A Reproducible Technique for Arthroscopic Acromioclavicular Joint Excision

Arthroscopic acromioclavicular joint excision is a commonly performed but technically demanding procedure. Incomplete excision can leave residual symptoms. We present a simple, reproducible technique ensuring satisfactory excision of the joint.     

肩锁钩钢板内固定治疗RockwoodⅢ～V型肩锁关节脱位

目的总结肩锁钩钢板内固定治疗RockwoodⅢ～Ⅴ型肩锁关节脱位的疗效。方法2001年3月-2003年12月,对12例肩锁关节脱位患者采用切开复位肩锁钩钢板内固定治疗,其中RockwoodⅢ型8例,Ⅳ型2例,Ⅴ型2例；脱位距就诊时间为2 h～5 d,平均2．5 d。结果术后10例获得3个月～2年随访,2例失访。术后肩锁关节位置恢复,肩关节外展上举活动范围达160°～170°,2例在举重物时肩锁关节有轻度的疼痛,1例肩关节外展80°时肩锁关节开始疼痛,患侧上肢肌力较健侧稍减弱。肩关节功能按Constant标准评定为86～96分,平均92分。结论肩锁钩钢板内固定可恢复肩锁关节的解剖位置和微动特性,是治疗重度肩锁关节脱位的良好术式。     

Ipsilateral mid-third clavicle fracture with grade V acromioclavicular joint dislocation

We report the case of a 20-year-old man with an ipsilateral mid-third clavicle fracture with grade V acromioclavicular joint (ACJ) dislocation. The combination of these two injuries is rare. A literature search produced various treatment algorithms. In this case, the patient was successfully treated with a Bosworth screw.This work was carried out in the Department of Orthopaedics, William Harvey Hospital, Ashford, Kent, UK     

Posterior Acromioclavicular Dislocation with Clavicular Fracture and Trapezius Entrapment

AbstractBackground: Posterior acromioclavicular dislocation is rare. Dislocation associated with fracture of the clavicle and simultaneous entrapment of the lateral end of the clavicle by trapezius muscle has not been reported. Posterior dislocation occurs frequently owing to forceful move of the scapula anteriorly and superiorly or from direct force applied to the lateral end of the clavicle and this may be associated with clavicular fracture. In acute dislocations, open reduction, internal joint stabilization and soft tissues reconstruction have been recommended.Case Study: Acute posterior dislocation occurred in a 32-year-old man. The lateral end of the clavicle was displaced posteriorly and inferiorly, and firmly entrapped in trapezius muscle. The clavicular fracture was undisplaced. The coracoclavicular ligaments were stretched but intact. Open reduction was secured with two smooth Kirschner wires. The disrupted soft tissues were repaired. The clavicular fracture was not explored. Shoulder movement started at 6 weeks. Wires were removed. 10 years later he had pain-free, unrestricted shoulder movement, and the radiographs showed wellreduced, essentially normal acromioclavicular joint.Conclusion: Open reduction, internal joint stabilization and soft tissue reconstruction will result in return and long lasting unrestricted pain-free function of the shoulder.     

Arthroscopic Coracoclavicular Ligament Reconstruction Using Biologic and Suture Fixation

Presented in this report is a modified arthroscopic approach to acromioclavicular joint reconstruction via suture and allograft fixation. An arthroscopic approach is used to expose the base of the coracoid by use of electrocautery. After an open distal clavicle excision is performed, clavicular and coracoid tunnels are created under arthroscopic visualization as previously described by Wolf and Pennington. The myotendinous end of a semitendinosus allograft is sutured to a Spider plate (Kinetikos Medical, San Diego, CA). The tendinous end of the graft is prepared with a running baseball stitch. A Nitinol wire with a loop end (Arthrex, Naples, FL) is used to pass 2 free FiberTape sutures (Arthrex) and the leading sutures from the tendinous end of the graft through the clavicular and coracoid tunnels, exiting out the anterior portal. One of the FiberTape sutures is retrieved with a grasper and passed over the anterior aspect of the distal clavicle. The second FiberTape suture and the allograft are passed over the distal end of the resected clavicle. While the acromioclavicular joint is held reduced, the FiberTape sutures are tied to the plate and the allograft is tensioned medially until the plate is embedded against the superior surface of the clavicle. The tendinous end of the graft is secured to the superior surface of the clavicle with a Bio-tenodesis screw (Arthrex) medial to the clavicular tunnel.     

Minimally Invasive Coracoclavicular Ligament Augmentation With a Flip Button/Polydioxanone Repair for Treatment of Total Acromioclavicular Joint Dislocation

Treatment of complete acromioclavicular joint disruption remains controversial and ranges from rehabilitation to extensive surgical reconstruction. However, high-grade injuries (type IV, V, and VI) are typically treated surgically. Most reconstruction techniques addressing these injuries selectively focus on coracoclavicular ligament augmentation because it has been shown to be the primary stabilizer of the acromioclavicular joint. The conventional coracoclavicular polydioxanone (PDS) loop, which is widely performed, has been detected to have some pivotal disadvantages, including anterior subluxation of the clavicle, extensive preparation of the coracoid, and bony avulsion of the clavicle as a result of rotational clavicle movement. Therefore we present an augmentation technique that reduces these complications by replicating the orientation of the native coracoclavicular ligament complex and providing a minimally invasive subcoracoid and clavicular fixation of a double PDS loop by use of 2 flip buttons, typically used for extracortical anterior cruciate ligament graft fixation. The key step of the procedure includes the anatomic, secure, and stable placement of the double PDS cerclage under the coracoid base transferring a flip button through a coracoid bone tunnel. Our clinical experience shows that the presented technique is easy to perform and has a comparable invasiveness to recently presented arthroscopic techniques.     

肩锁关节脱位X线投照方法的探讨

目的：探讨肩锁关节脱位的X线投照方法。方法：对20例肩锁关节脱位患者采用肩部前后立位、应力位、部分内旋位X线投照方法。结果：20例肩锁关节脱位患者中，Ⅰ型3例，占15％；Ⅱ型7例，占35％；Ⅲ型10例，占50％。结论：肩锁关节脱位以肩部前后立位、应力位X线投照法为主，Ⅲ型患者可用内旋位投照。     

锁骨钩钢板内固定与喙锁结构重建治疗肩锁关节脱位

肩锁关节完全性脱位修复的方法众多,从2002年5月起,对锁骨钩钢板(clavicular hook plate,CHP)的应用与传统的动力性喙锁稳定结构重建的方法进行比较,评价该技术在治疗肩锁关节脱位中选择运用的价值。1资料与方法1.1一般资料本组48例。锁骨钩钢板内固定组27例:男18例,女9例;年龄20~29岁7例,30~39岁9例,40~49岁9例,50岁以上2例;交通伤14例,跌倒、坠落伤11例,击打伤2例;受伤距手术时间4d以内16例,4~7d8例,7d以上3例。喙锁结构重建术组21例:男13例,女8例;年龄20~29岁6例,30~39岁8例,40~49岁6例,50岁以上1例;交通伤10例,跌倒、坠落伤9例,击打伤…