A modified single-endobutton technique combined with nice knot for treatment of Rockwood type III or V acromioclavicular joint dislocation

Purpose Double-endobutton technique, as a widely accepted strategy for the treatment of acromioclavicular joint dislocation, is undergoing constant improvement. This study aims to assess the clinical effect of a modified single-endobutton combined with the nice knot in the fixation of Rockwood type III or V acromioclavicular joint dislocation. Methods From January 2016 to June 2019, 16 adult patients (13 males and 3 females) with Rockwood type III or V acromioclavicular joint dislocation were treated with a modified single-endobutton technique combined with the nice knot in our department. The age ranged from 18 to 64 years old with an average of 32.8 years old. Operative time, intraoperative blood loss, post-operative clinical outcomes and radiographic results were recorded and analyzed. Preoperative and last follow-up scores in the Constant-Murley Scale, Neer score, Rating Scale of the American Shoulder and Elbow Surgeons and VAS scale and complications such as infection, re-dislocation, implant loosening, medical origin fracture and hardware pain were recorded and evaluated. Results Sixteen patients were followed up for 6 to 18 months with an average of 10.3 months. The operative time was 50–90 min with an average of (62.5 ± 3.10) min. The intraoperative blood loss was 30–100 ml, with an average of (55.0 ± 4.28) ml. The complications, such as wound infection, internal fixation failure and fractures, were not found in these cases. According to Karlsson criteria, there were excellent in 14 cases, good in 2 cases at the final follow-up. The mean VAS score of the patients was 5.88 ± 0.26 preoperatively, compared with 0.19 ± 0.14 at the final follow-up evaluation. The difference was statistically significant (P < 0.05). The mean Constant score was 45.5 ± 2.0 preoperatively, compared to 94.0 ± 0.73 at the final follow-up evaluation. The difference was statistically significant (P < 0.05). Patients had statistically significant preoperative and postoperative AC (acromioclavicular distance) and CC (coracoclavicular distance) distances (P < 0.05); 6 months postoperatively the AC(P = 0.412) and CC(P = 0.324) distances were not statistically significant compared to the healthy side. Conclusion Nice knot provides a reliable fixation for the single-endobutton technique in the treatment of acromioclavicular dislocations. The modified single-endobutton technique combined with the nice knot can achieve good clinical outcomes in the treatment of Rockwood type III or V acromioclavicular joint dislocation.

Clinical outcomes of bending versus non-bending of the plate hook in acromioclavicular joint dislocation

Background: We aimed to assess the effect of plate hook bending in treatment of acromioclavicular (AC) dislocation by analyzing clinical and radiological results according to the angle of the plate hook (APH).Methods: This was a retrospective, observational, case-control study including 76 patients with acute AC joint dislocation that were divided into two groups according to treatment with bent or unbent plate hook. The visual analog scale (VAS), the American Shoulder and Elbow Surgeons (ASES) shoulder score, and range of motion (ROM) were evaluated as clinical outcomes. Comparative coracoclavicular distance (CCD) was measured to evaluate radiological outcomes.Results: While the VAS and ASES of the bending group at 4 months after surgery were significantly higher (P=0.021, P=0.019), the rest of those and ROM showed no significant difference. The initial CCD decreased from 183.2%±25.4% to 114.3%±18.9% at the final follow-up in the bending group and decreased from 188.2%±34.4% to 119.1%±16.7% in the non-bending group, with no statistical difference (P=0.613). The changes between the initial and post-metal removal CCD were 60.2%±11.2% and 57.3%±10.4%, respectively, with no statistical difference (P=0.241). The non-bending group showed greater subacromial osteolysis (odds ratio, 3.87). Pearson’s coefficients for the correlation between APH and VAS at 4 months after surgery and for that between APH and ASES at 4 months after surgery were 0.74 and –0.63 (P=0.027 and P=0.032), respectively.Conclusions: The APH was associated with improved postoperative pain and clinical outcomes before implant removal and with reduced complications; therefore, plate hook bending is more useful clinically during plate implantation.

Os acromiale may be a contraindication of the clavicle hook plate: case reports and literature review

Background Os acromiale can be potentially missed or misdiagnosed as acromion fracture, and this can affect treatment determination if it is complicated with an ipsilateral shoulder injury. The clavicle hook plate is a widely used technique for distal clavicle injuries, leading to transacromial erosion, particularly when in the presence of os acromiale. Case presentation A 70-year-old man and a 78-year-old man who had limited mobility and severe pain in their right shoulders following falls attended the emergency center. Both patients were diagnosed with os acromiale with CT or MRI and acute distal clavicle fracture or acromioclavicular joint dislocation. Following a comprehensive evaluation, os acromiale may limit the application of a clavicle hook plate due to potential transacromial erosion. The distal clavicle fracture with ipsilateral os acromiale received treatment with a volar radius locking T plate, and the acromioclavicular joint dislocation with ipsilateral os acromiale was reconstructed using suture anchors. Both yielded satisfactory outcomes and voided transacromial erosion. Conclusions Ipsilateral os acromiale may be a relative contraindication to the clavicle hook plate. An axillary lateral radiograph is recommended to detect potential os acromiale in patients using a hook plate.