Double-button Fixation System for Management of Acute Acromioclavicular Joint Dislocation

Document Type: RESEARCH PAPER

Authors

1 Firuzgar Hospital, Iran University of Medical Sciences, Tehran, Iran

2 Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran

3 Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

4 Department of Pharmacology, school of Medicine, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran Departments of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

Abstract

 
Background: Surgical treatments for acromioclavicular (AC) joint dislocation present with some complications. The present study was designed to evaluate the double-button fixation system in the management of acute acromioclavicular joint dislocation.

Methods:
This cross sectional study, done between February 2011 to June 2014, consisted of 28 patients who underwent surgical management by the double-button fixation system for acute AC joint dislocation. Age, sex, injury mechanism, dominant hand, side with injury, length of follow up, time before surgery, shoulder and hand (DASH), constant and visual analogue scale (VAS) scores, and all complications of the cases during the follow up were recorded.

Results:
The mean age of patients was 33.23±6.7 years. Twenty four patients (85.71%) were male and four (14.28%) were female. The significant differences were observed between pre-operation VAS, constant shoulder scores and post-operation measurements (P=0.001, P=0.0001, P=0.0001, respectively). There were not any significant differences between right and left coracoclavicular (P=0.238), but two cases of heterotrophic ossifications were recorded. The mean follow-up time was 16.17±4.38 months.

Conclusion:
According to the results, the double-button fixation system for management of acute acromioclavicular joint dislocation has suitable results and minimal damage to the soft tissues surrounding the coracoclavicular ligaments.

Keywords


  1. Collins DN. Disorders of the acromioclavicular joint. In: Rockwood Jr CA, editor. The shoulder. 4th ed. Philadelphia: Elsevier Health Sciences; 2009. P. 453–526.
  2. Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med. 2007; 35(2):316-29.
  3. Babhulkar A, Pawaskar A. Acromioclavicular joint dislocations. Cur Rev Musculoskeletal Med. 2014; 7(1):33-9.
  4. Verdano M, Pellegrini A, Zanelli M, Paterlini M, Ceccarelli F. Modified Phemister procedure for the surgical treatment of Rockwood types III, IV, V acute acromioclavicular joint dislocation. Musculoskeletal Surg. 2012; 96(3):213-22.
  5. Rockwood CA, Williams GR, Young D. Disorders of the acromioclavicular joint. In: Rockwood CA, Matsen FA, editors. The shoulder. 2th ed . Philadelphia: WB Saunders; 1998. P. 483–553.
  6. MacDonald PB, Lapointe P. Acromioclavicular and sternoclavicular joint injuries. Orthop Clin North Am. 2008; 39(4):535-45.
  7. Pan Z, Zhang H, Sun C, Qu L, Cui Y. Arthroscopy-assisted reconstruction of coracoclavicular ligament by Endobutton fixation for treatment of acromioclavicular joint dislocation. Arch Orthop Trauma Surg. 2015; 135(1):9-16.
  8. Iannotti JP, Williams GR. Disorders of the shoulder: diagnosis and management. 2th ed. Philadelphia: Lippincott Williams & Wilkins; 2007. P. 979–1006.9.
  9. Mazzocca AD, Santangelo SA, Johnson ST, Rios CG, Dumonski ML, Arciero RA. A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med. 2006; 34(2):236-46.
  10. Virtanen KJ, Remes VM, Tulikoura IT, Pajarinen JT, Savolainen VT, Björkenheim JM, et al. Surgical treatment of Rockwood grade-V acromioclavicular joint dislocations: 50 patients followed for 15-22 years. Acta Orthop. 2013; 84(2):191-5.
  11. Di Francesco A, Zoccali C, Colafarina O, Pizzoferrato R, Flamini S. The use of hook plate in type III and V acromio-clavicular Rockwood dislocations: clinical and radiological midterm results and MRI evaluation in 42 patients. Injury. 2012; 43(2):147-52.
  12. Leidel BA, Braunstein V, Kirchhoff C, Pilotto S, Mutschler W, Biberthaler P. Consistency of long-term outcome of acute Rockwood grade III acromioclavicular joint separations after K-wire transfixation. J Trauma. 2009; 66(6):1666-71.
  13. Huang TW, Hsieh PH, Huang KC, Huang KC. Suspension suture augmentation for repair of coracoclavicular ligament disruptions. Clin Orthop Relat Res. 2009; 467(8):2142-8.
  14. Kim SH, Lee YH, Shin SH, Lee YH, Baek GH. Outcome of conjoined tendon and coracoacromial ligament transfer for the treatment of chronic type V acromioclavicular joint separation. Injury. 2012; 43(2):213-8.
  15. Karlsson J, Arnarson H, Sigurjonsson K. Acromioclavicular dislocations treated by coracoacromial ligament transfer. Arch Orthop Traum Surg. 1986; 106(1):8-11.
  16. De Baets T, Truijen J, Driesen R, Pittevils T. The treatment of acromioclavicular joint dislocation Tossy grade III with a clavicle hook plate. Acta Orthop Belg. 2004; 70(6):515-9.
  17. Habernek H, Weinstabl R, Schmid L, Fialka C. A crook plate for treatment of acromioclavicular joint separation: indication, technique, and results after one year. J Trauma. 1993; 35(6):893-901.
  18. Phillips AM, Smart C, Groom AF. Acromioclavicular dislocation: Conservative or surgical therapy. Clin Orthop Relat Res. 1998; 353(2):10-7.
  19. Gstettner C, Tauber M, Hitzl W, Resch H. Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg. 2008; 17(2):220-5.
  20. Swanik KA, Lephart SM, Swanik CB, Lephart SP, Stone DA, Fu FH. The effects of shoulder plyometric training on proprioception and selected muscle performance characteristics. J Shoulder Elbow Surg. 2002; 11(6):579-86.
  21. De Smet L. The DASH questionnaire and score in the evaluation of hand and wrist disorders. Acta Orthop Belg. 2008; 74(5):575-81.
  22. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987; 214(12):160-4.
  23. Dimakopoulos P, Panagopoulos A, Syggelos SA, Panagiotopoulos E, Lambiris E. Double-loop suture repair for acute acromioclavicular joint disruption. Am J Sports Med. 2006; 34(7):1112-9.
  24. Koukakis A, Manouras A, Apostolou CD, Lagoudianakis E, Papadima A, Triantafillou C, et al. Results using the AO hook plate for dislocations of the acromioclavicular joint. Expert Rev Med Devices. 2008; 5(5):567-72.
  25. Mlasowsky B, Brenner P, Düben W, Heymann H. Repair of complete acromioclavicular dislocation (Tossy stage III) using Balser’s hook plate combined with ligament sutures. Injury. 1988; 19(4):227-32.
  26. Paavolainen P, Björkenheim JM, Paukku P, Slätis P. Surgical treatment of acromioclavicular dislocation: a review of 39 patients. Injury. 1983; 14(5):415-20.
  27. Hellmich A, Sievers U. Operative repair of acromioclavicular separation via transcutaneous Kirschner wire fixation: results of follow-up examinations in 45 patients. Aktuelle Traumatol. 1988; 18(3):9-13.
  28. Mazet R. Migration of a Kirschner wire from the shoulder region into the lung. J Bone Joint Surg. 1943; 25(2):477-83.
  29. Norrell H Jr, Llewellyn RC. Migration of a threaded Steinmann pin from an acromioclavicular joint into the spinal canal. J Bone Joint Surg Am. 1965; 47(5):1024-6.
  30. Lindsey RW, Gutowski WT. The migration of a broken pin following fixation of the acromioclavicular joint. A case report and review of the literature. Orthopedics. 1986; 9(3):413-6.
  31. Bosworth BM. Acromioclavicular separation. New method of repair. Surg Gynecol Obstet. 1941; 73(1):866-71.
  32. Costic RS, Labriola JE, Rodosky MW, Debski RE. Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med. 2004; 32(8):1929-36.
  33. Harris RI, Vu DH, Sonnabend DH, Goldberg JA, Walsh WR. Anatomic variance of the coracoclavicular ligaments. J Shoulder Elbow Surg. 2001; 10(6):585-8.
  34. Wellmann M, Zantop T, Weimann A, Raschke MJ, Petersen W. Biomechanical evaluation of minimally invasive repairs for complete acromioclavicular joint dislocation. Am J Sports Med. 2007; 35(6):955-61.
  35. Ponce BA, Millett PJ, Warner JJ. Acromioclavicular joint instability—reconstruction indications and techniques. Oper Tech Sports Med. 2004; 12(1):35-42.
  36. Beris A, Lykissas M, Kostas-Agnantis I, Vekris M, Mitsionis G, Korompilias A. Management of acute acromioclavicular joint dislocation with a double-button fixation system. Injury. 2013; 44(3):288-92.
  37. Shin SJ, Kim NK. Complications after arthroscopic coracoclavicular reconstruction using a single adjustable–loop-length suspensory fixation device in acute acromioclavicular joint dislocation. Arthroscopy. 2015; 31(5):816-24.