Surgical treatment of dislocated acromioclavicular syndesmolysis remains controversial
Keywords:
acromioclavicular joint, injury, dislocation, operative treatment, outcomeAbstract
Background: Operative treatment of acromioclavicular (AC) joint dislocations Allman-Tossy III type is controversial. There are more than 30 types of operative treatments described. At the Department of Traumatology of Celje General and Teaching Hospital (CGTH) we operate the AC joint dislocation by the AC joint opened reduction and fixation using two Kirschner wires and additional figure of eight wire loop over the AC joint. The purpose of the analysis is to evaluate the results of acromioclavicular joint complete dislocation Allman-Tossy III type operative treatment.
Patients and methods: In the 2-year period from July 1st 1997, to June 31st, 1999, at the Department of Traumatology of CGTH we operatively treated 59 injured persons with the AC joint dislocation. There were 55 men (93 %) and 4 women (7 %). The average age was 40 years (from 20 to 72 years). 56 (95 %) injured persons had the AC joint injury of Allman-Tossy III type. In first three weeks (early reconstruction) we operated 45 injured persons (76.3 %). The applied material was removed after 8 weeks. 47 (79.7 %) injured persons were re-examined at least one year after the injury (27 months in average; 14–39 months). The results were evaluated according to University of California at Los Angeles (UCLA) scale for the shoulder function evaluation. The impact of factors on a good treatment result was presented by the odds ratio and uni-variant analysis calculation.
Results: Out of 47 injured persons re-examined according to the UCLA scale at least one year after the injury there were 17 injured persons (36.2 %) rated with an excellent result (UCLA 34– 35), 22 good (46.8 %) (UCLA 28–33), 5 satisfactory (10.6 %) (UCLA 21–27) and 3 bad (6.4 %) (UCLA 0–20). In total we achieved 83 % of excellent and good results. The injured persons age did not significantly affect the treatment result. Complications occurred in 14 (29.8 %) injured patients. If no complications were occurred the odds ratio for good result was 6.7. 39 % of the injured persons were on the sick leave for more than 4 months. In the injured persons with accident insurance we noticed a longer sick leave status (odds ratio 1.25). The injury did not affect the injured persons employment. The majority of the employed (92.4 %) carried out the same work after treatment as before the injury.
Conclusion: By the operative treatment of the AC joint dislocation a good or excellent result is achieved in the majority of the injured persons (83 % in total).
Downloads
References
Larsen E, Bjerg Nielsen A, Christensen P. Conservative or surgical treatment of acromioclavicular dislocation. J Bone Joint Surg 1986; 68A: 552–5.Phillips AM, Smart C, Groom AFG. Acromioclavicular dislocation. Conservative or surgical therapy. Clin Orthop 1998; 353: 10– 17.
Bosh U, Fremerey RW. AC Gelenkverletzungen. Trauma Berufskrankh 2003; 5 Suppl 1: 126–9
Dawe CJ. Acromioclavicular joint injuries J Bone Joint Surg 1980; 62B: 269.
Weinstein MD, McCann DP, McIlveen SJ, Flatow EL, Bigliani LU. Surgical treatment of complete acromioclavicular dislocations. Am J Sport Med 1995; 23: 324–31.
Bjernheld H, Hovelius L, Thorling L. Acromio-clavicular separation treated conservatively: A 5-year follow-up study Acta Orthop Scand 1983; 54: 743–5.
Cox JS. Current method of treatment of acromioclavicular joint dislocation. Orthopaedics 1992; 15: 1041–4.
Mc Farland EG, Blivin SJ, Doehring CB, Curl LA, Silberstein C. Treatment of grade III acromioclavicular sparations in professional throwing athletes: results of survey. Am J Orthop 1997; 26: 771–4.
Murphy M, Connoly P, Murphy P, McElwain JP. Retrospective review of outcome post open reduction and K-wire fixation for grade III acromioclavicular joint subluxation. Eur J Orthop Surg Traumatol 2004; 14: 147–50.
Ryhanen J, Leminen A, Jamsa T, Tuukkanen J, Pramila A, Raatikainen T. A novel treatment of grade III acromioclavicular joint dislocation with C hook implant. Arch Orthop Trauma Surg 2006; 126: 22–7.
Dias JJ, Steingold RF, Richardson RA. The conservative treatment of acromioclavicular dislocation: review after 5 years. J Bone Joint Surg 1987; 69B: 719–22.
Rockwood CA, Williams GR, Young DC. Injuries to acromioclavicular joint. In: Rockwood CA, Green DP, Buckholz RW, Heckman JD, eds. Fourth edition Rockwood and Green’s fractures in adults. Philadelphia: Lippincott-Raven; 1987. p. 1181–240.
Linke R, Moschinski D. Combined method of operative treatment of ruptures of the acromioclavicular joint. Unfallheilkunde 1984; 87: 223–5.
Tossy JD, Mead NC, Sigmond HM. Acromioclavicular separations: Useful and practical classification for treatment. Clin Orthop 1963; 28: 111–9.
Stare J. Relative risk and odds ratio. Zdrav Vestn 1998; 67: 297– 9.
Kiefer H, Claes L, Burri C, Holzoworth J. The stabilizing effect of various implants on the torn acromioclavicular joint: A biomechanical study. Arch Orthop Trauma Surg 1986; 106: 42–6.
Kortmann HR, Bohm HJ. Akromioklavikulargelenkluxation. Konservative oder operative Therapie?-Operativ. Trauma Berufskrankh 2000; 5 Suppl 1: 98–101.
Prokop A, Helling HJ, Monig S, Rehm KE. AC Gelenksprenungen Typ Tossy III. Was sollen wir noch operieren. Orthopaede 2003; 32: 432–6.
Downloads
Issue
Section
License
The Author transfers to the Publisher (Slovenian Medical Association) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Slovenian Medical Association) has the right to transfer the rights of acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
