Acromioclavicular Joint Injuries and Distal Clavicle Fractures

Department of Orthopaedic Surgery, Northwestern University Medical School, Chicago.
The Journal of the American Academy of Orthopaedic Surgeons (Impact Factor: 2.53). 02/1997; 5(1):11-18.
Source: PubMed


The acromioclavicular joint is commonly affected by traumatic and degenerative conditions. Most injuries are due to direct trauma, such as a fall on the shoulder. Six types of acromioclavicular sprains and three types of distal clavicle fractures have been described in adults. Although there is general agreement on treatment of type I, II, IV, V, and VI acromioclavicular injuries, the treatment of type III injuries remains controversial. Studies have shown no distinct advantage for surgical reconstruction over nonoperative treatment. Because type II distal clavicle fractures are prone to nonunion, operative fixation may be advisable to avoid this complication.

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    • "In most of the cases sports injuries, especially hiking and road traffic injuries are the reason for AC joint dislocations. Many different types of operative procedures have been described to treat acromioclavicular dislocations and operative versus conservative treatment of Rockwood III lesions is still discussed controversially [2-6]. Results and complication rates of the countless procedures vary [27]. "
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    ABSTRACT: Acromioclavicular joint dislocations often occur in athletic, young patients after blunt force to the shoulder. Several static and dynamic operative procedures with or without primary ligament replacement have been described. Between February 2003 and March 2009 we treated 313 patients suffering from Rockwood III-V lesions of the AC joint with an AC-hook plate. 225 (72 %) of these patients could be followed up. Mean operation time was 42 minutes in the conventional group and 47 minutes in the minimal invasive group. The postoperative pain on a scale from 1 to 10 (VAS-scale) was rated 2.7 in the conventional group and 2.2 in the minimal invasive group. Taft score showed very good and good results in 189 patients (84%). Constant score showed an average of 92.4 of 100 possible points with 89 % excellent and good results and 11 % satisfying results. All patients had some degree of pain or discomfort with the hook-plate in place. These symptoms were relieved after removal of the plate. The overall complication rate was 10.6 %. There were 6 superficial soft tissue infections, 1 fracture of the acromion, 7 redislocations after removal of the hook-plate. We observed 4 broken hooks which could be removed at the time of plate removal, 4 seromas and 2 cases of lateral clavicle bone infection, which required early removal of the plate. We can conclude that clavicle hook plate is a convenient device for the surgical treatment of Rockwood Grade III-V dislocations, giving good mid-term results with a low overall complication rate compared to the literature. Early functional therapy is possible and can avoid limitations in postoperative shoulder function.
    European journal of medical research 02/2011; 16(2):52-6. DOI:10.1186/2047-783X-16-2-52 · 1.50 Impact Factor
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    • "The migration of Steinman pins, Hagie pins, and Kirschner wires from the AC joint to the neck [56], spinal cord [57], and lung [58] [59] has been reported in the literature. As a result, the current trend is to avoid transfixion pins around the shoulder whenever possible [32] [44] [60]. The use of hardware has also been associated with breakage and fixation failure [15] [61] (Fig. 4) as well as erosion of the clavicle by nonabsorbable suture or wire used for fixation [62 – 65]. "
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    ABSTRACT: Although common, AC joint injuries and their treatments are not benign. The injury itself and both nonsurgical and surgical treatments may result in complications yielding persistent pain, deformity, or dysfunction. Sternoclavicular joint injuries are far less common and are typically the result of higher energy trauma. As such, the associated complications may be more serious. Familiarity with the potential complications of these injuries can help the treating physician to develop strategies to minimize their incidence and sequelae.
    Clinics in Sports Medicine 05/2003; 22(2):387-405. DOI:10.1016/S0278-5919(03)00013-9 · 1.22 Impact Factor
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    ABSTRACT: In order to compare the prevalence of post-surgical pain in patients who undergone a meniscal extraction during coracoclavicular repair with those who didn't have it after a grade III or worse acromio-clavicular joint dislocation, we did make a transverse cohort study on 25 patients between January 2005 and April 2007 at Clínica Universitaria El Bosque. Fifteen patients were menisectomized and ten patients weren't. Post-surgical follow up was 24.4 months (range 13 to 50) for the menisectomized group of patients, and 23.4 months (range 12 to 51) for the not menisectomized group of them. Presence of pain was taken as a dicotomic variable among the groups and wasn't considered as a nominal variable as is usually performed. Three patients in the not menisectomized group complained of pain (30%), whether only one patient (6.66%) of the menisectomized counterpart presented it. Although this difference only express a tendency and is far away from statistical significance because of the sample size, further multicentric studies should be perform to clarify this tendency.
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