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Evaluation of Patients with Acromioclavicular Joint Separation Treated Using the Clavicular Hook Plate

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Turgut M. C., Semis H. S., Yamak K., Çelebi F.
Ortopedia Traumatologia Rehabilitacja
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2022
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vol. 24(2)
73-78
EN
Background. This study aimed to evaluate the outcomes of patients who underwent surgical treatment using the clavicular hook plate for diagnosed Rockwood Type 3 – Type 4 – Type 5 acromioclavicular joint separation. Material and methods. Patients who were operated with the diagnosis of acute traumatic acromioclavicular joint separation between the years 2017-2021 were evaluated retrospectively. Patients' age, gender, mechanism of injury, time to surgery, follow-up duration, and complications were evaluated. Functional results were evaluated using pre-op and post-op VAS and the Constant-Murley Shoulder Score. Results. A total of thirty patients admitted with the diagnosis of acromioclavicular joint separation were included. All patients underwent surgical treatment using the clavicular hook plate. Twenty (66.6%) patients were male and 10 (33.6%) were female. Seventeen of the patients were admitted due to sports injuries, 6 due to traffic accidents, and 7 due to workplace accidents. The patients were followed up for an average of 26.1 weeks. The Rockwood Classification was used for classification of injuries. Accordingly, 12, 13, and 5 of the patients had Type 3, Type 4, and Type 5 injury, respectively. While the mean pre-op VAS score was 7.4 (5-9), it was 1.8 (1-4) in the post-op period. The mean pre-op Constant-Murley score was 31.5 (22-42), compared to 85.1 (72-100) in the post-op period. The differences between the pre-op and post-op VAS and Constant-Murley Shoulder Scores were statistically significant. Conclusion. In this study, we achieved good functional results in the treatment of acromioclavicular joint separation by using a clavicular hook plate providing stable fixation and allowing early mobilization.
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Clinical Evaluation and Instrumental Diagnostics in Acute Acromioclavicular Joint Dislocation

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Bezruchenko S., Dolhopolov O., Yarova M., Luchko R., Mazevych V.
Ortopedia Traumatologia Rehabilitacja
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2022
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vol. 24(1)
1-12
EN
Background. The aim was to improve the diagnosis of acromioclavicular joint dislocation by studying the capabilities and characteristics of clinical and instrumental diagnostic methods. The idea is expressed that modern clinical and instrumental diagnostic methods comprise a large number of techniques, but no single algorithm for diagnosing injury to the AC joint has been developed. A gold standard for investigating and diagnosing acute AC joint dislocation does not currently exist. Materials and Methods. A retrospective study of the characteristics and capabilities of clinical and instrumental diagnostic methods was performed in 152 patients with traumatic shoulder pathology. The patients were divided into two groups: Group I of 102 patients (67%) with acromioclavicular joint dislocation type III-VI according to Rockwood classification and Group II of 50 patients (33%) with a partial tear of the rotator cuff. Clinical and instrumental examinations involved specific provocative tests; the radiological diagnostics comprised conventional radiographs with the Zanca, axillary and Alexander views, and CT, MRI, and ultrasound examinations. Results. The characterization of examination methods was based on the records of patients in Group I and II. The most sensitive clinical test to establish Rockwood type V of acromioclavicular joint dislocation was the Paxinos test (91%). The lowest sensitivity across the tests used was observed with the active compression test to diagnose type IV of dislocation (50%). As regards the X-ray examination, the axial view was 100% sensitive for detecting type IV and VI AC joint dislocation. The Zanca view is highly sensitive for patients with Rockwood type V and Alexander view for Rockwood type III and V dislocations. The accuracy of ultrasound work-up in Group I was 95%, with 96% sensitivity and 93% specificity, while MRI accuracy was 97%, with 96% sensitivity and 98% specificity, and CT accuracy was 81%, with 83% sensitivity and 75% specificity. Conclusions. 1. Determination of the sensitivity and specificity of the X-ray examination revealed the absence of a 100% effective X-ray view for type III and V AC joint dislocation. 2. The accuracy and sensitivity of the ultrasound, MRI, and CT examinations are high. 3. There is currently no consensus on a protocol to view acute AC joint injuries. 4. Complete and timely early diagnosis of acromioclavicular dislocation allows for a differentiated approach to surgical treatment tactics, preventing possible complications and restoring the function of the injured shoulder joint to the fullest extent.
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