Clinical and Radiological Outcomes of Hook Plate Fixation in the Lateral End Fracture of the Clavicle and Acromioclavicular Dislocation

Young Kyoung Min,Jung Han Kim,Heui Chul Gwak 대한견주관절의학회 2016 대한견주관절의학회지 Vol.19 No.4

Background: The purpose of this study was to identify the clinical and radiological outcomes of hook plate fixation for lateral end fracture of the clavicle and acromioclavicular dislocation. Methods: There were a total of 20 cases with lateral end fracture of the clavicle and 16 cases with acromioclavicular dislocation. All patients were evaluated for range of motion, functional score by using Constant score, and American Shoulder and Elbow Surgeons shoulder index at just before implant removal and at final follow-up. Coracoclavicular distance was measured in acromioclavicular dislocation and bony union was evaluated in the lateral end fracture of the clavicle. Results: The clinical outcomes and range of motion were increased at the final follow-up compared with just before implant removal in both the lateral end fracture of the clavicle and acromioclavicular dislocation. In acromioclavicular dislocation, all cases—except one—showed maintenance of reduction after implant removal. Moreover, in the lateral end fracture of the clavicle, all cases—except one—showed bony union. Conclusions: Hook plate fixation in the lateral end fracture of the clavicle and acromioclavicular dislocation resulted in good clinical and radiological results.

오구 쇄골간 슬링으로 보강된 변형 Phemister 술식을 이용한 견봉 쇄골 관절 탈구의 치료

김덕원(Deok-Weon Kim),김성태(Sung-Tae Kim) 대한견주관절의학회 2010 대한견주관절의학회지 Vol.13 No.2

목적: 본 연구는 네 가닥의 Ethibond로 오구 쇄골간 sling으로 보강된 변형 Phemister 술식을 이용한 견봉 쇄골 관절 탈구의 치료의 임상적 결과 및 방사선 소견을 평가하고자 하였다. 대상 및 방법: 1999년 9월부터 2007년 5월까지 네 가닥 Ethibond sling으로 보강된 변형된 Phemister 술식으로 30예의 견봉 쇄골 관절 탈구를 치료하였다. 평균 추시 기간은 28.2(24~33)개월 이었다. 술 후 기능 평가는 Weitzman 분류로 하였고 오구 쇄골 간격의 정복 정도를 방사선 영상에서 측정하였다. 결과: Weitzman 분류를 이용한 기능 평가에서는 우수 24예, 양호 4예, 보통 2예였고 오구 쇄골간격은 수상 시 16.9 mm간격에서 수술 직후 7.3 mm로 정복되었고 최종 추시 시 건측과 비교하여 오구 쇄골 인대의 간격 비율은 평균 1.24 (0.68~1.71) 이었다. 합병증으로 5예에서 K-강선 후퇴와 4예에서 관절 운동 제한이 있었다. 결론: 견봉 쇄골 관절의 탈구에서 네 가닥의 Ethibond로 오구 쇄골간 sling으로 보강된 변형 Phemister 술식은 임상적으로 유용한 치료 방법으로 사료된다. Purpose: The purpose of this study was to evaluate the clinical and radiological results of a modified Phemister method reinforcing the 4 strands of an Ethibond sling for acromioclavicular joint dislocation. Materials and Methods: Between September 1999 and May 2007, 30 acromioclavicular joint dislocation cases underwent a modified Phemister method reinforcing the 4 strands of an Ethibond sling. The average follow-up period was 28.2 months (range: 24~33 months). Clinical outcomes were evaluated using the Weitzman classification; the state of coracoclavicular space reduction was done using radiologic findings. Results: According to the Weitzman classification, there were 24 excellent, 4 good and 2 fair case outcomes. The average coracoclavicular distance improved from 16.9 mm to 7.3 mm immediately after surgery. The average ratio of coracoclavicular distance comparing to the contralateral side at the final follow-up was 1.24 (range: 0.68~1.71). Complications included retraction of K-wires in 5 cases and restriction of joint motion in 4 cases. Conclusion: The modified Phemister operation using augmentation of the coracoclavicular ligament by 4 strands of Ethibond is an effective treatment modality in acromioclavicular joint dislocation.

견봉쇄골 관절탈구의 수술적 치료의 비교 : Comparative Study Between Modified Phemister Method and Weaver and Dunn Method

정형진,김동수,안종국,정병현,성열보,김동수,권칠수 인제대학교 1999 仁濟醫學 Vol.20 No.1

견봉쇄골 관절탈구의 치료방법으로 여러 가지 수술적 방법과 보전적 방법이 소개되어 왔으나 아직도 논란의 대상이 되고 있다. 이에 저자들은 1993년 3월부터 1997년 5월까지 인제대학 부속 상계백병원 정형외과에서 견봉쇄골 관절탈구에 주로 사용된 수술적 방법인 modified Phemister 방법과 Wever and Dunn 방법 사이의 임상적 결과를 비교분석하여 보고 하고자 한다. There has been considerable controversy as to the treatment of dislocation of the acromiocavicular joint. Also various operative treatment have been suggested. The purpose of this study is to compare the clinical result between modified Phemister method and Weaver and Dunn method in treatment of acromioclavicular dislocation. The authors analysed the radiological & clinical results of 27 patients with acromioclavicular dislocation, in whom 15 patients were treated by modified Phemister method and 12 patients were treated by Weaver and Dunn method. The patient were treated from February 1993 to May 1997 at Sanggye Paik Hospital, Inje University, They were followed up more than 12 months. The results were at follows : 1.The differance of coracoclavicular distance compared with normal side after operation was 1.30±0.24 in modified Phemister method and 1.31±0.27 in weaver and Dunn method. And these difference were not changed at follow up significantly. 2.The complications were one pin migration, one posttraumatic arthritis and two upward displacement of clavicle in modified Phemister method and one upward displacement of clavicle and one heterotropic ossification in Weaver and Dunn method. 3.Clinical results shows that good or fair in 13 cases(87%) after modified Phemister method and good and fair in all cases after Weaver and Dunn method. In conclusions, there were no significant difference of results regarding the difference two methods.

견봉쇄골관절 완전탈구에 대한 수술치험 : Weaver & Dunn술식 및 Modified Broswor술식 Weaver & Dunn and Modified Broswor Method

황성관,원유옥 최신의학사 1985 最新醫學 Vol.28 No.10

견봉쇄골관절 탈구의 수술적 방법과 보존적 방법의 임상적 비교

이용수,김민기 예수병원 1998 예수병원학술지 Vol.19 No.-

Comparison of Results between Hook Plate Fixation and Ligament Reconstruction for Acute Unstable Acromioclavicular Joint Dislocation

윤종필,이병주,남상진,정석원,정원주,민우기,오주한 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.1

Background: In the present study, we aimed to compare clinical and radiographic outcomes between hook plate fixation andcoracoclavicular (CC) ligament reconstruction for the treatment of acute unstable acromioclavicular (AC) joint dislocation. Methods: Forty-two patients who underwent surgery for an unstable acute dislocation of the AC joint were included. We dividedthem into two groups according to the treatment modality: internal fixation with a hook plate (group I, 24 cases) or CC ligamentreconstruction (group II, 18 cases). We evaluated the clinical outcomes using a visual analog scale (VAS) for pain and Constant-Murley score, and assessed the radiographic outcomes based on the reduction and loss of CC distance on preoperative, postoperative,and final follow-up plain radiographs. Results: The mean VAS scores at the final follow-up were 1.6 ± 1.5 and 1.3 ± 1.3 in groups I and II, respectively, which were notsignificantly different. The mean Constant-Murley scores were 90.2 ± 9.9 and 89.2 ± 3.5 in groups I and II, respectively, which werealso not significantly different. The AC joints were well reduced in both groups, whereas CC distance improved from a mean of215.7% ± 50.9% preoperatively to 106.1% ± 10.2% at the final follow-up in group I, and from 239.9% ± 59.2% preoperatively to133.6% ± 36.7% at the final follow-up in group II. The improvement in group I was significantly superior to that in group II (p < 0.001). Furthermore, subluxation was not observed in any case in group I, but was noted in six cases (33%) in group II. Erosions of the acromionundersurface were observed in 9 cases in group I. Conclusions: In cases of acute unstable AC joint dislocation, hook plate fixation and CC ligament reconstruction yield comparablesatisfactory clinical outcomes. However, radiographic outcomes based on the maintenance of reduction indicate that hook platefixation is a better treatment option.

Acromioclavicular joint dislocation and concomitant labral lesions: a systematic review

Jad Mansour,Joseph E Nassar,Michel Estephan,Karl Boulos,Mohammad Daher 대한견주관절학회 2024 대한견주관절의학회지 Vol.27 No.2

Acromioclavicular (AC) joint dislocations frequently co-occur with intra-articular glenohumeral pathologies. Few comprehensive studies have focused on labral tears specifically associated with AC joint trauma. This systematic review will address this gap. A comprehensive electronic search was conducted across PubMed, Cochrane Library, and Google Scholar (pages 1–20) spanning from 1976 to May 19, 2023. Seven studies met the inclusion criteria for this systematic review, consisting of three retrospective studies and four case series. These studies collectively involved 1,044 patients, of whom 282 had concomitant labral lesions. The pooled prevalence of intra-articular labral injuries associated with acute AC joint dislocation was 27%. The prevalence of these labral lesions varied significantly between studies, ranging from 13.9% to 84.0% of patients, depending on the study and the grade of AC joint dislocation. Various types of labral tears were reported, with superior labrum anterior to posterior (SLAP) lesions being the most common. The prevalence of SLAP lesions ranged from 7.2% to 77.4%, with higher grades of AC joint dislocations often associated with a higher prevalence of SLAP tears. Moreover, grade V dislocations exhibited a complete correlation with SLAP tears. The studies yielded contradictory findings regarding older age and higher grades of AC joint dislocation as risk factors for concurrent labral lesions. This review underscores the frequent association between labral lesions and AC joint dislocations, particularly in cases of lower-grade injuries. Notably, SLAP lesions emerged as the predominant type of labral tear.

Clinical and Radiological Outcomes of Modified Phemister Operation with Coracoclavicular Ligament Augmentation Using Suture Anchor for Acute Acromioclavicular Joint Dislocation

Nam Su Cho,Sung Ju Bae,Joong Won Lee,Jeung Hwan Seo,이용걸 대한견주관절학회 2019 대한견주관절의학회지 Vol.22 No.2

Background: Modified Phemister operation has been widely used for the treatment of acute acromioclavicular (AC) joint dislocation. Additionally, the use of suture anchor for coracoclavicular (CC) fixation has been reported to provide CC stability. This study was con-ducted to evaluate the clinical and radiological results of a modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation.Methods: Seventy-four patients underwent the modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation and were followed-up for an average of 12.3 months. The visual analogue scale (VAS), range of motion, Con-stant score, and Korean shoulder scoring system (KSS) were used for clinical assessment. Acromioclavicular interval (ACI), coracoclavicu-lar distance (CCD), and acromioclavicular distance (ACD) were obtained to evaluate the radiological assessments.Results: At the last follow-up, the mean VAS Score was 1.7 points, the mean joint range of the forward flexion was 164.6°, external rotation at the side was 61.2°, and internal rotation to the posterior was a level of T12. The mean Constant score and the mean KSS was 82.7 points and 84.2 points, respectively. At the mean ACI, CCD, and ACD, significant differences were found preoperatively and at the last follow-up. When the ACI, CCD, and ACD were compared with the contralateral unaffected shoulder at the last follow-up, the af-fected shoulders had significantly higher values.Conclusions: The modified Phemister operation with CC ligament augmentation using suture anchor is clinically and radiologically ef-fective at acute AC joint dislocation.

Tight-Rope<SUP>®</SUP>을 이용한 급성 견봉 쇄골 관절 탈구의 치료

권석현(Seok Hyun Kweon),최상수(Sang Su Choi),이성인(Seong In Lee),김정우(Jeong Woo Kim),김광미(Kwang Mee Kim) 대한견주관절의학회 2013 대한견주관절의학회지 Vol.16 No.2

목적: 급성 견봉 쇄골 관절 탈구에서 Tight-Rope<SUP>®</SUP> (Arthrex)를 이용한 오구 쇄골 인대 보강술의 유용성을 알아보고자 하였다. 대상 및 방법: 2009년 10월부터 2011년 3월까지 급성 견봉 쇄골 관절 탈구 환자에 대해 Tight-Rope<SUP>®</SUP>를 이용하여 치료한 환자 중에서 12개월 이상 추시 관찰이 가능한 30명을 대상으로 하였다. 술 후 정복 상태의 평가는 쇄골의 방사선학적 추시를 통해 분석하였으며 임상적 결과는 UCLA 점수, Constant 점수 및 VAS 통증 점수를 사용하였다. 결과: 임상적 평가에서 UCLA 점수는 22예(73%)에서 우수, 5예(17%)에서 양호, 2예(7%)에서 보통, 1예(3%)에서 불량이었으며, Constant 점수는 평균 92.5±7.5점이었다. 방사선학적 결과는 26예(86%)에서 해부학적 정복을 보였으며, 2예(7%)에서 중등도의 정복 소실, 2예(7%)에서 완전 재탈구를 보였으며, 이중 완전 재탈구를 보였던 2예에서 임상적 결과가 만족스럽지 않았으며 재수술을 필요로 하였다. 결론: 급성 견봉 쇄골 관절 탈구에서 Tight-Rope<SUP>®</SUP>를 이용한 오구 쇄골 인대 보강술은 신뢰할 만한 임상적 결과를 제공하는 좋은 치료 방법이라 생각한다. Purpose: The purpose of this study is to analyze the results of acute acromioclavicular joint dislocation treatment with coracoclavicular ligament augmentation using Tight-Rope<SUP>®</SUP> (Arthrex). Materials and Methods: From October 2009 to March 2011, 30 patients with acute acromioclavicular joint dislocation underwent coracoclavicular ligament augmentation using Tight-Rope<SUP>®</SUP> and were followed up for at least 12 months after surgery. The radiologic results were qualified according to serial plain radiographs, and the clinical results according to University of California - Los Angeles (UCLA) Shoulder Scale, Constant score, and VAS pain score. Results: Using the UCLA scoring system, excellent results were observed in 22 cases (73%), good results in five cases (17%), fair results in two cases (7%), and a poor result in one case (3%). The average Constant score was 92.5±7.5. According to radiologic results, anatomical reduction was achieved in 26 cases, and two cases showed a moderate loss of reduction, and two cases showed complete re-dislocation. Clinical results for patients with re-dislocation were unsatisfactory and reoperation was required. Conclusion: Coracoclavicular ligament augmentation using Tight-Rope<SUP>®</SUP> is a good option providing reliable functional results in patients with acute acromioclavicular joint dislocation.

Clinical and Radiologic Outcomes of Acute Acromioclavicular Joint Dislocation

Yong Girl Rhee,Jung Gwan Park,Nam Su Cho,Wook Jae Song 대한견주관절의학회 2014 대한견주관절의학회지 Vol.17 No.4

Background: Kirschner’s wire (K-wire) transfixation and locking hook plate fixation techniques are widely used in the treatment of acute acromioclavicular joint (ACJ) dislocation. The purpose of this study was to compare the clinical and radiologic outcomes between K-wires transfixation and a locking hook plate fixation technique. Methods: Seventy-seven patients with acute ACJ dislocation managed with K-wire (56 shoulders) and locking hook plate (21 shoulders) were enrolled for this study. The mean follow-up period was 61 months. Results: At the last follow-up, the shoulder rating scale of the University of California at Los Angeles (UCLA) was higher in patients treated with locking hook plate than with K-wires (33.2 ± 2.7 vs. 31.3 ± 3.4, p=0.009). In radiologic assessments, coracoclavicular distance (CCD) (7.9 mm vs. 7.7 mm, p=0.269) and acromioclavicular distance (ACD) (3.0 mm vs. 1.9 mm, p=0.082) were not statistically different from contralateral unaffected shoulder in locking hook plate fixation group, but acromioclavicular interval (ACI) was significant difference. However, there were significant differences in ACI, CCD, and ACD in K-wire fixation group (p<0.001). Eleven complications (20%) occurred in K-wire transfixation group and 2 subacromial erosions on computed tomography scan occurred in locking hook plate fixation group. Conclusions: ACJ stabilization was achieved in acute ACJ dislocations treated with K-wires or locking hook plates. Locking hook plate can provide higher UCLA shoulder score than K-wire and maintain CCD, and ACD without ligament reconstruction. K-wire transfixation technique resulted in a higher complication rate than locking hook plate.