Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-10-2008 | Orthopaedic Surgery

Acromioclavicular dislocation Rockwood III–V: results of early versus delayed surgical treatment

Authors: Olaf Rolf, Andreas Hann von Weyhern, Alexander Ewers, Thomas Dirk Boehm, Frank Gohlke

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2008

Abstract

Introduction

The management of acute acromioclavicular joint (ACJ-) injuries especially of type III is still controversial.

Methods

In this retrospective study the results of early ACJ reconstructions immediately after trauma (group early repair, ER) were compared with the results of delayed reconstructions in patients who first got conservative treatment and failed after some time (group delayed repair, DR). Overall, 49 patients were analysed clinically and radiographically with a mean follow-up of 53 months (range 20–92). In group ER twenty-nine patients were treated with a modified Phemister technique according to Mayr including a PDS coracoclavicular sling and temporary K- wire fixation. In group DR twenty patients were treated with a modified Weaver–Dunn-procedure with additionally transposition of the coracoacromial ligament and AC-joint resection.

Results

A comparison of the overall results revealed a statistically significant better outcome in the early repair group, regarding the Constant Score, the degree of acromioclavicularjoint-reduction, numbers of complications and patient`s satisfaction.

Conclusion

Our results point out that early reconstruction of ACJ-injuries in type III–V avoids the inferior clinical results of delayed reconstructions using a modified Weaver–Dunn-procedure.

Bannister GC, Wallace WA, Stableforth PG, Hutson MA (1989) The management of acute acromioclavicular dislocation. A randomised prospective controlled trial. J Bone Joint Surg Br 71:848–850PubMed

Bathis H, Tingart M, Bouillon B, Tiling T (2000) Conservative or surgical therapy of acromioclavicular joint injury: what is reliable? A systematic analysis of the literature using “evidence-based medicine” criteria. Chirurg 71:1082–1089PubMedCrossRef

Bradley JP, Elkousy H (2003) Decision making: operative versus nonoperative treatment of acromioclavicular joint injuries. Clin Sports Med 22:277–290PubMedCrossRef

Calvo E, Lopez-Franco M, Arribas IM (2006) Clinical and radiologic outcomes of surgical and conservative treatment of type III acromioclavicular joint injury. J Shoulder Elbow Surg 15(3):300–305PubMedCrossRef

Fremerey RW, Lobenhoffer P, Ramacker K, Gerich T, Skutek M, Bosch U (2001) Acute acromioclavicular joint dislocation-operative or conservative therapy? Unfallchirurg 104:294–299PubMedCrossRef

Guy DK, Wirth MA, Griffin JL, Rockwood CA Jr (1998) Reconstruction of chronic and complete dislocations of the acromioclavicular joint. Clin Orthop Relat Res 347:138–149PubMedCrossRef

Hedtmann A, Fett H, Ludwig J (1998) Management of old neglected posttraumatic acromioclavicular joint instability and arthrosis. Orthopade 27(8):556–566PubMed

Lancaster S, Horowitz M, Alonso J (1987) Complete acromioclavicular separations. Clin Orthop 216:80–88PubMed

Larsen E, Bjerg-Nielsen A, Christensen P (1986) Conservative or surgical treatment of acromioclavicular dislocation: a prospective, controlled, randomized study. J Bone Joint Surg Am 68:552–555PubMed

10.

Mayr E, Braun W, Eber W, Ruter A (1999) Treatment of acromioclavicular joint separations. Central Kirschner-wire and PDS-augmentation. Unfallchirurg 102(4):278–286PubMedCrossRef

11.

Meislin RJ, Zucherman JD, Nainzadeh N (1992) Type III acromioclavicular joint separation associated with late brachial-plexus neurapraxia. J Orthop Trauma 6:370–372PubMedCrossRef

12.

Mouhsine E, Garofalo R, Crevoisier X, Farron A (2003) Grade I and II acromioclavicular dislocations: results of conservative treatment. J Shoulder Elbow Surg 12(6):599–602PubMedCrossRef

13.

Nuber GW, Bowen MK (1997) Acromioclavicular joint injuries and distal clavicle fractures. J Am Acad Orthop Surg 5:11–18PubMed

14.

Phemister PB (1942) The treatment of dislocation of the acromioclavicular joint by open reduction and threaded wire fixation. J Bone Joint Surg 24:166–168

15.

Philips AM, Smart C, Groom AF (1988) Acromioclavicular dislocation. Conservative or surgical therapy. Clin Orthop 353:10–17

16.

Press J, Zuckerman JD, Gallagher M, Cuomo F (1997) Treatment of grade III acromioclavicular separations. Operative versus nonoperative management. Bull Hosp Jt Dis 56:77–83PubMed

17.

Rawes ML, Dias JJ (1996) Long-term results of conservative treatment for acromioclavicular dislocation. J Bone Joint Surg Br 78(3):410–412PubMed

18.

Rockwood CA Jr, Williams GR, Young DC (1996) Injuries to the Acromioclavicular Joint. In: Rockwood CA Jr, Green DP, Buchholz RW, Heckman JD (eds) Fractures in adults. Lippincott Raven, Philadelphia, pp 1341–1413

19.

Taft TN, Wilson FC, Oglesby JW (1991) Dislocation of the acromioclavicular joint. An end-result study. J Bone Joint Surg Am 69:1045–1051

20.

Tibone J, Sellers R, Tonino P (1992) Strength testing after third-degree acromioclavicular dislocations. Am J Sports Med 20:328–331PubMedCrossRef

21.

Weaver JK, Dunn HK (1972) Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am 54(6):1187–1194PubMed

22.

Wojtys EM, Nelson G (1991) Conservative treatment of grade III acromioclavicular dislocations. Clin Orthop 268:112–119PubMed

23.

Zeiler G (1994) Die operative Behandlung der akromioklavikulären Luxation. Operat Orthop Traumatol 6: 38–45CrossRef

Title: Acromioclavicular dislocation Rockwood III–V: results of early versus delayed surgical treatment
Authors: Olaf Rolf
Andreas Hann von Weyhern
Alexander Ewers
Thomas Dirk Boehm
Frank Gohlke
Publication date: 01-10-2008
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 10/2008
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-007-0524-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Acromioclavicular dislocation Rockwood III–V: results of early versus delayed surgical treatment

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2008

Incidence and effect of calcifications after open-augmented Achilles tendon repair

Open reduction and internal fixation versus hybrid fixation for bicondylar/severe tibial plateau fractures: a systematic review of the literature

Special issue: orthopaedic surgery

Deformity correction for vitamin D-resistant hypophosphatemic rickets of adults

Digital templating in total hip arthroplasty with the Mayo stem

The effect of patient position on blood loss in primary cemented total hip arthroplasty