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Wang Y, Ren C, Niu J, Cao L, Yang C, Bi F, Tian K. Surgical treatment of acromioclavicular joint dislocation of Rockwood III/IV: a retrospective study on clavicular hook plate versus arthroscopic TightRope loop titanium button. BMC Musculoskelet Disord 2024; 25:174. [PMID: 38409002 PMCID: PMC10895789 DOI: 10.1186/s12891-024-07269-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/08/2024] [Indexed: 02/28/2024] Open
Abstract
PURPOSE To compare the clinical efficacy of arthroscopic TightRope loop titanium button and clavicular hook plate in the treatment of acromioclavicular joint (ACJ) dislocation of Rockwood III/IV. METHODS A retrospective analysis of patients with ACJ dislocation in our hospital from January 2018 to December 2020 was conducted. The patients were assigned to be treated with arthroscopic TightRope loop titanium button (TR group) or clavicular hook plate (HP group). The preoperative, intraoperative and postoperative data and imaging findings of the two groups were compared. RESULTS A total of 58 eligible patients were enrolled in this study. Compared with HP group, TR group had shorter incision length and less blood loss during operation. Postoperative follow-up ranged from 12 to 24 months (mean 15.4 months). At 6 months and 12months postoperatively, compared with HP group, TR group had lower VAS and higher CMS, and the difference was statistically significant. At 12 months postoperatively, compared with HP group, TR group had lower ACJ gap and coracoclavicular joint(CCJ) distance, and the difference was statistically significant.In HP group, there were 3 cases of subacromial impact, 1 case of redislocation, 2 cases of traumatic arthritis and 2 cases of wound infection. There was 1 case of redislocation in TR group. CONCLUSIONS Compared with clavicular hook plate, arthroscopic TightRope loop titanium button is minimally invasive, safe and effective in the treatment of ACJ dislocation, and has a good trend in clinical application.
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Affiliation(s)
- Yafei Wang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Chengzhen Ren
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Junqi Niu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Le Cao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Can Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Fanggang Bi
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Ke Tian
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China.
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2
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Paksoy A, Akgün D, Moroder P, Scheibel M, Minkus M. Position of scapula and clavicle in acute acromioclavicular joint dislocations: depressed scapula or elevated distal clavicle? JSES Int 2023; 7:2296-2303. [PMID: 37969526 PMCID: PMC10638563 DOI: 10.1016/j.jseint.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background Increased coracoclavicular distance due to acute acromioclavicular joint (ACJ) instability is often described as a pseudoelevation of the clavicle due to inferior hanging of the scapula, while the distal clavicle remains in its position. The aim of this study was to analyze whether the elevation of the distal clavicle, depression of the scapula, or both are associated with vertical instability and to evaluate the impact of weighted stress radiographs on the clavicle and scapular position in acute ACJ instabilities. Methods The cohort consisted of 505 patients (f = 52, m = 453; mean age 46 years) which presented to our emergency department or outpatient clinic and treated in our institution from 2006 to 2019 displaying an acute ACJ injury. The panorama views that displayed at least two vertebraes with their spinous processes were retrospectively evaluated. Two raters assessed the panorama views twice regarding the clavicular and coracoidal angle of both sides in relation to the cervicothoracal spine and the difference in height of both clavicles and coracoids. Results In our cohort, five types of displacement were distinguished: type A, only clavicle is elevated (N = 46); B, only scapula depressed (N = 36); C, the clavicle elevated and the scapula depressed (N = 67); D, both depressed (N = 133); and E, both elevated (N = 223). 123 patients had non-weighted radiographs and 353 patients stress views with 10 kg of axial load, whereas 29 patients had both radiological modalities. Among these 29 patients, a significant increase in coracoclavicular distance difference, clavicle, and scapula height (P < .05, respectively) was observed, when non-weighted radiographs were compared with weighted. A total of 13 shifts could be observed during the Rockwood type comparison of non-weighted radiographs with the weighted: six from Rockwood type II to III, two from type III to V, and five from type V to type III. Conclusion Acute injury to the ACJ does not exclusively lead to a depression of the scapula or an elevated distal clavicle but rather leads to various vertical displacement combinations, however mostly to the elevation of both structures possibly due to muscle spasm and pain. Comparing both radiological modalities of the same patients, the routine use of weighted views should be questioned, since often a shift of Rockwood stage can be observed might lead to on the one hand inadequate conservative treatment for underestimated injuries however on the other hand unnecessary surgery for overestimated dislocations.
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Affiliation(s)
- Alp Paksoy
- Charité University Hospital, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Doruk Akgün
- Charité University Hospital, Center for Musculoskeletal Surgery, Berlin, Germany
| | | | - Markus Scheibel
- Charité University Hospital, Center for Musculoskeletal Surgery, Berlin, Germany
- Schulthess Klinik, Zurich, Switzerland
| | - Marvin Minkus
- Charité University Hospital, Center for Musculoskeletal Surgery, Berlin, Germany
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Watanabe A, Machida T, Takashima K, Hirooka T. Discovering the Forgotten Trauma Behind Chronic Shoulder Pain: The Critical Role of a Thorough Medical Interview. Cureus 2023; 15:e49173. [PMID: 38130510 PMCID: PMC10734337 DOI: 10.7759/cureus.49173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
We report a rare case of a patient experiencing pain and dysfunction attributable to bone fragments from a trauma sustained over two decades prior. A 43-year-old Japanese woman presented with persistent left shoulder pain. Initial radiographs revealed glenohumeral joint osteoarthritis, an unusual finding for her age. Her medical history included a previously overlooked traumatic dislocation of the left acromioclavicular joint over 20 years ago. Computed tomography scans later uncovered bone fragments below the coracoid process without signs of scapular or tuberosity fractures. The fragments were arthroscopically removed, resulting in significant pain relief. The patient's Shoulder Pain and Disability Index score improved from 60 to 9 at the six-month postoperative follow-up. This case underscores the importance of considering historical trauma in patients presenting with atypical shoulder pain and highlights the potential diagnostic value of revisiting a patient's medical history when unusual lesions are discovered.
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Paul RW, Aman ZS, Kemler BR, Osman A, Doran JP, Brutico J, Tjoumakaris FP, Freedman KB. Clinical and Patient-Reported Outcomes for Acute Acromioclavicular Joint Fixation are Similar With or Without Allograft Augmentation. Arthrosc Sports Med Rehabil 2022; 4:e1481-e1487. [PMID: 36033197 PMCID: PMC9402475 DOI: 10.1016/j.asmr.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/29/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Methods Results Conclusion Level of Evidence
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Affiliation(s)
- Ryan W. Paul
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | | | | | - Alim Osman
- Eastern Virginia Medical School, Norfolk, Virginia
| | - James P. Doran
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Joseph Brutico
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | | | - Kevin B. Freedman
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
- Address correspondence to Kevin B. Freedman, M.D., Rothman Orthopaedic Institute at Thomas Jefferson University, 825 Old Lancaster Rd., Suite 200, Bryn Mawr, PA 19010.
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5
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Yan YY, Holmes RD, Mallinson PI, Andrews GT, Munk PL, Ouellette HA. Imaging Review of Hockey-Related Upper Extremity Injuries. Semin Musculoskelet Radiol 2022; 26:3-12. [PMID: 35139555 DOI: 10.1055/s-0041-1731422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Ice hockey is a fast-paced contact sport with a high incidence of injuries. Upper extremity injury is one of the most common regions of the body to be injured in hockey. This imaging review will equip the radiologist with a knowledge of the more common and severe upper extremity injuries that occur in this sport.
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Affiliation(s)
- Yet Yen Yan
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, Changi General Hospital, Singapore, Singapore
| | - R Davis Holmes
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Paul I Mallinson
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Gordon T Andrews
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Peter L Munk
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Hugue A Ouellette
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
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Tuxun A, Keremu A, Aila P, Abulikemu M, Xie Z, Ababokeli P. Combination of Clavicular Hook Plate with Coracoacromial Ligament Transposition in Treatment of Acromioclavicular Joint Dislocation. Orthop Surg 2022; 14:613-620. [PMID: 35142059 PMCID: PMC8926994 DOI: 10.1111/os.13197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the clinical efficacy of Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate (CHP) combined with coracoacromial ligament transposition for Rockwood III-V dislocation of AC joint, providing an alternative choice for AC joint dislocation treatment. METHODS Twenty-five patients diagnosed with Rockwood III-V dislocation of acromioclavicular (AC) joint, including 18 males and seven females, aged 43.5 ± 2.4 years old on average, who had undergone open reduction and AO CHP in combination with coracoacromial (CC) ligament transposition between January 2010 and December 2015, were retrospectively analyzed. Among them, 17 cases were diagnosed as type III, five cases were type IV, and three cases were type V. The surgery mainly included three main steps: bone flap incision, drilling in the clavicle, and hook plate fixation and AC joint reposition. The treatment efficacy was evaluated through clinical examinations and imaging studies for the shoulder joint, including gross observation and measuring coracoid clavicle distance (CC-Dist) using orthophoria X-ray before and 1 year after the surgery, and University of California (UCLA) shoulder rating scale. RESULTS All the patients were followed up three to four times in 18 months (12-24 months) on average, and the UCLA rating results showed that there were 17 excellent cases (68%), five good cases (20%), and three fair cases (12%). The CC-Dist values after the surgery reduced to 9.7 ± 0.7 mm, which was significantly (P < 0.05) lower compared to that before the surgery (15.8 ± 1.6 mm). Most (88%) of the cases showed almost normal joint function and good anatomical arrangement of the acromioclavicular joint, without any secondary dislocation, and for them, 12 ± 2 weeks on average were needed to regain the normal function of shoulder joint movement. CONCLUSION Due to the stable fixation, fewer complications, and satisfactory therapeutic effect with great clinical value, the combination of AO CHP and CC ligament transposition is expected to be used for treating Rockwood III-V dislocation of AC joint.
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Affiliation(s)
- Aikebaier Tuxun
- Department of Orthopedics, The First People's Hospital of Kashgar Prefecture, Kashgar, China
| | - Ajimu Keremu
- Department of Orthopedics, The First People's Hospital of Kashgar Prefecture, Kashgar, China
| | - Pazila Aila
- Department of Orthopedics, The First People's Hospital of Kashgar Prefecture, Kashgar, China
| | - Maimaitiaili Abulikemu
- Department of Orthopedics, The First People's Hospital of Kashgar Prefecture, Kashgar, China
| | - Zengru Xie
- Department of Orthopedic Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Palati Ababokeli
- Department of Orthopedic Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Bao MH, DeAngelis JP, Wu JS. Imaging of traumatic shoulder injuries – Understanding the surgeon’s perspective. Eur J Radiol Open 2022; 9:100411. [PMID: 35265737 PMCID: PMC8899241 DOI: 10.1016/j.ejro.2022.100411] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/13/2022] [Accepted: 02/23/2022] [Indexed: 12/18/2022] Open
Abstract
Imaging plays a key role in the assessment and management of traumatic shoulder injuries, and it is important to understand how the imaging details help guide orthopedic surgeons in determining the role for surgical treatment. Imaging is also crucial in preoperative planning, the longitudinal assessment after surgery and the identification of complications after treatment. This review discusses the mechanisms of injury, key imaging findings, therapeutic options and associated complications for the most common shoulder injuries, tailored to the orthopedic surgeon’s perspective.
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Nordin JS, Mogianos F, Hauggaard A, Lunsjö K. Weighted or internal rotation radiographs are not useful in the classification of acromioclavicular joint dislocations. Acta Radiol 2021; 62:758-765. [PMID: 32660317 DOI: 10.1177/0284185120939270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Weighted radiographs are performed to classify acromioclavicular joint dislocations; however, the evidence regarding their usefulness is conflicting. Laboratory studies suggest that internal rotation views can replace weighted radiographs, but this has not been clinically evaluated. PURPOSE To evaluate whether weighted or internal rotation radiographs uncovers more high-grade acromioclavicular joint dislocations than non-weighted radiographs. MATERIAL AND METHODS A total of 162 patients with acromioclavicular joint dislocations were prospectively included. After applying exclusion criteria, 140 remained. Three panorama radiographs, including both coracoclavicular intervals, were completed of each participant: first, a weighted radiograph with 5-kg weights suspended from the wrists; second, a non-weighted radiograph; and third, an internal rotation radiograph. The coracoclavicular intervals were measured by two radiologists independently, and measurements were translated into Rockwood classifications. The classifications and measurements derived from the different radiographic views were compared. RESULTS Weighted radiographs caused no significant changes in classification. For the internal rotation views, there was a significant change in classification for radiologist 2; however, the reason was that more injuries were downgraded compared to the non-weighted views. Relative to the non-weighted radiographs, the mean increase of the coracoclavicular interval on the injured side in the weighted view was 0.5 mm (95% confidence interval [CI] 0.37-0.65) and in the internal rotation view 0.2 mm (95% CI 0.04-0.33). While these changes were statistically significant, they were small and not clinically important. CONCLUSION This study does not support the use of weighted and internal rotation radiographs in the classification of acromioclavicular joint dislocations.
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Affiliation(s)
- Jonas S Nordin
- Department of Orthopedics, Helsingborg Hospital, Lund University, Helsingborg, Sweden
| | | | - Anders Hauggaard
- Radiology Department, Helsingborg Hospital, Lund University, Helsingborg, Sweden
| | - Karl Lunsjö
- Department of Orthopedics, Helsingborg Hospital, Lund University, Helsingborg, Sweden
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9
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Kani KK, Porrino JA, Mulcahy H, Chew FS. Surgical techniques for management of acromioclavicular joint separations: review and update for radiologists. Skeletal Radiol 2020; 49:1195-1206. [PMID: 32193563 DOI: 10.1007/s00256-020-03417-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 02/02/2023]
Abstract
Imaging plays a central role in the postoperative management of acromioclavicular (AC) joint separations. There are more than 150 described techniques for the surgical management of AC joint injuries. These procedures can be categorized as varying combinations of the following basic techniques: a) soft-tissue repair, b) trans-articular AC joint fixation, c) coracoclavicular (CC) fixation, d) non-anatomic reconstruction of the CC ligaments, e) anatomic reconstruction of the CC ligaments, f) distal clavicle resection, and g) dynamic muscle transfer. The goals of this article are to describe the basic techniques for the surgical management of AC joint separations with an emphasis on technique-specific complications and postoperative imaging assessment.
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Affiliation(s)
- Kimia Khalatbari Kani
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Jack A Porrino
- Yale School of Medicine, Radiology and Biomedical Imaging, New Haven, CT, 06520-8042, USA
| | - Hyojeong Mulcahy
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA, 98105, USA
| | - Felix S Chew
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA, 98105, USA
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10
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Hosseinzadeh S, DeAngelis JP, Komarraju A, Wu AC, Wu JS. Imaging of Acute Shoulder Trauma. Semin Roentgenol 2020; 56:5-21. [PMID: 33422184 DOI: 10.1053/j.ro.2020.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Acute injuries to the shoulder girdle are common and frequently encountered by the practicing radiologist. The type of injury is highly dependent on the age of the patient and mechanism of trauma with injuries occurring at the site of greatest mechanical weakness. In this review, we discuss the main clinical features and key imaging findings for the most common shoulder injuries. For each injury, we also provide a section on the important features that the orthopedic surgeon needs to know in order to guide surgical versus nonsurgical management.
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Affiliation(s)
- Shayan Hosseinzadeh
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Joseph P DeAngelis
- Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Aparna Komarraju
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Allison C Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jim S Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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11
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Cibulas A, Leyva A, Cibulas G, Foss M, Boron A, Dennison J, Gutterman B, Kani K, Porrino J, Bancroft LW, Scherer K. Acute Shoulder Injury. Radiol Clin North Am 2019; 57:883-896. [DOI: 10.1016/j.rcl.2019.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Zhang L, Zhou X, Qi J, Zeng Y, Zhang S, Liu G, Ping R, Li Y, Fu S. Modified closed-loop double-endobutton technique for repair of rockwood type III acromioclavicular dislocation. Exp Ther Med 2017; 15:940-948. [PMID: 29399102 PMCID: PMC5772745 DOI: 10.3892/etm.2017.5487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/02/2017] [Indexed: 12/15/2022] Open
Abstract
Acromioclavicular dislocation (ACD) is a common injury. According to the Rockwood classification, ACD is classified into six types (type I–VI); however, for type III injuries, it remains controversial whether or not operative treatment should be applied. Numerous studies have advocated early surgical treatment to ensure early rehabilitation activities. Thus, the present study aimed to investigate a modified closed-loop double-endobutton technique (MCDT), that may be used to repair Rockwood type III ACD. In the current study, 61 patients with Rockwood type III ACD were enrolled during a period of 5 years at the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. Patients were divided into three groups according to the surgical method used, the MCDT group (n=20), the common closed-loop double-endobutton technique (CCDT) group (n=21), and the clavicular hook plate fixation (CHPF) group (n=20). Preoperative and intraoperative information were recorded. Furthermore, the functional scores of injured shoulder were evaluated prior to surgery and following surgery with a 1-year follow-up. Among the three groups, postoperative functional scores were significantly more improved compared with those prior to surgery (P<0.05), and no significant difference was observed regarding the coracoclavicular interval with the 1-year follow-up (P>0.05). Postoperative functional scores in the MCDT and CCDT groups were significantly more improved compared those in the CHPF group (P<0.05). In addition, the duration of surgery in the MCDT group was significantly shorter compared with that in the CCDT group (P<0.05). Furthermore, compared with the CHPF group, the incision length was significantly shorter with reduced hemorrhage in the MCDT group (P<0.05). In conclusion, the results of the current study suggest that MCDT is more simple, convenient and efficient compared with CCDT, and is worth popularizing.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China.,Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xin Zhou
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Ji Qi
- Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Yan Zeng
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Shaoqun Zhang
- Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Gang Liu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Ruiyue Ping
- Department of Dermatology, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510403, P.R. China
| | - Yikai Li
- Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Shijie Fu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
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13
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Jensen G, Ellwein A, Voigt C, Katthagen JC, Lill H. [Injuries of the acromioclavicular joint: Hook plate versus arthroscopy]. Unfallchirurg 2016; 118:1041-53; quiz 1054-5. [PMID: 26601846 DOI: 10.1007/s00113-015-0108-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Acute acromioclavicular (AC) joint injuries are common in clinical practice. The hook plate is a well-established conventional operative treatment option for high grade instability; however, arthroscopically-assisted flexible double button techniques are increasingly being used. Both procedures lead to good or excellent results. The advantages of the hook plate are the simple surgical technique and the possibility of an early functional aftercare. The minimally invasive one-step procedure with the possibility of identification and treatment of frequently concomitant glenohumeral pathologies is advantageous for the arthroscopic technique but mobilization is more restrictive. Available comparative studies have shown no significant clinical differences but a tendency towards better results with a higher degree of acceptance among patients for the arthroscopic and minimally invasive non-rigid double button procedures.
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Affiliation(s)
- G Jensen
- Abteilung des Berufsgenossenschaftlichen Unfallkrankenhauses Hamburg, Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH Hannover, Humboldtstr. 5, 30169, Hannover, Deutschland.
| | - A Ellwein
- Abteilung des Berufsgenossenschaftlichen Unfallkrankenhauses Hamburg, Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH Hannover, Humboldtstr. 5, 30169, Hannover, Deutschland
| | - C Voigt
- Abteilung des Berufsgenossenschaftlichen Unfallkrankenhauses Hamburg, Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH Hannover, Humboldtstr. 5, 30169, Hannover, Deutschland
| | - J C Katthagen
- Abteilung des Berufsgenossenschaftlichen Unfallkrankenhauses Hamburg, Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH Hannover, Humboldtstr. 5, 30169, Hannover, Deutschland
| | - H Lill
- Abteilung des Berufsgenossenschaftlichen Unfallkrankenhauses Hamburg, Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH Hannover, Humboldtstr. 5, 30169, Hannover, Deutschland
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14
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Mohammed H, Skalski MR, Patel DB, Tomasian A, Schein AJ, White EA, Hatch GFR, Matcuk GR. Coracoid Process: The Lighthouse of the Shoulder. Radiographics 2016; 36:2084-2101. [PMID: 27471875 DOI: 10.1148/rg.2016160039] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The coracoid process is a hook-shaped bone structure projecting anterolaterally from the superior aspect of the scapular neck. Surgeons often refer to the coracoid process as the "lighthouse of the shoulder" given its proximity to major neurovascular structures such as the brachial plexus and the axillary artery and vein, its role in guiding surgical approaches, and its utility as a landmark for other important structures in the shoulder. The coracoid also serves as a critical anchor for many tendinous and ligamentous attachments. These include the tendons of the pectoralis minor, coracobrachialis, and short head of the biceps brachii muscles, and the coracoclavicular, coracohumeral, coracoacromial, and transverse scapular ligaments. Consequently, the coracoid and its associated structures are linked to numerous shoulder pathologic conditions. This article will detail the anatomy of the coracoid and its associated structures and review the clinical and radiologic findings of corresponding pathologic conditions in this region with original illustrations and multimodality imaging examples. Highlighted in this article are the coracoclavicular joint, the classification and management of coracoid fractures, subcoracoid impingement, the coracoacromial arch and subacromial impingement, the coracohumeral ligament and the biceps pulley, the coracoclavicular ligament and its surgical reconstruction, adhesive capsulitis, the suprascapular notch and suprascapular notch impingement, subcoracoid bursitis, coracoid transfer procedures, and coracoid tumors. A brief summary of the pathophysiology, potential causes, and management options for each of the pathologic entities will also be discussed. ©RSNA, 2016.
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Affiliation(s)
- Hussan Mohammed
- From the Departments of Radiology (H.M., D.B.P., A.T., A.J.S., E.A.W., G.R.M.) and Orthopaedic Surgery (G.F.R.H.), Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033-5313; and Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.)
| | - Matthew R Skalski
- From the Departments of Radiology (H.M., D.B.P., A.T., A.J.S., E.A.W., G.R.M.) and Orthopaedic Surgery (G.F.R.H.), Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033-5313; and Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.)
| | - Dakshesh B Patel
- From the Departments of Radiology (H.M., D.B.P., A.T., A.J.S., E.A.W., G.R.M.) and Orthopaedic Surgery (G.F.R.H.), Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033-5313; and Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.)
| | - Anderanik Tomasian
- From the Departments of Radiology (H.M., D.B.P., A.T., A.J.S., E.A.W., G.R.M.) and Orthopaedic Surgery (G.F.R.H.), Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033-5313; and Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.)
| | - Aaron J Schein
- From the Departments of Radiology (H.M., D.B.P., A.T., A.J.S., E.A.W., G.R.M.) and Orthopaedic Surgery (G.F.R.H.), Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033-5313; and Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.)
| | - Eric A White
- From the Departments of Radiology (H.M., D.B.P., A.T., A.J.S., E.A.W., G.R.M.) and Orthopaedic Surgery (G.F.R.H.), Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033-5313; and Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.)
| | - George F Rick Hatch
- From the Departments of Radiology (H.M., D.B.P., A.T., A.J.S., E.A.W., G.R.M.) and Orthopaedic Surgery (G.F.R.H.), Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033-5313; and Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.)
| | - George R Matcuk
- From the Departments of Radiology (H.M., D.B.P., A.T., A.J.S., E.A.W., G.R.M.) and Orthopaedic Surgery (G.F.R.H.), Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033-5313; and Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.)
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Theopold J, Marquass B, von Dercks N, Mütze M, Henkelmann R, Josten C, Hepp P. Arthroscopically guided navigation for repair of acromioclavicular joint dislocations: a safe technique with reduced intraoperative radiation exposure. Patient Saf Surg 2015; 9:41. [PMID: 26702301 PMCID: PMC4689049 DOI: 10.1186/s13037-015-0087-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 11/26/2015] [Indexed: 12/13/2022] Open
Abstract
Background Accuracy evaluation of navigated image free placement of double cortical fixation buttons for coracoclavicular tunnel position in comparison to conventional drill guide based placement. Methods Twenty-six patients with acute acromioclavicular joint instability were included in this non-randomized cohort study. All patients were treated with a Double- TightRope technique. In 13 cases the conventional drill guide based placement was used (group 1). In 13 patients surgery was performed as a navigated procedure with a fluoro-free optoelectronic system (group 2). The number of coracoclavicular drillings per patient (First pass accuracy; FPA (%)) was documented, the subcoracoidal position of the fixation buttons has been evaluated and graded as “intended position achieved (IPA)” or “intended position not achieved (IPnA)”. Results In group 1 drilling had to be repeated in four patients (30.8 %) to achieve proper placement of the subcoracoidal fixation buttons. 100 % first pass accuracy was observed in group 2 (p = 0.03). In group 1, the intended position of the subcoracoid buttons was not achieved (IPnA) in six patients (46.2 %). In group 2 all intended positions were achieved (p = 0.005). Conclusion Arthroscopic controlled fluoro-free navigated coracoclavicular drilling for the repair of acromioclavicular joint dislocation has higher first pass accuracy in comparison to conventional drill guide based placement. Therefore the navigation enables a precise position of the drill holes, may reduce the risk of an iatrogenic coracoid fracture and migration of fixation devices. Trial registration Local institutional review board No. 061-14-10032014
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Affiliation(s)
- Jan Theopold
- Department of Orthopaedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany ; Devision of Arthroscopy, Joint Surgery and Sport Injuries, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Bastian Marquass
- Department of Orthopaedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany ; Devision of Arthroscopy, Joint Surgery and Sport Injuries, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Nikolaus von Dercks
- Department of Orthopaedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany ; Devision of Arthroscopy, Joint Surgery and Sport Injuries, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Maria Mütze
- Department of Orthopaedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany ; Devision of Arthroscopy, Joint Surgery and Sport Injuries, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Ralf Henkelmann
- Department of Orthopaedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany ; Devision of Arthroscopy, Joint Surgery and Sport Injuries, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Christoph Josten
- Department of Orthopaedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Pierre Hepp
- Department of Orthopaedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany ; Devision of Arthroscopy, Joint Surgery and Sport Injuries, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
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Friedman MV, Smith C, Hillen TJ, Baker JC. Review of supplemental views and stress radiography in musculoskeletal trauma: upper extremity. Emerg Radiol 2015; 22:583-8. [DOI: 10.1007/s10140-015-1316-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 03/25/2015] [Indexed: 11/30/2022]
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Image-free navigated coracoclavicular drilling for the repair of acromioclavicular joint dislocation: a cadaver study. Arch Orthop Trauma Surg 2015; 135:1077-82. [PMID: 25967532 DOI: 10.1007/s00402-015-2243-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Reconstruction of the coracoclavicular ligament functions to restore anatomic alignment of the clavicle and may improve biomechanical function and clinical outcomes. Improper placement of the coracoclavicular tunnel may inherently weaken the coracoid. The purpose of this study was to evaluate the feasibility and accuracy of navigated image-free placement of K-wires for coracoclavicular tunnel position in comparison to conventional drill guide-based placement. MATERIALS AND METHODS Eight human shoulder specimens were assigned for conventional technique with a coracoclavicular guide device (group CP) and the paired contralateral side for the navigated procedure (group NP) with an optoelectronic system with a fluoro-free software module. First-pass accuracy (%) and the K-wire trajectory (lateral-center orientation (LC), center-center (CC) orientation and medial-center orientation (MC) were measured. RESULTS In all navigated K-wires a 100 % first-pass accuracy was observed. In three of the eight (37.5 %) specimens of the drill guide-based group, drilling had to be repeated. One of them had to be repeated twice, resulting in eight versus twelve drillings for the navigated versus conventional group, respectively (p = 0.021). K-wire trajectory showed an MC orientation in most of the specimen (n = 9, group NP 4, group CP 5). CONCLUSIONS Image-free navigated coracoclavicular drilling for the repair of acromioclavicular joint dislocation has higher first-pass accuracy in comparison to conventional drill guide-based placement and, therefore, may enable a precise anatomic position of the drill holes and reduce the risk of an iatrogenic coracoid fracture.
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Joukainen A, Kröger H, Niemitukia L, Mäkelä EA, Väätäinen U. Results of Operative and Nonoperative Treatment of Rockwood Types III and V Acromioclavicular Joint Dislocation: A Prospective, Randomized Trial With an 18- to 20-Year Follow-up. Orthop J Sports Med 2014; 2:2325967114560130. [PMID: 26535287 PMCID: PMC4555529 DOI: 10.1177/2325967114560130] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The optimal treatment of acute, complete dislocation of the acromioclavicular joint (ACJ) is still unresolved. Purpose: To determine the difference between operative and nonoperative treatment in acute Rockwood types III and V ACJ dislocation. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: In the operative treatment group, the ACJ was reduced and fixed with 2 transarticular Kirschner wires and ACJ ligament suturing. The Kirschner wires were extracted after 6 weeks. Nonoperatively treated patients received a reduction splint for 4 weeks. At the 18- to 20-year follow-up, the Constant, University of California at Los Angeles Shoulder Rating Scale (UCLA), Larsen, and Simple Shoulder Test (SST) scores were obtained, and clinical and radiographic examinations of both shoulders were performed. Results: Twenty-five of 35 potential patients were examined at the 18- to 20-year follow-up. There were 11 patients with Rockwood type III and 14 with type V dislocations. Delayed surgical treatment for ACJ was used in 2 patients during follow-up: 1 in the operatively treated group and 1 in the nonoperatively treated group. Clinically, ACJs were statistically significantly less prominent or unstable in the operative group than in the nonoperative group (normal/prominent/unstable: 9/4/3 and 0/6/3, respectively; P = .02) and in the operative type III (P = .03) but not type V dislocation groups. In operatively and nonoperatively treated patients, the mean Constant scores were 83 and 85, UCLA scores 25 and 27, Larsen scores 11 and 11, and SST scores 11 and 12 at follow-up, respectively. There were no statistically significant differences in type III and type V dislocations. In the radiographic analysis, the ACJ was wider in the nonoperative than the operative group (8.3 vs 3.4 mm; P = .004), and in the type V dislocations (nonoperative vs operative: 8.5 vs 2.4 mm; P = .007). There was no statistically significant difference between study groups in the elevation of the lateral end of the clavicle. Both groups showed equal levels of radiologic signs of ACJ osteoarthritis and calcification of the coracoclavicular ligaments. Conclusion: Nonoperative treatment was shown to produce more prominent or unstable and radiographically wider ACJs than was operative treatment, but clinical results were equally good in the study groups at 18- to 20-year follow-up. Both treatment methods showed statistically significant radiographic elevations of the lateral clavicle when compared with a noninjured ACJ.
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Affiliation(s)
- Antti Joukainen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland. ; BCRU, Institute of Clinical Medicine, University of Eastern Finland, Finland
| | - Lea Niemitukia
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | | | - Urho Väätäinen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland. ; Ite-Lasaretti Private Hospital, Kuopio, Finland
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Ye T, Ouyang Y, Chen A. Evaluation of coracoclavicular stabilization of acute acromioclavicular joint dislocation with multistrand titanium cables. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:1061-6. [PMID: 24327005 DOI: 10.1007/s00590-013-1385-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/28/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to evaluate the outcome of surgical treatment of acute acromioclavicular (AC) joint dislocation with multistrand titanium cables for coracoclavicular (CC) stabilization. METHODS Forty-two patients with acute AC joint dislocation, including Rockwood type III 14 cases, type IV 2 cases and type V 26 cases, were operated with CC stabilization using multistrand titanium cables. The cables were removed 3-12 months after surgery. The function outcome was evaluated by Constant scores and visual analog scale (VAS) scores. Radiological examination included bilateral antero-posterior and axillary radiography. RESULTS Three patients were lost to follow-up. Thirty-nine patients had an average follow-up time of 42 months (range 34-60). The Constant scores were 95.3 ± 9.3 at final evaluation. Preoperative and final follow-up VAS scores were 5.6 ± 1.5 and 0.4 ± 1.2, respectively (P < 0.05). Radiographs showed anatomical reduction in 32 patients. Cables breakage occurred in two patients. CONCLUSIONS CC stabilization with multistrand titanium cables was an effective and safe alternative to other procedures for the treatment of acute high-grade AC joint dislocations. It can provide immediate joint stabilization and allow early mobilization of limb with satisfied functional recovery.
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Affiliation(s)
- Tianwen Ye
- Department of Orthopaedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
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