any suspicion of Major Mechanism, Open Injury or Neurovascular Compromise.

Ref1. https://faculty.washington.edu/jeff8rob/trauma-radiology-reference-resource/9-upper-extremity/rockwood-classification-of-acromioclavicular-joint-separation/
​Ref2. ​https://www.researchgate.net/figure/Rockwood-classification-of-acromioclavicular-injuries_tbl1_272096166

Steve Fordham Oct 2020