Post-traumatic osteolysis of the distal extremity of the clavicle]

Post-traumatic osteolysis of the acromial extremity of the clavicle is a rare condition, usually occurring sometime after an injury to the shoulder. Three cases of PTOAC and one case of athlete's osteolysis are reported. The semiology is summed up, as well as the differential diagnoses and the associated forms. This is a benign disease, which should be suggested by the clinical findings and diagnosed on the radiographs, which demonstrate early signs of osteolysis. The treatment is mainly based on immobilization.     

Does osteolysis of the distal clavicle occur following spinal cord injury?

 Objective. To determine whether there is an association between spinal cord injury and ”atraumatic” osteolysis of the distal clavicle. Patients and design. Seventy-seven consecutive spinal cord injury patients without upper extremity injuries were studied. Of these, 39 each had a pair of chest radiographs – one at admission and one at least 1 month later – which included both acromioclavicular joints. Each radiograph was evaluated by two independent musculoskeletal radiologists, who were masked as to which radiograph was the baseline. Results. Ten of 76 acromioclavicular joints demonstrated osteolysis of the distal clavicle: three bilateral, three left side only, and one right side only. There was one case in which the admission radiograph was read as osteolysis but reverted to normal at 35 months follow-up. Conclusion. There is an apparent association between spinal cord injury and osteolysis of the distal clavicle.     

Stress-induced osteolysis of the clavicle

Osteolysis in the distal clavicle--manifested radiographically by erosions, resorption of the subchondral cortical bone, and an increased space between the acromion and clavicle--may occur in patients who experience repeated stress or microtrauma to the shoulder. This entity has a radiographic appearance similar to posttraumatic osteolysis of the clavicle. One patient with painful shoulders and typical osteolytic changes of the clavicles on radiographs is described, with three other cases reported.     

Stress-induced osteolysis of distal clavicle: imaging patterns and treatment using CT-guided injection

Osteolysis of distal clavicle (ODC) may occur in patients who experience repeated stress or microtrauma to the shoulder. This entity has clinical and radiological findings similar to post-traumatic ODC. We describe a case of successful treatment of stress-induced ODC with CT-guided injection of corticosteroid and anesthetic drug into the acromioclavicular joint. Received: 26 November 1999/Revised: 12 May 2000/Accepted: 15 May 2000     

Post-traumatic and stress-induced osteolysis of the distal clavicle: MR imaging findings in 17 patients

OBJECTIVE: To describe the MR imaging findings in patients with osteolysis of the distal clavicle and to compare the MR imaging appearance of clavicular osteolysis following acute injury with that related to chronic stress. DESIGN AND PATIENTS: MR imaging examinations were reviewed in 17 patients (14 men, 3 women; ages 16-55 years) with the diagnosis of post-traumatic or stress-induced osteolysis of the clavicle. A history of a single direct injury was present in seven patients and a history of weight-lifting, participation in sports, or repetitive microtrauma was present in 10 patients. RESULTS: MR imaging showed edema in the distal clavicle in 17 patients and, of these, eight also had edema in the acromion. The edema was most evident in STIR and fat-suppressed T2-weighted pulse sequences. Other findings about the acromioclavicular (AC) joint were prominence of the joint capsule in 14, joint fluid in eight, cortical irregularity in 12, and bone fragmentation in six patients. No differences in the MR imaging features of post-traumatic and stress-induced osteolysis of the distal clavicle were observed. CONCLUSION: Post-traumatic and stress-induced osteolysis of the distal clavicle have similar appearances on MR imaging, the most common and conspicuous MR imaging feature being increased T2 signal intensity in the distal clavicle.     

MR observations of postraumatic osteolysis of the distal clavicle after traumatic separation of the acromioclavicular joint

PURPOSE: The purpose of this work was to characterize the MR features of post-traumatic osteolysis of the distal clavicle in patients who have sustained a previous separation of the ipsilateral acromioclavicular (AC) joint. METHOD: We studied eight male patients (mean age 25 years) with intractable pain in the AC joint after sustaining a traumatic joint separation. With use of the Rockwood classification, the separations were classified as Type 1 in one patient, Type 2 in two patients, and Type 3 in five patients. The MR studies were evaluated for periarticular soft tissue swelling, cortical irregularity defined as thinning or absence of portions of the cortex in the acromial and clavicular articular surfaces, hypertrophic osseous changes, periostitis, bone marrow edema, periarticular cyst-like changes, and joint space widening exceeding 6 mm. Radiographs were evaluated independently of the MR studies. Osteolysis of the distal clavicle was confirmed pathologically in seven patients and with surgery in one patient. RESULTS: The incidence of osteolysis in patients who have had a previous AC joint separation was estimated to be approximately 6%. Observations on MRI included soft tissue swelling, bone marrow edema in the distal clavicle, and cortical irregularity associated with periarticular cyst-like erosions in eight patients, joint space widening in six patients, clavicular periostitis in three patients, and marrow edema in the cromion in five patients. Only one patient had osteophyte formation. Radiographic observations of periarticular soft tissue swelling, osteopenia of the distal clavicle, articular erosions, and joint space widening allowed diagnosis in only four patients prospectively. CONCLUSION: The MR features of posttraumatic osteolysis are characteristic of this process. We advocate the use of MRI in patients with chronic AC joint pain who have had a prior AC joint dislocation, particularly if follow-up radiographs are nonspecific, equivocal, or do not indicate the presence of secondary osteoarthritis.     

Post-traumatic osteolysis of the clavicle: MR features

We present the magnetic resonance findings in a pathologically proven case of post-traumatic osteolysis of the distal clavicle. High signal intensity tissue centered on the acromioclavicular joint was seen on T2-weighted images, consistent with synovial proliferation.     

Arthroscopic distal clavicle resection

The acromioclavicular joint is a potential source of pain in the shoulder. There are a variety of disorders that can affect this joint, including distal clavicle osteolysis, posttraumatic arthritis, osteoarthritis, and rheumatoid arthritis. Nonoperative treatment for this condition with nonsteroidal medication and activity modification can alleviate the pain. When conservative treatment is exhausted, surgical resection of the distal clavicle is often necessary. Arthroscopic resection of the distal clavicle preserves the acromioclavicular ligaments to prevent postoperative distal clavicle instability. The procedure is performed in either the beach chair or lateral position and requires the use of a shaver, electrocautery, and a burr for soft tissue and debridement and bone resection.     

Open distal clavicle resection

Since 1941, resection of the distal clavicle has been a proven treatment for symptomatic acromioclavicular (AC) joint pathology. Although arthroscopic techniques have been well developed, open distal clavicle resection remains the gold standard and in certain patients is the preferred technique for removal of the distal clavicle. A thorough understanding of the historical presentation, physical examination, and radiographic and MRI findings, as well as an appreciation for possible concomitant pathology, is necessary to properly select patients who will benefit from distal clavicle resection. Open distal clavicle resection may be performed expeditiously and at low cost through a cosmetically acceptable small saber-type incision, often in less time than it takes to set up arthroscopic equipment. Results of open distal clavicle resection demonstrate excellent symptomatic relief with low morbidity in properly selected patients. Attention to detail and knowledge of the anatomy of the AC joint is necessary to assure adequate but not excessive bone removal (usually 1 cm), and meticulous preservation of the superior capsule and deltotrapezial fascia allows for an anatomic closure of these stabilizing structures.     

Osteolysis of the distal clavicle in the overhead athlete

Atraumatic osteolysis of the distal clavicle (AODC) is a painful stress overload syndrome of the distal clavicle. Early AODC research basically concentrated on primary weight-lifters (PWL). A review of the literature shows that this condition has been infrequently described in throwing athletes who were adjunct weight-lifters (AWL). Adjunct weight-lifters train with heavy resistance in addition to their sport-specific conditioning program. It appears that the throwing athlete who lifts weight as adjunct training is susceptible to AODC. Although throwing athletes have been included in previous research studies, there has been no specific review of the relationship between AODC and the throwing athlete. The purpose of this article is to investigate whether there are significant differences between the presentation, diagnosis, and treatment of AODC in the throwing athlete who is an AWL and the PWL. It is our belief that there is a cumulative affect, when combining throwing sports with weight-training, that leads to an earlier age of presentation of AODC in adjunct weight-lifters. We have found the diagnostic results, treatment options, and treatment outcomes to be identical for AWLs and PWLs with AODC. Therefore, we recommend all throwing athletes with a history of weight training and shoulder pain be evaluated for AODC, even when presenting as a teenager.     

Evaluation and treatment of distal clavicle fractures

Of all clavicle fractures, those involving the lateral aspect are the most controversial. These fractures, adjacent to the strong coracoclavicular ligaments, often create an imbalance of stability and motion between the proximal and distal fragment. There are many surgical options, but the complication rates of these procedures can be high. Although nonsurgical management results in relatively high nonunion rates, the subjective and functional outcome is usually quite good. The evaluation and controversies involving management of distal clavicle fractures are reviewed in this article.     

Operative techniques for displaced distal clavicle fractures

Displaced distal clavicle fractures remain a treatment dilemma. Nonunion rates as high as 30% have been reported (Anderson K: in Miller MD (ed): Clinics in Sports Medicine. Philadelphia, PA, Saunders, 2003, pp 319–326). In a high-demand, young, active patient surgical treatment has been recommended to provide the most predictable result. When surgery is deemed appropriate, multiple techniques have been utilized. This paper reviews several accepted techniques and introduces a surgical technique utilizing a very strong nonabsorbable suture to permit repair. The author has utilized this technique in a small series of patients where there has been significant comminution or poor bone quality precluding metal fixation.     

三种不同内固定方式治疗锁骨远端骨折的疗效比较

目的比较三种内固定方式治疗锁骨远端的临床疗效,以期指导临床合理选择和应用。方法回顾性分析2011年1月—2013年5月东营市人民医院采用锁骨远端解剖型钢板内固定(A组)、锁骨钩钢板内固定(B组)和双钢板垂直内固定(C组)三种方法治疗63例锁骨远端粉碎性骨折患者,其中A组18例,CraigⅡ类Ⅱ型15例,Ⅱ类V型3例;B组24例,CraigⅡ类Ⅱ型20例,Ⅱ类V型4例;C组21例,CraigⅡ类Ⅱ型18例,Ⅱ类V型3例。采用Constant-Murley评分系统评价肩关节功能,并对三组患者的骨折愈合时间、术后并发症发生情况等进行对比分析。结果 63例患者术后获13~19个月(平均17.2个月)随访。三组患者肩关节Constant-Murley评分优良率分别为94.4%、75.0%、90.5%,A组、C组明显优于B组,差异均有统计学意义(P0.001)。B组术后并发症发生率为16.7%,明显高于A组(0)和C组(4.8%),差异有统计学意义(P0.05)。结论三种内固定技术治疗锁骨远端骨折均可获得较好的临床效果,锁骨远端解剖型钢板及双钢板垂直内固定术后肩关节疼痛及肩关节活动受限发生率更低。     

Arthroscopic debridement of theacromioclavicular joint and distal clavicle resection

Painful disorders of the acromioclavicular joint that have not responded to extensive nonoperative management are well treated by arthroscopic resection of the distal clavicle. When the acromioclavicular and coracoclavicular ligaments are intact and the joint is stable, excellent pain relief and function may be achieved, and bone removal is comparable with that obtained with open techniques. When acromioclavicular disease is isolated, a direct (superior) approach to the acromioclavicular joint is preferred. When a sub-acromial procedure (usually acromioplasty) is also planned, a bursal approach is used.     

Stabilization of the clavicle after distal resection: a biomechanical study

BACKGROUND: The potential destabilizing effect of distal clavicle resection has received limited attention. HYPOTHESIS: Suturing the coracoacromial ligament to the undersurface of the distal clavicle after resection could counter clavicle instability. STUDY DESIGN: Controlled laboratory study. METHODS: The effect of ligament augmentation on posterior translation of the clavicle after resection was evaluated using 12 fresh-frozen cadaveric shoulders. Posterior clavicular displacement was measured after the application of a 70-N load under 4 different conditions: (1) the intact joint, (2) after distal clavicle resection, (3) clavicle resection plus acromioclavicular capsular ligament repair, and (4) clavicle resection plus acromioclavicular capsular ligament repair plus coracoacromial ligament augmentation. RESULTS: Mean displacements for each of the test conditions were as follows: (1) 5.60 mm, (2) 7.38 mm, (3) 7.54 mm, and (4) 6.34 mm. A 32% increase in posterior translation was measured after resection compared to the intact specimen. No reduction in posterior displacement was noted after capsular repair; however, displacement decreased significantly when capsular repair was coupled with ligament augmentation. CONCLUSIONS: Results suggest that the destabilizing effect of clavicle resection can be partially countered by the proposed ligament augmentation. CLINICAL RELEVANCE: That the destabilizing effect of clavicle resection can be partially countered by the proposed ligament augmentation may be particularly relevant in cases of resection for posttraumatic arthritis after acromioclavicular separation in which some degree of preexisting acromioclavicular capsular attenuation and consequently acromioclavicular joint laxity may be presumed.     

Arthroscopic treatment of distal clavicle fractures: a technical note

This article describes a new technique for the arthroscopic treatment of distal clavicle fractures. This technique requires the use of posterior and anterior standard arthroscopic portals. The base of the coracoid process is exposed through the rotator interval. The ancillary system drill guide is placed at the undersurface of the coracoid process. A small incision is performed above the clavicular body and the corresponding part of the guide is pushed down to the clavicle. A 4-mm hole is drilled through the clavicle and the coracoid process. A double button device is pushed through both the holes. The first button is pushed below the coracoid. The device is tightened and the second button is fixed on top of the clavicular cortical bone, allowing reduction and fixation of the fracture. Four patients treated with this technique were evaluated at 6 months postoperatively. All patients showed bony union and a full recovery of the shoulder function. The technique provides firm fixation of fractures of the distal clavicle.