Acromioclavicular Joint/diagnostic imaging* ; Clavicle/diagnostic imaging* ; Fracture Fixation, Internal ; Fractures, Bone/surgery* ; Humans ; Joint Dislocations/diagnostic imaging* ; Missed Diagnosis

OBJECTIVES: To explore the safety and effectiveness of arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation to manage the acute acromioclavicular joint dislocation. METHODS: From January 2016 to December 2017, 18 cases of acute acromioclavicular joint dislocation were carried out with arthroscopic reconstruction of coracoclavicular ligament by double Endobutton plate suspensory fixation. Anteroposterior view X-ray plain radiographs were obtained on the second day, 6 months and 12 months after the surgery, MRI was performed in 1 year after operation. Meanwhile, subjective and objective scoring were obtained by Vsual Analogue Scale (VAS), Rating Scale of the American Shoulder and Elbow Surgeons (ASES) and University of California at Los Angeles Shoulder Rating Scale (UCLA). RESULTS: All patients were followed up for 12 to 30 months (an average of 18 months). There was no patient with infection, neurovascular injury, loosening and breakage of internal fixation, re-dislocation of acromioclavicular joint, clavicular fracture, coracoid process fracture, etc. Postoperative X-ray showed that all acromioclavicular joints were completely relocated. The follow-up of MRI after 1 year showed no obvious dislocation of acromioclavicular joint and good recovery of acromioclavicular space. Postoperative shoulder joint function, VAS, ASES, UCLA and acromioclavicular distance were significantly improved compared with those before surgery, with statistically significant differences (all <0.05). CONCLUSIONS Arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation to manage the acute acromioclavicular joint dislocation has the advantages of minimal invasive, rapid functional recovery and less complications and satisfactory early clinical results.
Acromioclavicular Joint ; diagnostic imaging ; surgery ; Follow-Up Studies ; Humans ; Joint Dislocations ; diagnostic imaging ; surgery ; Magnetic Resonance Imaging ; Shoulder Dislocation ; diagnostic imaging ; surgery ; Treatment Outcome

OBJECTIVETo observe the clinical effects of clavicular hook plate combined with suture anchor in treating type Tossy III chronic acromioclavicular dislocation.

METHODSFrom January 2008 to December 2012,18 patients with type Tossy III chronic acromioclavicular dislocation were treated with clavicular hook plate and suture anchor. There were 12 males and 6 females, aged from 20 to 56 years old with an average of 31.5 years. Ten cases were left dislocation and 8 cases were right dislocation. Operation time was 3 weeks to 4 months after injury with a mean of 1.8 months. Functional exercise was adopted 2 weeks after operation. And Karlsson standard was used to evaluate curative effect.

RESULTSAll patients were followed up for 6 to 24 months with an average of 16 months. According to Karlsson standard, 17 cases were excellent and 1 was poor.

CONCLUSIONClavicular hook plate combined with suture anchor can repair conoid ligament and trapezoid ligament in treating type Tossy III chronic acromioclavicular dislocation, and had advantages of simple operation, less trauma, stable fixation, it can obtain satisfactory effects.

Acromioclavicular Joint ; diagnostic imaging ; injuries ; surgery ; Adult ; Bone Plates ; Female ; Follow-Up Studies ; Humans ; Joint Dislocations ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Radiography ; Suture Anchors ; Treatment Outcome ; Young Adult

An 82-year-old man presented with neck pain, right upper limb radiculopathy and right shoulder pain. Physical examination revealed a soft lump over the right shoulder joint, as well as reduced range of shoulder movements. On magnetic resonance imaging, the soft lump was shown to be a cystic mass over the acromioclavicular joint and was related to a full-thickness supraspinatus tendon tear. This is the classic geyser sign. The pathophysiology and clinical features of the geyser sign, and its imaging features with various imaging modalities, are discussed.
Acromioclavicular Joint ; diagnostic imaging ; injuries ; Aged ; Aged, 80 and over ; Fluoroscopy ; Humans ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging ; Male ; Range of Motion, Articular ; Shoulder ; physiology ; Shoulder Joint ; pathology ; Tendon Injuries ; pathology

OBJECTIVETo study measurement methods of acromioclavicular and coracoclavicular ligament injuries,its therapeutic effects and complications during internal fixation operation for the treatment of fresh acromioclavicular joint dislocations of Tossy type III.

METHODSFrom July 2003 to May 2012,127 patients with acromioclavicular joint dislocations of Tossy type III were treated with wire fixation from coracoid process to clavicle or hook-plate fixation. The patients were divided into group A (63 cases) and group B (64 cases) according to whether acromioclavicular ligament and coracoclavicular ligament were repaired or not. In group A (ligaments repaired), there were 39 males and 24 females with an average age of (33.25 +/- 8.46) years old (ranged from 17 to 59 years). And in group B (no ligaments repaired), there were 41 males and 23 females with an average age of (34.10 +/- 7.19) years (ranged from 19 to 57 years). The operation times, intraoperative blood loss, postoperative infections, internal fixation failure, recurrence and other complications, together with therapeutic effects were compared between two groups.

RESULTSThe outcome was analyzed according to Karlsson standard. In group A, 54 patients got an excellent result and 9 good according to Karlsson standard;the average operative time was (55.90 +/- 26.56) min; the average intraoperative bleeding amount was (99.80 +/- 50.30) ml; 1 patient had wire broken without re-dislocation at 16 weeks after operation, 3 patients got wound fat liquefaction and recovered after treatment, 1 patient had pain after shoulder joint motion and pain disappeared after implants were taken out. In group B, 52 patients got an excellent result and 12 good according to Karlsson standard; the average operative time was (49.50 +/- 23.14) min; the average intraoperative bleeding amount was (87.30 +/- 46.41) ml; 2 patients got wound fat liquefaction, and 2 patients had pain after shoulder joint motion. All the patients were followed up, and the duration ranged from 9 to 16 months. All internal steel-wire or hook plate were taken out during 4 to 9 months without acromioclavicular joint re dislocation. There were no significant difference in the average operative time, the average intraoperative blood less, complication recurrence rates of fixation failure, wound fat liquefaction, postoperative infection, acromioclavicular joint re-dislocation, and therapeutic effects between two groups.

CONCLUSIONBoth wire and clavicular hook plate fixation, performed for fresh acromioclavicular joint dislocation with Tossy type III, are simple, effective, less invasive method with less blood loss. In addition, the treatment without ligaments repaired could not increase incidence of complications.

Acromioclavicular Joint ; diagnostic imaging ; injuries ; surgery ; Adolescent ; Adult ; Case-Control Studies ; Clavicle ; Female ; Humans ; Joint Dislocations ; diagnostic imaging ; surgery ; Ligaments ; diagnostic imaging ; injuries ; surgery ; Male ; Middle Aged ; Orthopedic Procedures ; methods ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the long-term clinical effects of modified double Endobutton technique for the treatment of acromioclavicular joint dislocations of Tossy type III.

METHODSA retrospective study was done in 42 patients with acromioclavicular joint dislocations of Tossy type III treated with modified double Endobutton technique from December 2008 to December 2010. There were 24 males and 18 females, ranging in age from 21 to 56 years old (averaged, 32.5 years old). All the patients were treated with open reduction, coracoclavicular ligament reconstruction using double Endobutton technique, and repair of acromioclavicular ligament. The Karlsson system was used to evaluate therapeutic effects. The distance from coracoid to clavicle was measured to evaluate reduction loss.

RESULTSAll the patients were followed up, and the duration ranged from 2.0 to 3.2 years (averaged,2.4 years). According to Karlsson system, 32 patients got an A degree and 10 patients got a B degree at three months post-operatively; 26 patients got an A degree and 16 patients got a B degree at the latest follow-up; 6 patients got an A degree at 3 months after operation lowered to B degree at the latest follow-up. The coracoid-clavicle distance increased from (26.91 +/- 0.91) mm at 3 months after operation to (27.41 +/- 1.10) mm at the latest follow-up. Te patients treated with over-reduction during operation or with heavy physical labour work after operation had obvious widened coracoid-clavicle distance. Bone absorption was found around the plate in most cases, mainly in the clavicular side.

CONCLUSIONTreatment for acromioclavicular joint dislocations of Tossy type III with modified double Endobutton technique has satisfactory early clinical results. But with time passing, loss of reduction and bone absorption around the plate could be observed, and clinical outcomes of some cases downgrade during the long-term follow-up.

Acromioclavicular Joint ; diagnostic imaging ; injuries ; surgery ; Adult ; Female ; Humans ; Joint Dislocations ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Orthopedic Procedures ; methods ; Retrospective Studies ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

BACKGROUNDRoutine anteroposterior radiographs of the acromioclavicular (AC) joint with or without weight bearing have limitations in demonstrating the AC joint. Transarticular fixation with Kirschner wire is a treatment choice for AC dislocations. However, percutaneous fixation of the AC joint is technically demanding. The C-arm fluoroscopy can be used as routine intraoperative guidance to facilitate this procedure. The current study aims to introduce new projections, the axial and tangential views of AC joint, to help evaluate the severity of the injury and facilitate the percutaneous procedure.

METHODSThree shoulder specimens were used to find the projection directions of the axial and tangential views of the AC joint by using the digital radiography (DR) unit. The axial and tangential views were taken of 20 adult volunteers by referencing the projection directions determined in the shoulder specimens. The angles showed on the DR system and the angles between the coronal plane of the body and the vertical plane of the flat panel detector (FPD) during taking these radiographs were recorded. The C-arm fluoroscopy unit was used to take the axial and tangential views referencing the angles measured on the DR system. Routine anteroposterior radiographs of the AC joint were taken on the volunteers. The minimal distances from the distal clavicle to the acromion were measured on both tangential and anteroposterior radiographs. The data was statistically analyzed.

RESULTSThe clear axial and tangential radiographs of AC joints of the volunteers were obtained using both DR and C-arm fluoroscopy units. The angles demonstrated on the DR window are (20.8 ± 2.4)° for male and (18.3 ± 2.3)° for female. During taking the axial views, the angles between the coronal plane of the body and vertical plane of FPD are (23.3 ± 3.2)° for male and (20.1 ± 2.4)° for female. During taking tangential views, the corresponding angles are (117.5 ± 3.7)° for male and (113.1 ± 3.3)° for female. On the tangential radiographs, the minimal distance from the distal clavicle to the acromion is (6.1 ± 1.2) mm, wider than the same measurement on the anteroposterior radiographs (P < 0.05). Statistical analyses showed no significant differences in the above-mentioned angles and the minimal distances between the left and right AC joints (P > 0.05). There were no significant differences in the above-mentioned angles between DR and C-arm fluoroscopy units (P > 0.05).

CONCLUSIONSThe axial and tangential radiographs of the AC joint can demonstrate the joint clearly and they can be easily obtained with both DR system and C-arm fluoroscopy unit in similar projection directions.

Acromioclavicular Joint ; diagnostic imaging ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Radiographic Image Enhancement

OBJECTIVETo compare clinical effects of clavicular hook plate fixation, coracoid transplantation, and clavicular hook plate fixation combined with modified dynamic muscle transfer for the treatment of the complete acromioclavicular dislocation.

METHODSFrom January 2006 to November 2009, 65 patients with sustained complete acrominoclavicular dislocation were treated with clavicular hook plate fixation, coracoid transplantation,and clavicular hook plate fixation combined with modified dynamic muscle transfer. All the patients were divided into three groups: 22 patients in group A were treated with clavicular hook plate fixation, including 17 males and 5 females, with an average age of (31.0 +/- 10.0) years; 21 patient in group B were treated with coracoid transplantation, including 16 males and 5 females,with an average age of (33.0 +/- 6.4) years; 22 patients in group C were treated with clavicular hook plate fixation combined with modified dynamic muscle transfer,including 18 males and 4 females, with an average age of (30.0 +/- 5.3) years. Postoperative functional recovery was evaluated by Karlsson criteria.

RESULTSAll the patients were followed up, and the duration ranged from half to three years (averaged 1.5 years). In group A, 8 patients got half re-dislocation, 2 patients got complete re-dislocation and arthritis of acromioclavicular joint after internal fixations removal, 1 patient had clavicular hook plate broken after operation. In group B, 7 patients got half re-dislocation, 1 patient got complete re-dislocation,and 5 patients had arthritis of acromioclavicular joint with acute pain and limited shoulder function after internal fixations removal. In group C,2 patients got half re-dislocation, no complete re-dislocation and arthritis of acromioclavicular joint occurred after internal fixations removal. According to Karlsson evaluation, in group A, 12 patients obtained an excellent result, 8 good and 2 poor; in group B, the data were 9, 7 and 5 respectively; in group C, they were 20, 2 and 0 respectively. There were remarkable differences of therapeutic effects between the clavicular hook plate fixation combined with modified dynamic muscle transfer and that with either of the former two treatment methods (P < 0.05).

CONCLUSIONClavicular hook plate combined with modified dynamic muscle transfer is a reliable and good treatment for the complete acrominoclavicular dislocation, with advantages such as easy to handle,stable fixation and early exercise.

Acromioclavicular Joint ; diagnostic imaging ; injuries ; physiopathology ; surgery ; Adult ; Female ; Humans ; Joint Dislocations ; diagnostic imaging ; physiopathology ; surgery ; Male ; Middle Aged ; Postoperative Complications ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate clinical results of AO clavicular hook plate for the treatment of fresh Tossy type III acromioclavicular joint dislocation.

METHODSFrom December 2006 to December 2008, 28 patients with fresh Tossy type III acromioclavicular joint dislocation were treated with AO clavicular hook plates. There were 23 males and 5 females. The average age at surgery were 46.4 years (ranged, 22 to 68 years). The average time from suffering injuries to the operation was 3.9 days(ranged, 1 to 21 days). And the average time from the operation to plate removal was 9.4 months(ranged, 6 to 22 months).

RESULTSAll the patients were followed up, the duration ranged from 6 to 24 months, with an average of 15 months. There was 1 patient with traumatic arthritis, 1 patient with plate fracture. And the others had good results without fracture and re-dislocation after operation. According to Karlsson standards, 21 patients got an excellent result, 6 good and 1 poor. Eight patients had pain and restricted activities in shoulder joints before the plate removal, and all the symptoms were catabatic after removing the clavicular hook plates. After exercise, the function of the shoulder joints achieved normal level.

CONCLUSIONClavicular hook plate used for the fresh Tossy type III acromioclavicular joint dislocation has advantages such as simple operation, little wound, less blood loss and early exercises.

Acromioclavicular Joint ; diagnostic imaging ; injuries ; physiopathology ; surgery ; Adult ; Aged ; Bone Plates ; Clavicle ; surgery ; Female ; Fracture Fixation, Internal ; instrumentation ; Humans ; Joint Dislocations ; diagnostic imaging ; physiopathology ; surgery ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

OBJECTIVETo explore the minimally invasive treatment for fresh acromioclavicular dislocation and the distal clavicle fracture.

METHODSThirty skeletons of human shoulder were measured and compared, and the normal data on healthy people were measured with the help of ultrasound-guided. So the invasion point was located at the cross between subclavian axis and the line from coracoid tip to apophysis behind cone ligament node. From January 2001 to January 2010, 127 patients with fresh acromioclavicular dislocation and distal clavicle fracture were treated with minimally invasive internal fixation after locating the invasive point at the body surface. Among the patients, 97 patients were male and 30 patients were female, ranging in age from 19 to 56 years, with an average of 43 years. According to Rockwood classification, among 93 patients with fresh acromioclavicular dislocation, 67 patients were type III, 11 patients were type IV and 15 patients were type V. All the 34 patients with distal clavicle fractures were associated with coracoclavicular ligament broken. The duration from injury to operation ranged from 1 to 8 days. The therapeutic effects were evaluated by using the of shoulder scoring system, University of California (UCLA).

RESULTSAfter the minimally invasive treatment, all the patients had completely reduction at early time. One hundred and thirteen patients were followed up,and the duration ranged from 13 to 15 months,averaged 14 months. Nine patients had screw loose slightly within 30 days, but the reductions and functions were acceptable. Seven patients had complications of frozen shoulder and recovered in 6 months. The average UCLA shoulder score was (32.0 +/- 4.7), and 87 patients got an excellent result, 20 good and 6 fair.

CONCLUSIONThis minimally invasive treatment has advantages such as little trauma and low cost, which is worthy of clinical applications.

Acromioclavicular Joint ; diagnostic imaging ; injuries ; physiopathology ; surgery ; Adult ; Clavicle ; diagnostic imaging ; injuries ; physiopathology ; surgery ; Female ; Fractures, Bone ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Joint Dislocations ; diagnostic imaging ; physiopathology ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult