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http://dx.doi.org/10.5397/CiSE.2011.14.1.059

Operative Treatment of Distal Clavicle Fracture with Acromioclavicular Joint Injury  

Kang, Ho-Jung (Department of Orthopaedic Surgery, Yonsei University, College of Medicine)
Koh, Il-Hyun (Department of Orthopaedic Surgery, Yonsei University, College of Medicine)
Joo, Jong-Hwan (Department of Orthopaedic Surgery, Yonsei University, College of Medicine)
Chun, Yong-Min (Department of Orthopaedic Surgery, Yonsei University, College of Medicine)
Kim, Hyung-Sik (Department of Orthopaedic Surgery, Yonsei University, College of Medicine)
Publication Information
Clinics in Shoulder and Elbow / v.14, no.1, 2011 , pp. 59-66 More about this Journal
Abstract
Purpose: We wanted to evaluate the clinical and radiological outcomes and the prognosis of various surgical treatments for the distal clavicle fracture with an acromioclavicular joint injury. Materials and Methods: A retrospective study of 21 patients with a minimum of 12 months follow up was done. We classified acromioclavicular (AC) injury into type I (only intra-articular fracture (IAF), 5 cases), type II (IAF with widening of the AC joint > 7 mm, 9 cases) and type III (IAF with AC joint superior subluxation > 50%, 7 cases). The distal clavicle fractures were fixed using plate (9 cases), mini screws (1 case), K wire and tension band wiring (10 cases) and transarticular pinning (1 case). Acromioclavicular or coracoacromial ligament reconstruction was not done in all the cases. Results: In 20 of 21 cases, bone union was achieved at an average of 8.4 weeks. Traumatic arthritis (5 cases), AC joint widening (4 cases) and AC joint subluxation (2 cases) were noted at the last follow up. The average UCLA score was 32.6 in the type I AC joint injuries, 34 in type II and 34.1 in type III. There was no relationship between the clinical outcomes and the preoperative AC joint injury pattern, postoperative traumatic arthritis, AC joint widening or AC joint subluxation (p>0.05). Conclusion: Satisfactory results were achieved by acute reduction and firm fixation of the distal clavicle fracture with AC joint injury. There was no relationship between the pattern of AC joint injury, the residual radiologic findings and the functional outcome.
Keywords
Distal clavicle fracture; Acromioclavicular joint injury; Internal fixation;
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1 Taft TN, Wilson FC, Oglesby JW. Dislocation of the acromioclavicular joint. An end-result study. J Bone Joint Surg Am. 1987;69:1045-51.
2 Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986;68:1136-44.
3 Allman FL, Jr. Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am. 1967;49:774-84.
4 Petersson CJ, Redlund-Johnell I. Radiographic joint space in normal acromioclavicular joints. Acta Orthop Scand. 1983;54:431-3.   DOI
5 Simovitch R, Sanders B, Ozbaydar M, Lavery K, Warner JJ. Acromioclavicular joint injuries: diagnosis and management. J Am Acad Orthop Surg. 2009; 17:207-19.
6 Nuber GW, Bowen MK. Acromioclavicular joint injuries and distal clavicle fractures. J Am Acad Orthop Surg. 1997;5:11-8.
7 Fukuda K, Craig EV, An KN, Cofield RH, Chao EY. Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg Am. 1986;68:434-40.
8 Hessmann M, Gotzen L, Kirchner R, Gehling H. Therapy and outcome of lateral clavicular fractures. Unfallchirurg. 1997;100:17-23.   DOI
9 Ko SH. Minimal incision Wolter plate fixation on the displaced lateral end fracture of the clavicle and the acromioclavicular dislocation. J Korean Shoulder Elbow Soc. 2002;5:23-8.   DOI   ScienceOn
10 Ko SH, Cho SD, Park MS, Ryu SG. The use of hook plate on the management of unstable Neer II lateral end fracture of the clavicle. J Korean Shoulder Elbow Soc. 2003;6:131-7.   과학기술학회마을   DOI   ScienceOn
11 Galpin RD, Hawkins RJ, Grainger RW. A comparative analysis of operative versus nonoperative treatment of grade III acromioclavicular separations. Clin Orthop Relat Res. 1985;193:150-5.
12 Bannister GC, Wallace WA, Stableforth PG, Hutson MA. A classification of acute acromioclavicular dislocation: a clinical, radiological and anatomical study. Injury. 1992;23:194-6.   DOI   ScienceOn
13 Craig EV. Fractures of the clavicle. In: Rockwood CA, Matsen FA, eds. The shoulder. Philadelphia: WB Saunders; 1998. 428-82.
14 Hessmann M, Kirchner R, Baumgaertel F, Gehling H, Gotzen L. Treatment of unstable distal clavicular fractures with and without lesions of the acromioclavicular joint. Injury. 1996;27:47-52.   DOI   ScienceOn
15 Neer CS, 2nd. Fracture of the distal clavicle with detachment of the coracoclavicular ligaments in adults. J Trauma. 1963;3:99-110.   DOI
16 Rockwood CA. Fractures of the outer clavicle in children and adults. J Bone Joint Surg Br. 1982;64:642.
17 Kao FC, Chao EK, Chen CH, Yu SW, Chen CY, Yen CY. Treatment of distal clavicle fracture using Kirschner wires and tension-band wires. J Trauma. 2001;51:522-5.   DOI
18 Neer CS, 2nd. Fractures of the distal third of the clavicle. Clin Orthop Relat Res. 1968;58:43-50.
19 Kalamaras M, Cutbush K, Robinson M. A method for internal fixation of unstable distal clavicle fractures: early observations using a new technique. J Shoulder Elbow Surg. 2008;17:60-2.   DOI   ScienceOn
20 Kashii M, Inui H, Yamamoto K. Surgical treatment of distal clavicle fractures using the clavicular hook plate. Clin Orthop Relat Res. 2006;447:158-64.   DOI
21 Rockwood CA, Williams GR, Young DC. Disorders of the acromioclavicular joint. In: Rockwood CA, Matsen FA, eds. The shoulder. Philadelphia: WB Saunders; 1998. 483-553.
22 Kona J, Bosse MJ, Staeheli JW, Rosseau RL. Type II distal clavicle fractures: a retrospective review of surgical treatment. J Orthop Trauma. 1990;4:115-20.   DOI