• Clinics in Shoulder and Elbow
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• 제1권1호
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• pp.128-131
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• 1998

Fracture of the clavicle and dislocation of the acromioclavicular joint occur commonly as separate injuries. However, complete acromioclavicular dislocation with an ipsilateral clavicle fracture is quite rare. We experienced a case of acromioclavicular joint dislocation associated with fracture of clavicle and brachial plexus injury treated by open reduction and internal fixation.

• Clinics in Shoulder and Elbow
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• 제4권1호
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• pp.24-29
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• 2001

Purpose: To describe a technique of the modified Neviaser method and to evaluate the clinical outcome of the technique in the treatment of the complete acromioclavicular joint dislocation, Materials and Method: We evaluated 20 patients who were treated by a modified Neviaser method from June 1996 to January 1999, They were followed up for a minimum of two years. The operative technique includes fixation of the acromioclavicular joint, repair of coracoclavicular ligament and transfer of the anterolateral band of coracoacromial ligament. Results: The 20 patients were evaluated clinically using Kang's criteria. The satisfactory results obtained in 85%. The mean coracoclavicular interval ratio was decreased from 2.22 preoperatively to 1.07 postoperatively. At the time of two year follow-up, the mean ratio was 1.20. There was no definite complication such as re-dislocation of the joint. Conclusion: In above type 3 acromioclavicular dislocation, the modified Neviaser method provided the advantage of strong and stable fixation with a low complication rate. Therefore, it is thought to be one of the useful operative technique.

• Clinics in Shoulder and Elbow
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• 제2권1호
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• pp.1-7
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• 1999

Purpose : There has been considerable controversy as to the method of the treatment of acute acromioclavicular joint dislocation classified to type III injury. The purpose of this study is to compare the conservative and operative treatment of the type III acute acromioclavicular joint dislocation in terms of clinical and radiological results. Materials and Methods: We treated 31 cases of acute, type III acromioclavicular joint dislocation, 17 cases were treated by operative methods and 14 patients by conservative treatment, and 1 year minimum follow-up was done from January 1990 to January 1996. We used UCLA Shoulder Rating Scale for clinical results. And for the radiological results coracoclaviclar distance were measured. We used Fisher's exact test for statistical analysis of results between the two treatment methods. Results: Fifteen(88.2%) of seventeen patients in operative treatment and eleven(78.6%) of fourteen patients in nonoperative treatment were rated excellent or good on the UCLA rating scale. In radiographic evaluation, the average coracoclavicular distances of preoperative state, immediate postoperation(or postreduction) and last follow-up were as follows. In operative cases, it was 1.75±0.21mm, 1.14±0.24mm and 1.33± 0.22mm respectively. In nonoperative cases, it was 1.65±0.14mm, 1.26±0.26mm, and 1.42±0.27mm respectively. Conclusion : This study demonstrated that there was no significant difference in clinical and radiological results between the operative and nonoperative treatment groups. So, nonoperative treatment is recommended for acute type III acromioclavicular dislocation as general rule.

• Clinics in Shoulder and Elbow
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• 제22권2호
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• pp.93-99
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• 2019

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 conducted 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, Constant score, and Korean shoulder scoring system (KSS) were used for clinical assessment. Acromioclavicular interval (ACI), coracoclavicular 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 $164.6^{\circ}$, external rotation at the side was $61.2^{\circ}$ 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 affected shoulders had significantly higher values. Conclusions: The modified Phemister operation with CC ligament augmentation using suture anchor is clinically and radiologically effective at acute AC joint dislocation.

• Clinics in Shoulder and Elbow
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• 제17권1호
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• pp.36-39
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• 2014

Clavicular hook plate is known to be an effective treatment on acromioclavicular (AC) joint injury, but there have been some reports of complications, like osteolysis and bony erosion of the undersurface of acromion. Fifty-five year old male underwent open reduction and hook plate insertion on Rockwood type 5 acromioclavicular joint dislocation. He complained of protrusion of posterior acromion at 1 month after the surgery, and acromial fracture was noted in simple radiographs. The hook plate was removed and any other treatment for osteosynthesis was refused by the patient. At the 18 months after the surgery, the patient had no pain and a full range of motion with no tenderness around the shoulder joint. After two years, plain radiographs revealed complete bony union of the acromion fracture.

• Clinics in Shoulder and Elbow
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• 제8권2호
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• pp.135-140
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• 2005

Purpose: To find out the early results after surgical treatment of the acute acromioclavicular dislocation with LIGASTIC artificial ligament. Material and Method: 6 patients who were diagnosed as acute acomioclavicular joint dislocation and treated with LIGASTIC artifical ligament through March 2005 to July 2005. The radiologic and clinical results using Imatani evaluation system were analyzed. Results: By clinical evaluation, 4 cases(67%) were excellent and 2 cases(33%) were good. By radiologic evaluation, 3 cases(50%) were excellent and 3 cases(50%) were good. All cases showed satisfactory results. Till the final follow up, there were no complication. Conclusion: Surgical treatment of the acute acromioclavicular dislocation with LIGASTIC articifial ligament is simple, but provides enough stability for early postoperative rehabilitation, decreases arthritis of acomioclavicular joint and there is no burden of removal of the fixture, so it is thought as a very effective surgery.

• Clinics in Shoulder and Elbow
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• 제22권3호
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• pp.149-153
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• 2019

We experienced acromial erosion and subsequent fracture after the treatment of Rockwood type V acromioclavicular dislocation with hook plate and coracoclavicular ligament augmentation. It was treated by using a surgical technique to address an acromial fracture and subsequent losses of reduction in acromioclavicular joint with two trans-acromial cortical screws (crossbar technique). The reduction state of acromioclavicular joint could be maintained by these two screws. Our crossbar technique could be considered as a good salvage procedure for the reduction loss caused by cutout or significant erosion of acromion after insertion of clavicular hook plate.

• Clinics in Shoulder and Elbow
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• 제13권2호
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• pp.217-222
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• 2010

목적: Rockwood 제 5형 견봉 쇄골 관절 탈구에서 두개의 봉합 나사못 및 Kirschner 강선을 이용한 수술적 치료의 임상적 결과에 대해 알아보고자 하였다. 대상 및 방법: 2006년 5월부터 2009년 5월까지 두개의 봉합 나사못 및 Kirschner 강선을 이용하여 수술적 치료를 시행한 Rockwood 제 5형 견봉 쇄골 관절 탈구 10예를 대상으로 하였으며, 평균 추시 기간은 12.0 (7~31)개월 이였다. 한국 견관절 점수와 Constant-Murley 점수로써 임상적 평가를 시행하였으며, 단순 방사선 사진에서 견봉 쇄골 관절의 정복 상태를 측정하였다. 결과: 전 예에서 대부분 회복되어 만족할만한 임상적 결과를 얻었으며, 한국 견관절 점수는 평균 89.9 (81~100)점이고 Constant-Murley 점수는 평균 87.8 (82~93)점 이였다. 방사선학적으로 해부학적 정복이 8예, 경도의 정복 소실 1예, 중등도의 정복 소실이 1예였으며, 심부 감염이나 재탈구 등의 합병증은 발생하지 않았다. 결론: Rockwood 제 5형 견봉 쇄골 관절 탈구에서 두 개의 봉합 나사못 및 Kirschner 강선을 이용한 수술적 치료를 통해 만족할 만한 결과를 얻을 수 있었으며, 견봉 쇄골 관절을 통과하지 않은 K-강선 고정술을 시행함으로써 관절 연골에 대한 추가적인 손상을 예방할 수 있었다.

• Clinics in Shoulder and Elbow
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• 제21권1호
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• pp.48-55
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• 2018

While non-operative treatment with structured rehabilitation tends to be the strategy of choice in the management of Rockwood type III acromioclavicular joint injury, some advocate surgical treatment to prevent persistent pain, disability, and prominence of the distal clavicle. There is no clear consensus regarding when the surgical treatment should be indicated, and successful clinical outcomes have been reported for non-operative treatment in more than 80% of type III acromioclavicular joint injuries. Furthermore, there is no gold standard procedure for operative treatment of type III acromioclavicular joint injury, and more than 60 different procedures have been used for this purpose in clinical practice. Among these surgical techniques, recently introduced arthroscopic-assisted procedures involving a coracoclavicular suspension device are minimally invasive and have been shown to achieve successful coracoclavicular reconstruction in 80% of patients with failed conservative treatment. Taken together, currently available data indicate that successful treatment can be expected with initial conservative treatment in more than 96% of type III acromioclavicular injuries, whereas minimally invasive surgical treatments can be considered for unstable type IIIB injuries, especially in young and active patients. Further studies are needed to clarify the optimal treatment approach in patients with higher functional needs, especially in high-level athletes.

• Clinics in Shoulder and Elbow
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• 제9권2호
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• pp.196-201
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• 2006

We report two cases of migration of K-wires from the acromioclavicular joint to the neck. A 73-year-old man complained of right shoulder pain for one month and had undergone orthopedic surgery because of acromioclavicular joint dislocation about 27 years earlier. Another 56-year-old man complained of left shoulder pain and neck pain for 5 years and had undergone orthopedic surgery because of acromioclavicular joint dislocation about 25 years earlier. In both cases, we took X-rays to look for the cause of shoulder pain and discovered broken and migrated K-wires in the neck. We removed the K-wires from the trapezius muscle and the paraspinal muscle respectively. K-wire fixation technique is simple and effective but should be followed up with X-rays periodically. In addition, we should warn patients of the possibility of migration of K-wire. And it is desirable for us to avoid using K-wire near major neurovascular structures like the sternoclavicular joint and the clavicle.