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Archives of Orthopaedic and Trauma Surgery

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01-01-2012 | Orthopaedic Surgery

Hook plate fixation for acromioclavicular joint separations restores coracoclavicular distance more accurately than PDS augmentation, however presents with a high rate of acromial osteolysis

Authors: Anica Eschler, Georg Gradl, Philip Gierer, Thomas Mittlmeier, Markus Beck

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 1/2012

Abstract

Introduction

Hook plate fixation of acromioclavicular (AC) joint separations carries the disadvantage of compulsory implant removal, occasional implant fatigue and secondary loss of reduction. This study compares the clinical and radiological outcome of a new polyaxial angular stable hook plate (HP) with absorbable polydioxansulfate (PDS) sling.

Materials and methods

Between 2002 and 2009, out of a consecutive series of 81 patients with symptomatic Rockwood type V lesions 52 patients received clinical and radiographic follow-up (HP: n = 27; PDS: n = 25). HP patients were prospectively analyzed and retrospectively compared with the PDS group. Radiological follow-up included comparative coraco- and acromioclavicular distance (CCD/ACD) measurements as percentage of the uninjured shoulder. For clinical follow-up a standardized functional shoulder assessment with Constant Score, DASH Score, Taft Score and a self-report questionnaire including the visual analog scale (VAS) was carried out.

Results

Direct postoperative radiographs showed an overcorrection of CCD in the HP group (−4.4% of the uninjured side) and failure of anatomic correction in the PDS group (+11.0%). After implant removal, CCD increased in the HP group extensively to 16.7% (overall loss of reduction: 21.1%) and 23.9% in the PDS group. Redisplacement (100% increase of CCD) occurred in five cases (HP: 2, PDS: 3) and partial loss of reduction in four cases of each group. Comparing functional results no differences could be seen between both the groups (Constant-Score HP: 91.2 points, PDS: 94.6 points; Taft-Score HP: 9.4 points, PDS: 10.0 points). The DASH-Score revealed better results for PDS group (3.4 points, HP: 8.0 points). Signs of acromial osteolysis appeared in five cases (18.5%) in HP group. There was no case of implant failure. The X-rays of six patients (HP: 4, PDS: 2) showed AC-joint-osteoarthritis.

Conclusion

Hook plate fixation employing a polyaxial angular stable plate finally restores the coracoclavicular distance more accurately than augmentation with a PDS sling. Although in HP group no implant failure occurred, major disadvantages are initial overcorrection and acromial osteolysis. Both have no influence on final functional results.

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Title: Hook plate fixation for acromioclavicular joint separations restores coracoclavicular distance more accurately than PDS augmentation, however presents with a high rate of acromial osteolysis
Authors: Anica Eschler
Georg Gradl
Philip Gierer
Thomas Mittlmeier
Markus Beck
Publication date: 01-01-2012
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 1/2012
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-011-1399-x

At a glance: The STEP trials

Springer Medicine

Hook plate fixation for acromioclavicular joint separations restores coracoclavicular distance more accurately than PDS augmentation, however presents with a high rate of acromial osteolysis

Abstract

Introduction

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

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