Treatment of the Treatment of the Acromioclavicular Joint Acromioclavicular Joint

Dislocation with External Dislocation with External Fixation DeviceFixation Device

Chelnokov A.N. Tyrtseva E.S.Chelnokov A.N. Tyrtseva E.S.Ural Scientific Research Institute of Ural Scientific Research Institute of Traumatology and Orthopaedics, Traumatology and Orthopaedics,

Ekaterinburg, RussiaEkaterinburg, Russia

BackgroundBackground

• To date there has been no consensus To date there has been no consensus about optimal treatment of the about optimal treatment of the traumatic dislocation of the acromio-traumatic dislocation of the acromio-clavicular joint.clavicular joint.

Many treatment modalities for Many treatment modalities for the ACJ dislocationthe ACJ dislocation

• From aggressive From aggressive surgerysurgery……

……to nonoperative to nonoperative managementmanagement

– A Prospective Evaluation of Untreated Acute A Prospective Evaluation of Untreated Acute Grade III Acromioclavicular Separations. T.F. Grade III Acromioclavicular Separations. T.F. Schlegel. The American Journal of Sports Schlegel. The American Journal of Sports Medicine 29:699-703 (2001):Medicine 29:699-703 (2001):

– 20 of the 25 patients completed the 1-year 20 of the 25 patients completed the 1-year evaluation and strength-testing protocol; evaluation and strength-testing protocol;

– objective examination and strength testing of the objective examination and strength testing of the 20 patients revealed no limitation of shoulder 20 patients revealed no limitation of shoulder motion in the injured extremity and no difference motion in the injured extremity and no difference between sides in rotational shoulder muscle between sides in rotational shoulder muscle strengthstrength

• Aim of this study was to estimate Aim of this study was to estimate capabilities of small wire monolateral capabilities of small wire monolateral external fixator for closed treatment external fixator for closed treatment of complete acromioclavicular of complete acromioclavicular dislocations. dislocations.

Rockwood type III

Rockwood type V

Neer type II-III10

8

6

Material and methodsMaterial and methods

• 24 patients24 patients– 14 male14 male– 10 female10 female

• 3,2 days after the 3,2 days after the injury (0-14)injury (0-14)

External FixationExternal Fixation

• G.S.Sushko, G.A.Ilizarov, 1977, 1979G.S.Sushko, G.A.Ilizarov, 1977, 1979

Surgery and post-op periodSurgery and post-op period

• 10-30 minutes10-30 minutes

• Regional anesthesiaRegional anesthesia

• Discharge in 1-2 daysDischarge in 1-2 days

• Sling for 1-3 daysSling for 1-3 days

Duration of fixationDuration of fixation

• 4 weeks for acute cases (fixation 4 weeks for acute cases (fixation within 0-5 days after the injury), within 0-5 days after the injury),

• 6-8 weeks for delayed admission (6-6-8 weeks for delayed admission (6-14 days)14 days)

• In cases of dislocations older 2 weeks => AC In cases of dislocations older 2 weeks => AC and CC ligaments repair by tendon allograftsand CC ligaments repair by tendon allografts

• Stability test before hardware Stability test before hardware removalremoval

ResultsResults

• Self-care, light housework – 3-5 daysSelf-care, light housework – 3-5 days• Deep infection 0/24Deep infection 0/24

– 1010 patients (42%) sustained skin irritation and patients (42%) sustained skin irritation and serum drainage from acromial wire site only serum drainage from acromial wire site only

• 23/24 healed23/24 healed– 1/24: missed acromial wire cut-out => 1/24: missed acromial wire cut-out =>

symptomatic instability => AC+CC repair (allo symptomatic instability => AC+CC repair (allo tendons) => uneventful healingtendons) => uneventful healing

• 1 year follow up - 15 patients.1 year follow up - 15 patients.– All restored their pre-injury statusAll restored their pre-injury status– Occasional pain in hyperabduction – 3/15 Occasional pain in hyperabduction – 3/15

Rockwood type V injuryRockwood type V injury

After 6 weeksAfter 6 weeks

ResultResult

Neer Type II injury Neer Type II injury

Follow-up (3 year)Follow-up (3 year)

Follow-up (3 year)Follow-up (3 year)

Follow-up (3 years)Follow-up (3 years)

Affected side

Discussion: Advantages of the Discussion: Advantages of the techniquetechnique

• Controllable fixationControllable fixation– With ex-fix we control the situation, With ex-fix we control the situation,

without it the situation controls uswithout it the situation controls us

• Minimally invasiveMinimally invasive– Fast recoveryFast recovery– Good cosmetic effectGood cosmetic effect

• Minimal time and effortsMinimal time and efforts• Short learning curveShort learning curve

Discussion: DisadvantagesDiscussion: Disadvantages

• Temporary discomfort, decreased Temporary discomfort, decreased quality of lifequality of life

• Pin site care, outpatient visits Pin site care, outpatient visits necessarynecessary

• Hardware removalHardware removal

ConclusionConclusion

• External fixation can be technique of External fixation can be technique of choice for acute cases where choice for acute cases where operative treatment is indicatedoperative treatment is indicated

Thank youThank you

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