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Wignadasan W, Al-Obaedi O, Chambers A, Lee M, Rajesparan K, Rashid A. Concomitant coracoid base fracture and acromioclavicular joint disruption: A series of patients treated with a clavicle hook plate and review of the literature. J Orthop Surg (Hong Kong) 2022; 30:10225536221139888. [PMID: 36373510 DOI: 10.1177/10225536221139888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Concomitant acromioclavicular joint (ACJ) disruptions with coracoid base fractures are rare high energy injuries. The management of these injuries can be challenging. The aim of this study is to assess the functional and radiographic outcomes of a retrospective case series of patients presenting with concomitant ACJ and coracoid base injuries managed with a clavicle hook plate with subsequent hardware removal at a later stage. METHODS Six patients were identified for inclusion in the study. Radiographic and clinical data were available which allowed for collection of demographic information as well as classification of the fractures. Telephone consultation with patients allowed for collection of functional scores which included the Oxford shoulder score (OSS), QuickDASH (Q-DASH), Euroqol-5 Dimension (EQ-5D) and the SF-12 score. RESULTS All patients were male with a mean age of 39.8 years and a median follow-up period of 34 months. All patients underwent a successful operative procedure with a median time to union of 3.75 months. Good functional outcomes were reported by all patients: mean OSS 45.0, mean Q-DASH 4.8, mean EQ-VAS 82.8 and encouraging SF-12 scores (mean PCS 56.0, mean MCS 56.4). CONCLUSION The use of a lateral clavicle hook plate can achieve good healing and functional outcomes when managing patients with acromioclavicular joint disruptions associated with a coracoid base fracture.
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Affiliation(s)
| | | | | | - Marcus Lee
- 8964University College London Hospitals NHS Trust, London, UK
| | | | - Abbas Rashid
- 8964University College London Hospitals NHS Trust, London, UK
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Barth J, Duparc F, Andrieu K, Duport M, Toussaint B, Bertiaux S, Clavert P, Gastaud O, Brassart N, Beaudouin E, De Mourgues P, Berne D, Bahurel J, Najihi N, Boyer P, Faivre B, Meyer A, Nourissat G, Poulain S, Bruchou F, Ménard JF. Is coracoclavicular stabilisation alone sufficient for the endoscopic treatment of severe acromioclavicular joint dislocation (Rockwood types III, IV, and V)? Orthop Traumatol Surg Res 2015; 101:S297-303. [PMID: 26514849 DOI: 10.1016/j.otsr.2015.09.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/31/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The primary objective was to evaluate correlations linking anatomical to functional outcomes after endoscopically assisted repair of acute acromioclavicular joint dislocation (ACJD). HYPOTHESIS Combined acromioclavicular and coracoclavicular stabilisation improves radiological outcomes compared to coracoclavicular stabilisation alone. MATERIAL AND METHODS A prospective multicentre study was performed. Clinical outcome measures were pain intensity on a visual analogue scale (VAS), subjective functional impairment (QuickDASH score), and Constant's score. Anatomical outcomes were assessed on standard radiographs (anteroposterior view of the acromioclavicular girdle and bilateral axillary views) obtained preoperatively and postoperatively and on postoperative dynamic radiographs taken as described by Tauber et al. RESULTS Of 116 patients with acute ACJD included in the study, 48% had type III, 30% type IV, and 22% type V ACJD according to the Rockwood classification. Coracoclavicular stabilisation was achieved using a double endobutton in 93% of patients, and concomitant acromioclavicular stabilisation was performed in 50% of patients. The objective functional outcome was good, with an unweighted Constant's score ≥ 85/100 and a subjective QuickDASH functional disability score ≤ 10 in 75% of patients. The radiographic analysis showed significant improvements from the preoperative to the 1-year postoperative values in the vertical plane (decrease in the coracoclavicular ratio from 214 to 128%, p=10(-6)) and in the horizontal plane (decrease in posterior displacement from 4 to 0mm, p=5×10(-5)). The anatomical outcome correlated significantly with the functional outcome (absolute R value=0.19 and p=0.045). We found no statistically significant differences across the various types of constructs used. Intra-operative control of the acromioclavicular joint did not improve the result. Implantation of a biological graft significantly improved both the anatomical outcome in the vertical plane (p=0.04) and acromioclavicular stabilisation in the horizontal plane (p=0.02). The coracoclavicular ratio on the anteroposterior radiograph was adversely affected by a longer time from injury to surgery (p=0.02) and by a higher body mass index (BMI) (p=0.006). High BMI also had a negative effect on the difference in the distance separating the anterior edge of the acromion from the anterior edge of the clavicle between the injured and uninjured sides, as assessed on the axillary views (p=0.009). CONCLUSION This study demonstrates that acute ACJD requires stabilisation in both planes, i.e., at the coracoclavicular junction and at the acromioclavicular joint. Coracoclavicular stabilisation alone is not sufficient, regardless of the type of implant used. Implantation of a biological graft should be considered when the time from injury to surgery is longer than 10days. The weight of the upper limb should be taken into account, with 6weeks of immobilisation to unload the construct in patients who have high BMI values. LEVEL OF EVIDENCE II, prospective non-randomised comparative study.
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Affiliation(s)
- J Barth
- Centre ostéo-articulaire des cèdres, parc Sud-Galaxie, 5, rue des Tropiques, Echirolles, France.
| | - F Duparc
- Centre hospitalier universitaire de Rouen, Rouen, France
| | - K Andrieu
- Centre ostéo-articulaire des cèdres, parc Sud-Galaxie, 5, rue des Tropiques, Echirolles, France
| | - M Duport
- Médipôle Garonne, Toulouse, France
| | | | - S Bertiaux
- Centre hospitalier universitaire de Rouen, Rouen, France
| | - P Clavert
- Service de chirurgie de l'épaule et du coude, CCOM, CHRU de Strasbourg, Strasbourg, France
| | - O Gastaud
- Institut universitaire de l'appareil locomoteur et du sport, hôpital Pasteur 2, CHU de Nice, Nice, France
| | - N Brassart
- Clinique de Cagne-sur-Mer, Cagne-sur-Mer, France
| | - E Beaudouin
- Centre hospitalier régional de Chambéry, Chambéry, France
| | | | - D Berne
- Clinique Kennedy, Montélimar, France
| | - J Bahurel
- Clinique Générale d'Annecy, Annecy, France
| | - N Najihi
- Centre hospitalier universitaire de Rennes, Rennes, France
| | - P Boyer
- Hôpital universitaire Xavier-Bichat, Paris, France
| | - B Faivre
- Hôpital universitaire Ambroise-Paré, Boulogne-Billancourt, France
| | | | - G Nourissat
- Chirurgie de l'épaule, groupe Maussins, 67, rue de Romainville, Paris, France
| | - S Poulain
- Polyclinique du Plateau, Bezons, France
| | - F Bruchou
- Hôpital privé de l'ouest parisien, Trappes, France
| | - J F Ménard
- Unité biostatistique du CHU de Rouen, Rouen, France
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