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.

Acute high-grade acromioclavicular joint dislocation patients treated with titanium cable insertion under a homemade guider

Backgrounds To describe a new technique for implanting a double-bundle titanium cable to treat acromioclavicular (AC) joint dislocation via the new guider, and evaluate clinic outcomes. Methods A retrospective study of patients treated for acute high-grade acromioclavicular joint dislocation from June 2016 to January 2020 in our trauma center, twenty patients with AC joint dislocation were managed with double-bundle titanium cable. It includes the following steps: (1) Put the guider under the coracoid close to the cortical; (2) drill proximal clavicle; (3) place the titanium cable; (4) perforate distal clavicle, (5) reset the acromioclavicular joint and lock titanium cable; and (6) suture the acromioclavicular ligament. An independent reviewer conducted functional testing of these patients, including the use of coracoclavicular distance (CCD), visual analog scale (VAS) scores, and Constant–Murley scores (CMS). Results All patients are presented following at a median duration of 15 months (12-24months) after the surgery. All patients based on X-ray evaluation and clinic evaluation. The median CCD was 7.5 (6–14) mm, the VAS score was 0.55 (0-2), the CMS score was 95.5 (92-99). One patient had subluxation again at the final follow-up based on X-ray examination. Conclusions This study demonstrates that the AC joint fixation anatomically with double-bundle titanium, acquired excellent outcomes in terms of the recovery of shoulder joint function and radiographic outcomes. It has a low complication rate and need not remove the hardware.

Technique for Arthroscopic Resection of the Distal Clavicle in Patients with Symptomatic Acromioclavicular Joint Osteoarthritis: A Retrospective Study

Background: Arthroscopic resection of the distal clavicle has the potential risk of inadequate resection that may be associated with residual postoperative pain. We propose a new arthroscopic technique to excise the distal clavicle precisely and reproducibly without causing impingement or instability of the acromioclavicular (AC) joint. The purpose of this study was to evaluate the clinical and radiological results of arthroscopic distal clavicle resection in patients with symptomatic AC joint osteoarthritis.Methods: We retrospectively evaluated 26 patients (mean age, 55.3 ± 16.0 years) who underwent arthroscopic distal clavicle resection between April 2010 and September 2017 with a minimum 1-year follow-up (mean follow-up, 25.3 ± 11.1 months). Nine of these patients also underwent rotator cuff repair. Clinical evaluations performed preoperatively and at final follow-up included subjective pain scores according to a visual analogue scale (VAS), range-of-motion examinations, UCLA scores, and Shoulder-36 scores. Shoulder muscle strengths were measured with a handheld dynamometer. The amount of distal clavicle resection was measured on plain radiographs. Results: No patients had AC joint tenderness. There were significant differences between the preoperative and postoperative VAS, UCLA, and Shoulder-36 scores (P < 0.05). Muscle strengths were measured preoperatively and at final follow-up in 14 patients. Elevation and internal rotation strengths were significantly greater postoperatively, but there was no significant difference in external rotation strength. The mean amount of distal clavicle resection was 14.1 ± 2.1 mm. The mean coracoclavicular distance was 8.4 ± 1.6 mm preoperatively and 8.6 ± 1.8 mm at final follow-up, with no significant difference. Conclusions: Our arthroscopic technique of distal clavicle resection for AC joint osteoarthritis resulted in successful clinical outcomes at final follow-up. Bone resection was performed according to the amount planned, as confirmed on postoperative radiographs. The technique allows resection of the distal clavicle with accurate shape and amount as planned preoperatively with no postoperative instability of the AC joint.

Comparison between Trans-articular and Subacromial Stabilization with Ligament Repair for Acute Acromioclavicular Dislocation

Background: Although numerous treatment options for acromioclavicular joint dislocation have been reported, the treatment strategy is not yet standardized. Objective: The purpose of this study was to evaluate the clinical and radiographic results of coracoclavicular ligament repair with temporary acromioclavicular stabilization using suture anchors and Kirschner wires, and to compare the results between temporary trans-articular fixation and subacromial stabilization of the acromioclavicular joint. Methods: Thirty-three cases with displaced acromioclavicular joint dislocation were retrospectively evaluated. In the first 14 cases, the wires temporarily penetrated the joint for an average of 7 weeks (trans-articular group), while the acromioclavicular joint was temporarily stabilized by wires passing under the acromion that were inserted into the distal clavicle for an average of 13 weeks in the latter 19 cases (subacromial group). Clinical and radiographic results were evaluated and compared between the two groups. Results: The average UCLA score was 32.0 points in the trans-articular group and 32.8 points in the subacromial group, indicating no difference between the two groups (P = 0.418). Coracoclavicular distance ratio after surgery was significantly smaller in the subacromial group (P ≤ 0.035), and acromioclavicular dislocation ratio after removal of the wires was also smaller in the subacromial group (P ≤ 0.001) compared with the trans-articular group. Conclusion: This study revealed that coracoclavicular ligament repair with temporary acromioclavicular stabilization leads to favorable clinical results, with the subacromial group showing better maintenance of joint reduction compared with the trans-articular group. Subacromial wire stabilization is a viable option for long-term temporary fixation of acute displaced acromioclavicular joint dislocation.

Suture Button Versus Hook Plate for Acute Unstable Acromioclavicular Joint Dislocation: A Meta-analysis

Background: Surgical treatment is indicated for unstable acromioclavicular (AC) joint dislocation. The hook plate (HP) technique is a commonly used treatment method, but the use of the suture button (SB) technique is increasing. Purpose: To conduct a meta-analysis of clinical studies evaluating patient outcomes between the SB and HP techniques for acute unstable AC joint dislocation. Study Design: Meta-analysis. Methods: A literature search of the Embase, PubMed, and Cochrane Library databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Cohort studies and case-control studies comparing the SB and HP procedures for acute unstable AC joint dislocation were included. Statistical analysis was performed with RevMan (v 5.3.5). Results: Eight clinical studies that met the inclusion criteria were identified and included a total of 204 patients treated with the SB technique and 195 patients with the HP technique. Patients treated with the SB technique had a higher Constant score (mean difference [MD], 3.95; 95% CI, 1.20-6.70; P = .005) and a lower visual analog scale pain score (MD, –0.75; 95% CI, –1.12 to 0.37; P < .0001) when compared with the HP technique. No significant differences in operation time (MD, –0.38; 95% CI, –7.14 to 6.37; P = .91), coracoclavicular distance (MD, –0.07; 95% CI, –0.49 to 0.35; P = .75), complications (odds ratio, 0.59; 95% CI, 0.22-1.54; P = .28), and loss of reduction (odds ratio, 2.55; 95% CI, 0.66-9.83; P = .17) were found between the SB and HP techniques. The subgroup analysis showed that the arthroscopic SB technique resulted in a higher Constant score (MD, 6.75; 95% CI, 4.21-9.29; P < .00001) as compared with the HP technique, but no differences were observed between the open SB and HP techniques (MD, 0.69; 95% CI, –0.82 to 2.20; P = .37). Conclusion: This meta-analysis demonstrated that the SB technique resulted in better functional outcomes and a reduced visual analog scale pain score when compared with the HP technique. However, for operation time, coracoclavicular distance, complications, and loss of reduction, there were no statistically significant differences between the techniques. Compared with the open procedure, arthroscopic SB may be superior for better functional outcomes.

The Radiologic Comparison of Operative Treatment Using a Hook Plate versus a Distal Clavicle Locking Plate of Distal Clavicle Fracture

BACKGROUND: The purpose of this study was to compare the radiologic results of patients who underwent surgery with a hook plate and a locking plate in distal clavicle fractures.METHODS: Sixty patients underwent surgical treatment for Neer type IIa, IIb, III, and V distal clavicle fracture. Twenty-eight patients underwent fracture fixation with a hook plate and 32 with a locking plate. Coracoclavicular distance was measured on standard anteroposterior radiographs before and after the surgery, and union was confirmed by radiograph or computed tomography taken at 6 months postoperatively. Other radiologic complications like osteolysis was also checked.RESULTS: Bony union was confirmed in 59 patients out of 60 patients, and 1 patient in the hook plate group showed delayed union. Coracoclavicular distance was decreased more in the hook plate group after surgery (p < 0.01). After 6 weeks of the hook plate removal, the coracoclavicular distance was increased a little compared to before metal removal, but there was no difference compared to the contralateral shoulder. Eleven out of 28 patients (39.3%) showed osteolysis on the acromial undersurface in the hook plate group.CONCLUSIONS: Both the hook plate group and the locking plate group showed satisfactory radiologic results in distal clavicle fractures. Both hook plate and locking plate could be a good treatment option if it is used in proper indication in distal clavicle fracture with acromioclavicular subluxation or dislocation.

Anatomical Locking Plate with Additional K-wire Fixation for Distal Clavicle Fracture

BACKGROUND: Neer type II distal clavicle fractures have the drawback of coracoclavicular instability and insufficient distal bony fragment, thereby making it difficult to achieve adequate fixation. Although various surgical treatments have been described for Neer type II fracture, the optimal treatment remains controversial. This study reports the clinical results and usefulness of anatomical locking plate with additional K-wire fixation.METHODS: A totally of 21 patients with type II distal clavicle fracture were included in the study. The surgical procedure reduced the fracture temporarily; it included insertion of one or two K-wire from the lateral margin of the distal fragment to the proximal fragment through the fracture site, followed by application and fixation of the locking plate. The bony union and migration of K-wire was evaluated in the follow-up radiography. The coracoclavicular distance and acromioclavicular joint arthrosis were assessed at the final follow-up. The Constant Score (CS) and Korean Shoulder Score (KSS) were evaluated for clinical scoring.RESULTS: Bone union was achieved in all cases. At the final follow-up, coracoclavicular distance of the injured shoulder was increased, as compared to the intact shoulder (p=0.002), with no accompanying clinical symptoms. No K-wire migration was observed. At the final follow-up, K-wire irritation was observed in two cases and acromioclavicular arthrosis in one case, with no other adverse effects. Pain visual analogue scale, CS, and KSS were improved in all cases.CONCLUSIONS: The method of anatomical locking plate with additional K-wire fixation could be useful in achieving beneficial clinical results.

Treatment of Acute Acromioclavicular Joint Injuries Using AO Hook Locking Plate

BACKGROUND: To evaluate clinical and radiological outcome using AO hook locking plate in acute acromioclavicular joint injuries.METHODS: This study was based on patients with Rockwood type 3 or 5 acromioclavicular joint injuries who received surgery with AO hook locking plate from June 2008 until June 2009. Among the 22 patients, 19 of them were male and 3 were female, the mean age was 44.4 +/- 15.57 years (20-72 years) and follow-up period was 15.5 +/- 3.90 months (12-23 months). Preoperatively, postoperatively, and at the final follow-up after the plate removal, both coracoclavicular distances were measured from the anteroposterior radiograph. Also, the Shoulder Rating Scale of the University of California at Los Angeles scores (UCLA scores), the American Shoulder and Elbow Surgeons scores (ASES scores), Constant scores, and the Korean Shoulder Society scores (KSS scores) were measured at the final follow-up to evaluate the function of the shoulder joint.RESULTS: At the time of injury, the mean coracoclavicular distance of the injured side was 17.69 +/- 4.23 mm (9.57-27.82 mm) and the unaffected side was 7.55 +/- 2.20 mm (3.24-13.05 mm). The mean coracoclavicular distance measured postoperatively and at the final follow-up was 6.87 +/- 2.34 mm (4.07-14.13 mm) and 8.47 +/- 2.96 mm (4.37-17.48 mm), respectively. The mean UCLA, ASES, Constant, and KSS scores measured in the final follow-up were 33.5 +/- 1.30 (31-35), 90.8 +/- 8.36 (72-100), 78.6 +/- 8.80 (62-100), and 94.4 +/- 5.08 (84-100) each.CONCLUSIONS: From this short-term research, the surgical treatment using AO hook locking plates in acute acromioclavicular joint injuries is clinically and radiographically satisfying and considered as a useful treatment method.