scholarly journals Clavicle Elevation or Shoulder Girdle Depression in Acromioclavicular Joint Dislocation: A Radiological Investigation

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711987992 ◽  
Author(s):  
Fady Azar ◽  
Christian Pfeifer ◽  
Volker Alt ◽  
Benedikt Pregler ◽  
Isabella Weiss ◽  
...  
Keyword(s):  
Spinal Column ◽  
Shoulder Girdle ◽  
Classification Systems ◽  
Acromioclavicular Joint Dislocation ◽  
Ac Joint ◽  
Level Of Evidence ◽  
Radiological Investigation ◽  
Cross Sectional ◽  
Joint Injury ◽  
Joint Dislocations

Background: The side-comparative coracoclavicular (CC) distance is used to describe the vertical instability component of acute acromioclavicular (AC) joint dislocations. Elevation of the clavicle or a depression of the shoulder girdle can lead to an increased CC distance. The dislocation direction has not yet been investigated and is not included in common classification systems. Hypothesis: Clavicle elevation is primarily responsible for vertical dislocation in AC joint separation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Weighted and nonweighted bilateral plain anteroposterior views of the shoulder girdles of patients with AC joint dislocations (Rockwood [RW] types III and V), diagnosed in our trauma department between 2001 and 2018, were included in this study. After determining the CC distance, a side-comparative determination of the positions of both the clavicle and shoulder girdle, with reference to the spinal column, was conducted. Results: In total, 245 bilateral plain anteroposterior views were evaluated (RW III, n = 116; RW V, n = 129). All patients showed a side-comparative clavicle elevation (mean ± SD: RW III, 5 ± 14 mm; RW V, 11 ± 17 mm) in weighted and nonweighted views. While no depression of the shoulder girdle was measured in RW III injuries (weighted and nonweighted views, 0 ± 11 mm), dropping of the shoulder girdle in RW V lesions on nonweighted views was observed (–5 ± 11 mm). Conclusion: Vertical dislocation is mostly associated with clavicle elevation in RW III injures, while in high-grade AC joint dislocations (RW V), a combination of clavicle elevation and shoulder girdle depression is present. A significantly greater superior displacement of the clavicle in RW V injuries was seen in weighted views, while a depression of the shoulder girdle could be detected in nonweighted views. For the first time, these results include the dislocation direction in the classification of an AC joint injury. Further studies are needed to investigate the extent to which dislocation types differ in optimal therapy and outcome.

scholarly journals Treatment of acute high-grade acromioclavicular joint dislocation

2020 ◽  
Vol 23 (3) ◽  
pp. 159-165
Author(s):  
Jeung Yeol Jeong ◽  
Yong-Min Chun
Keyword(s):  
Standard Procedure ◽  
High Energy ◽  
Acromioclavicular Joint Dislocation ◽  
High Grade ◽  
Shoulder Injuries ◽  
Ac Joint ◽  
Joint Injury ◽  
Joint Dislocation ◽  
Treatment Type ◽  
Joint Dislocations

Acromioclavicular (AC) joint dislocations account for about 9% of shoulder injuries. Among them, acute high-grade injury following high-energy trauma accounts for a large proportion of patients requiring surgical treatment. However, there is no gold standard procedure for operative treatment of acute high-grade AC joint injury, and several different procedures have been used for this purpose in clinical practice. This review article summarizes the most recent and relevant surgical options for acute high-grade AC joint dislocation patients and the outcomes of each treatment type.

Factors Predicting the Outcome After Arthroscopically Assisted Stabilization of Acute High-Grade Acromioclavicular Joint Dislocations

2019 ◽  
Vol 47 (11) ◽  
pp. 2670-2677 ◽  
Author(s):  
Nina Maziak ◽  
Laurent Audige ◽  
Carmen Hann ◽  
Marvin Minkus ◽  
Markus Scheibel
Keyword(s):  
Clinical Outcome ◽  
Acromioclavicular Joint ◽  
High Grade ◽  
Radiological Outcome ◽  
Ac Joint ◽  
Level Of Evidence ◽  
Outcome Parameters ◽  
Joint Dislocations ◽  
Anatomic Reduction ◽  
Arthroscopically Assisted

Background: Factors influencing the outcome after arthroscopically assisted stabilization of acute high-grade acromioclavicular (AC) joint dislocations remain poorly investigated. Purpose: To identify determinants of the radiological outcome and investigate associations between radiological and clinical outcome parameters. Study Design: Cohort study; Level of evidence, 3. Methods: The authors performed a retrospective analysis of patients who underwent arthroscopically assisted stabilization for acute high-grade AC joint dislocations. The following potential determinants of the radiological outcome were examined using univariable and multivariable regression analyses: timing of surgery, initial AC joint reduction, isolated coracoclavicular (CC) versus combined CC and AC stabilization, ossification of the CC ligaments, age, and overweight status. In addition, associations between radiological (ie, CC difference, dynamic posterior translation [DPT]) and clinical outcome parameters (Subjective Shoulder Value, Taft score [TS] subjective subcategory, and Acromioclavicular Joint Instability Score [ACJI] pain subitem) were evaluated using univariable analysis. Results: One hundred four patients with a mean (±SD) age of 38.1 ± 11.5 years were included in this study. The mean postoperative follow-up was 2.2 ± 0.9 years. Compared with patients with an overreduced AC joint after surgery, the CC difference was 4.3 mm (95% CI, 1.3-7.3; P = .006) higher in patients with incomplete reduction. Patients with anatomic reduction were 3.1 times (95% CI, 1.2-7.9; P = .017) more likely to develop DPT than those with an overreduced AC joint. An incompletely reduced AC joint was 5.3 times (95% CI, 2.1-13.4; P < .001) more likely to develop DPT versus an overreduced AC joint. Patients who underwent isolated CC stabilization were 4.8 times (95% CI, 1.1-21.0; P = .039) more likely to develop complete DPT than patients with additional AC stabilization. Significantly higher CC difference values were noted for patients who reported pain on the subjective TS ( P = .025). Pain was encountered more commonly in patients with DPT ( PTS = .049; PACJI = .038). Conclusion: Clinicians should consider overreduction of the AC joint because it may lead to favorable radiological results. Because of its association with superior radiographic outcomes, consideration should also be given to the use of additional AC cerclage.

scholarly journals Ipsilateral midshaft clavicle fracture and acromioclavicular joint dislocation: a review of literature and evidence-based diagnosis guidelines

2020 ◽  
Author(s):  
Rongguang Ao ◽  
Zhen Jian ◽  
Jinhong Chen ◽  
Dejian Li ◽  
Xu Zhang ◽  
...  
Keyword(s):  
Clavicle Fracture ◽  
High Energy ◽  
Shoulder Function ◽  
Acromioclavicular Joint Dislocation ◽  
Evidence Based ◽  
Ac Joint ◽  
Level Of Evidence ◽  
Joint Dislocation ◽  
Type Iv ◽  
Ac Joint Dislocation

Abstract Background: Ipsilateral midshaft clavicle fracture and AC joint dislocation are rare, with very few cases reported. Once the AC joint dislocation were missed diagnosis, the shoulder function may be affected and medical dispute was easy to occur. The aim of this study was to gather data relating to ipsilateral midshaft clavicle fracture and AC joint dislocation to develop evidence-based diagnosis guidelines as none are currently available.Methods: A study was conducted of the PubMed and Google Scholar databases to identify cases of ipsilateral midshaft clavicle fracture and AC joint dislocation. Data collected about each case included age and gender of the patient, mechanism of injury, fracture and dislocation classification. The authors report 2 additional ipsilateral midshaft clavicle fracture and AC joint dislocation cases.Results: 21 cases were identified for inclusion in this research, 19 from the literature and 2 reported by the authors. All the patients were injured by high energy trauma. For the midshaft fracture, 16/21 (76.2%) patients belonged to Type A classification, and 5/21 (23.8%) patients belonged to Type B classification. For AC joint dislocation, 11/21 (47.6%) patients belonged to Type IV classification, 4/21 (19.0%) patients belonged to Type VI classification, 5/21 (23.8%) patients belonged to Type III classification and 1/21 (4.7%) patients belonged to Type V classification.Conclusions: There are limited data available about the diagnosis of ipsilateral midshaft clavicle fracture and AC joint dislocation. From the cases reviewed, we find that simple midshaft clavicle caused by high energy injuries may be associated with ipsilateral AC joint dislocation. Physical examination, careful observation of preoperative X-ray and fluoroscopy including the AC joint during operation were key to diagnose the injury. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

The Function of the Acromioclavicular and Coracoclavicular Ligaments in Shoulder Motion

2012 ◽  
Vol 40 (11) ◽  
pp. 2617-2626 ◽  
Author(s):  
Satoshi Oki ◽  
Noboru Matsumura ◽  
Wataru Iwamoto ◽  
Hiroyasu Ikegami ◽  
Yoshimori Kiriyama ◽  
...  
Keyword(s):  
Horizontal Plane ◽  
Acromioclavicular Joint ◽  
Sagittal Plane ◽  
Shoulder Girdle ◽  
Surgical Reconstruction ◽  
Acromioclavicular Joint Dislocation ◽  
Joint Dislocation ◽  
3 Dimensional ◽  
Joint Dislocations ◽  
Ligament Disruption

Background: Scapulothoracic dyskinesis is an important consequence of acromioclavicular joint dislocations. However, no reports have described changes in 3-dimensional motions of the scapula and clavicle with respect to the thorax caused by acromioclavicular joint dislocation. Hypothesis: Sectioning of the acromioclavicular (AC) and coracoclavicular (CC) ligaments affects scapular and clavicular motion in a whole-cadaver model. Study Design: Controlled laboratory study. Methods: We evaluated shoulder girdle motion (scapula, clavicle, and humerus) relative to the thorax of 14 shoulders from 8 whole cadavers after sequential sectioning of the AC and CC ligaments (trapezoid and conoid ligaments). An electromagnetic tracking device measured 3-dimensional kinematics of the scapula and clavicle during humerothoracic elevation in the coronal and sagittal planes and adduction in the horizontal plane. Results: Sectioning of the AC ligament increased clavicular retraction during sagittal plane elevation and horizontal plane adduction. Sectioning of the trapezoid ligament decreased scapular external rotation during sagittal plane elevation and horizontal plane adduction. Sectioning of the conoid ligament decreased scapular posterior tilting during sagittal plane elevation and horizontal plane adduction. Acromioclavicular and CC ligament sectioning also delayed clavicular posterior rotation and increased clavicular upward rotation during coronal plane elevation. Conclusion: Our study revealed that AC and CC ligament disruption affected in vitro shoulder girdle kinematics in the whole-cadaver model. Clinical Relevance: The results of this cadaveric study revealed that AC and CC ligament disruption could cause dyskinesis of the scapula and clavicle. The kinematic changes could be a potential source of pain and dysfunction in the shoulder with AC joint dislocation, and therefore surgical reconstruction may be indicated in certain patients.

scholarly journals Recurrent acromioclavicular joint dislocation with an associated coracoid fracture following acromioclavicular joint reconstruction

2020 ◽  
Vol 102 (6) ◽  
pp. e136-e140
Author(s):  
M Karia ◽  
N Al-Hadithy ◽  
G Tytherleigh-Strong
Keyword(s):  
Acromioclavicular Joint ◽  
High Strength ◽  
Shoulder Girdle ◽  
Coracoid Process ◽  
Acromioclavicular Joint Dislocation ◽  
Shoulder Injuries ◽  
Overhead Athletes ◽  
Joint Dislocations ◽  
Synthetic Ligament ◽  
Acromioclavicular Joint Instability

Acromioclavicular joint injuries are common and account for up to 12% of all shoulder girdle injuries and have been reported as being as high as 50% in sports-related shoulder injuries. While the majority of acromioclavicular joint dislocations can be treated non-operatively, there are certain injury configurations, which can include high-grade dislocations in overhead athletes, where surgery may be indicated. The surgical management of acromioclavicular joint instability has moved towards recreating the action of the coracoclavicular ligaments by resuspending the clavicle on to the coracoid. Multiple techniques using high-strength sutures, synthetic ligaments, tendon allografts or autografts passed either around or through the coracoid process have been described. However, an unusual, but significant, complication associated with these techniques is an iatrogenic fracture of the coracoid process. We report the case of a patient with an iatrogenic coracoid fracture following two failed acromioclavicular joint resuspensory reconstructions using a synthetic ligament. This injury was successfully treated with an autologous hamstring graft reconstruction, initially protected with a hook plate.

scholarly journals INTER- AND INTRA-OBSERVER RELIABILITY OF SCHATZKER, AO, AND LUO CLASSIFICATIONS FOR TIBIAL PLATEAU FRACTURES

2020 ◽  
Vol 28 (5) ◽  
pp. 216-220
Author(s):  
JONATAS BRITO DE ALENCAR NETO ◽  
CLODOALDO JOSÉ DUARTE DE SOUZA ◽  
PEDRO RAFAEL REIS COELHO ◽  
PEDRO GOMES DE FREITAS JÚNIOR ◽  
MÁRCIO BEZERRA GADELHA LOPES ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Cross Sectional Study ◽  
Classification Systems ◽  
Tibial Plateau Fractures ◽  
Observer Agreement ◽  
Kappa Index ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Schatzker Classification ◽  
Level Of Agreement

ABSTRACT Objective: To verify inter- and intra-observer agreement of three classification systems for tibial plateau fractures - Schatzker, AO/ASIF, and Luo’s - among orthopedic surgery residents. Methods: This cross-sectional study was conducted with 29 observers. Radiographic and tomographic imaging of the knee of 15 patients presenting with fractures were evaluated. After six weeks, the test was reapplied. The level of agreement was calculated by the Kappa index. Results: In test 1, inter-observer agreement of all residents, according to the Kappa index, for Schatzker classification was 0.226, for AO 0.431, and Luo’s 0.319. In test 2, values were 0.316, 0.333, and 0.347, respectively (p < 0.001). Regarding intra-observer analysis, the mean Kappa indexes of 1st-year residents were: Schatzker, 0.20; AO, 0.32; and Luo’s, 0.3. For 2nd-year residents, means were: 0.51, 0.58, and 0.38, respectively. As for 3rd-year, results were 0.42, 0.42, and 0.41, respectively (p < 0.001). Conclusion: AO/ASIF showed a better reproducibility than other classifications, with substantial inter- and intra-observer agreement. We also found a stronger agreement among 2nd- and 3rd-year residents. Level of Evidence III, Diagnostic Studies - Investigating a Diagnostic Test.

scholarly journals Fifteen-degree clavicular hook plate achieves better clinical outcomes in the treatment of acromioclavicular joint dislocation

2018 ◽  
Vol 46 (11) ◽  
pp. 4547-4559 ◽  
Author(s):  
Guanghui Li ◽  
Tuoen Liu ◽  
Xianfang Shao ◽  
Zhijun Liu ◽  
Jianhui Duan ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Postoperative Recovery ◽  
Hook Plate ◽  
Acromioclavicular Joint Dislocation ◽  
Ac Joint ◽  
Level Of Evidence ◽  
Joint Dislocation ◽  
Ac Joint Dislocation ◽  
Clavicular Hook Plate ◽  
Retrospective Comparative Study

Objective Clavicular hook plate application is one of the most commonly used treatment methods for acromioclavicular (AC) joint dislocation, although it may cause multiple postoperative complications. We modified the regularly used 0° hook plate to 15° and compared the clinical outcomes of these two hook plates for treatment of AC joint dislocation. Methods Forty-three patients with acute AC joint dislocation were randomly enrolled (0° hook plate, 20 patients; 15° hook plate, 23 patients). The American Shoulder and Elbow Surgeons (ASES) and visual analog scale for pain (VASP) scores were evaluated preoperatively and at 3 days and 1, 2, 3, and 6 months postoperatively and compared between the two groups. Results Compared with the preoperative scores, the 6-month postoperative ASES score gradually increased but the VASP score decreased in both groups. Furthermore, the ASES and VASP scores were significantly different between the two groups at every postoperative time point. Conclusion The 15° hook plate is superior to the 0° hook plate in reducing shoulder pain and improving postoperative recovery in the treatment of AC joint dislocation. Level of evidence Level III; Treatment study (retrospective comparative study).

scholarly journals Clinical and radiological results after coracoclavicular ligament reconstruction for type III acromioclavicular joint dislocation using three different techniques. A retrospective study

Joints ◽  
2015 ◽  
Vol 03 (02) ◽  
pp. 54-61 ◽  
Author(s):  
Alberto Vascellari ◽  
Stefano Schiavetti ◽  
Giuseppe Battistella ◽  
Enrico Rebuzzi ◽  
Nicolò Coletti
Keyword(s):  
Retrospective Study ◽  
Acromioclavicular Joint ◽  
Constant Score ◽  
Acromioclavicular Joint Dislocation ◽  
Dash Score ◽  
X Rays ◽  
Level Of Evidence ◽  
Type Iii ◽  
Joint Dislocations

Purpose: the purpose of this retrospective study was to present the outcomes of three different techniques for the treatment of type III acromioclavicular joint dislocations: arthroscopic TightRope (TR), arthroscopic GraftRope (GR), and open reconstruction of the coracoclavicular (CC) ligament using the Ligament Augmentation and Reconstruction System (LARS). Methods: eighteen patients underwent clinical and radiological evaluations after a mean follow-up time of 43 months. The following clinical outcome measures were considered: the Disability of the Arm, Shoulder and Hand outcome measure (DASH), the Nottingham Clavicle Score (NCS), and the Constant score (CS). On X-rays, the CC distance was measured. Results: the median DASH score at follow-up was 12.5 in the TR group, 5 in the GR group, and 4.2 in the LARS group. The median NCS value was 88 in the TR group, 88 in the GR group, and 91 in the LARS group. The median CS was 100 in the TR group, 95 in the GR group, and 94.5 in the LARS group. The mean CC distance was 10.3 mm in the TR group, 13.8 in the GR group, and 16.6 in the LARS group. Conclusions: all three techniques proved to be reliable in providing good clinical outcomes, although none of the studied techniques demonstrated reliability in maintaining anatomical reduction after surgery. Level of evidence: Level III, retrospective comparative study.

scholarly journals Outcome of Acromio-Clavicular joint dislocation operated using clavicle hook plate

2018 ◽  
Vol 8 (2) ◽  
pp. 41-43
Author(s):  
Akesh Prajapati ◽  
Jyoti Sitaula ◽  
Bishnu Dev Sharma ◽  
Sujit Shrestha ◽  
Pujan Pant ◽  
...  
Keyword(s):  
Los Angeles ◽  
Excellent Result ◽  
Hook Plate ◽  
Acromioclavicular Joint Dislocation ◽  
Ac Joint ◽  
Rockwood Classification ◽  
Joint Dislocation ◽  
Joint Dislocations ◽  
Rockwood Type Iii ◽  
Clavicle Hook Plate

Rockwood classification of AC joint dislocation is generally accepted worldwide. Treatment of Rockwood Type 1 and 2 AC joint is non-operative while all authors advocate operative treatment for Rockwood Type 4 and 5 AC joint dislocations. Thirty consecutive patients who underwent operation for acromioclavicular joint dislocation using clavicle hook plate from June 2015 were studied. The dislocations ranged from Rockwood type III to type V. Average follow up time was fourteen months ranging from four to twenty-four months. The outcome was measured using University of California Los Angeles (UCLA) shoulder score. All-the patient had good to excellent result.

The true axial shoulder projection: Diagnostic aid for acromioclavicular joint dislocation?

2020 ◽  
pp. 175857322090557
Author(s):  
SS Jassim ◽  
R Clough ◽  
T Yarashi ◽  
A Carlos ◽  
L Di Mascio
Keyword(s):  
Acromioclavicular Joint ◽  
Glenohumeral Joint ◽  
Case Series ◽  
Reference Line ◽  
Acromioclavicular Joint Dislocation ◽  
Level Of Evidence ◽  
Observer Reliability ◽  
Anterior Aspect ◽  
Joint Dislocations ◽  
Axial Radiograph

Introduction Acromioclavicular joint dislocations are common. Differentiating between horizontal and vertical instability is challenging, but possible to diagnose on axial radiographs. No clear consensus for axial radiograph parameters currently exists. We aim to establish a reproducible technique to assess whether an axial radiograph represents a true axial view of the shoulder. Methods One hundred CT scans of normal uninjured shoulders were examined using multiplanar reformatting to assess the distance between the anterior glenoid (reference line) and anterior-most aspect of the acromion in the axial plane. Measurements were repeated and performed by multiple observers to give of intra- and inter-observer reliability. Results The mean distance from the anterior acromion to the reference line was −2.6 mm (i.e. posteriorly placed) (SD = 5.8 mm, range −16.9–13.2 mm). Most (89%) of the measurements were between 9 and −9 mm to the reference line. Intra-observer reliability was high with Cronbach’s α measurement as 0.997. Inter-observer reliability gave a Cronbach’s α measurement of 0.959. Conclusion When the anterior aspect of the acromion lies within 10 mm either side of a line parallel to the scapula blade at the anterior aspect of the glenoid on an axial radiograph, it represents a true axial projection of the glenohumeral joint (GHJ). Level of evidence: IV, Case series

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