Retrospective review of outcome post open reduction and K-wire fixation for grade III acromioclavicular joint subluxations

There is controversy about the therapy for grade III acromioclavicular dislocation according to Tossy and Rockwood’s classification. We identified 25 patients who underwent acromioclavicular joint wiring for grade III subluxations under the care of a single consultant in the last 5-year period. All patients were asked to fill in a DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire to assess outcome following acromioclavicular joint repair, and their clinical notes were reviewed. Our results show that open reduction and Kirschner- (K) wire fixation of grade III AC joint disruptions results in good strength and range of motion of the affected shoulder. It is associated with DASH scores, which are comparable to those of the general population for the same age, indicating little residual disability. All patients returned to their pre-injury occupation, and all but one returned to previous sporting activities. Complications occurred in four patients, but only one required K-wire repositioning.     

带线铆钉治疗TossyⅡ、Ⅲ型肩锁关节脱位

 目的 探讨带线铆钉治疗TossyⅡ、Ⅲ型肩锁关节脱位的疗效。
方法 2008年1月至2009年2月,治疗TossyⅡ、Ⅲ型肩锁关节脱位患者31例,男19例,女12例;年龄33～49,平均41岁;TossyⅡ型9例,Ⅲ型22例。其中新鲜肩锁关节脱位19例,陈旧性肩锁关节脱位9例,锁骨钩接骨板固定失败3例;患者均不合并骨折。手术均采用Mitek 3.0mm带线铆钉植入喙突,以不可吸收尾线穿过锁骨固定脱位,同时修复喙锁韧带或转移喙肩韧带;其中12例采用克氏针辅助固定。采用日本骨科协会（Japanese Orthopaedic Association,JOA）肩关节疾患治疗判定标准和肩锁关节脱位评分系统对术后疗效进行评价。
结果 31例患者均获得随访,随访时间11～23个月,平均17个月。单纯铆钉固定组术后JOA肩关节疾患评分为65~95分,其中优8例、良9例、可1例、差1例,优良率为89.47%（17/19）;铆钉结合克氏针固定组术后JOA肩关节疾患评分为74~97分,其中优5例、良4例、可3例,优良率为75.00%（9/12）。两组肩锁关节脱位评价系统的优良率分别为94.74%（18/19）和91.67%（11/12）。5例患者在拔除克氏针1~ 3个月后出现肩锁关节复位部分丢失,但肩关节活动范围较术后无明显变化,未进一步治疗。
结论 带线铆钉治疗T ossyⅡ、Ⅲ型肩锁关节脱位,具有手术创伤小,并发症少,避免二次手术的特点,术后疗效肯定。     

带线铆钉治疗Tossy Ⅰ、Ⅲ型肩锁关节脱位

目的 探讨带线铆钉治疗TossyⅡ、Ⅲ型肩锁关节脱位的疗效.方法 2008年1月至2009年2月,治疗TossyⅡ、Ⅲ型肩锁关节脱位患者31例,男19例,女12例;年龄33～49,平均41岁;TossyⅡ型9例,Ⅲ型22例.其中新鲜肩锁关节脱位19例,陈旧性肩锁关节脱位9例,锁骨钩接骨板固定失败3例;患者均不合并骨折.手术均采用Mitek 3.0 mm带线铆钉植入喙突,以不可吸收尾线穿过锁骨固定脱位,同时修复喙锁韧带或转移喙肩韧带;其中12例采用克氏针辅助固定.采用日本骨科协会(Japanese Orthopaedlic Association,JOA)肩关节疾患治疗判定标准和肩锁关节脱位评分系统对术后疗效进行评价.结果 31例患者均获得随访,随访时间11～23个月,平均17个月.单纯铆钉固定组术后JOA肩关节疾患评分为65～95分,其中优8例、良9例、可1例、差1例,优良率为89.47%(17/19);铆钉结合克氏针固定组术后JOA肩关节疾患评分为74～97分,其中优5例、良4例、可3例,优良率为75.00%(9/12).两组肩锁关节脱位评价系统的优良率分别为94.74%(18/19)和91.67%(11/12).5例患者在拔除克氏针1～3个月后出现肩锁关节复位部分丢失,但肩关节活动范围较术后无明显变化,未进一步治疗.结论 带线铆钉治疗TossyⅡ、Ⅲ型肩锁关节脱位,具有手术创伤小,并发症少,避免二次手术的特点,术后疗效肯定.

Abstract：

Objective To study the treatment effect of rivet with thread,instead of clavicular hook plate,for Tossy Ⅱ & Ⅲ dislocation of acromioclavicular joint.Methods From January 2008 to February 2009,totally 31 patients with Tossy Ⅱ or Ⅲ dislocation of acromioclavicular joint were treated using rivets with thread,including 19 males and 12 females at the age of 33-49 years(mean,41 years).Among these patients,19 suffered fresh acromioclavicular joint dislocation,9 suffered old acromioclavicular joint dislocation,and 3 did a failed fixation by clavicular hook plate.None of them was combined fracture.Mitek 3.0 mm rivet with thread was embedded to coracoid,with nonabsorbable thread connected with the rivet passing through the clavicle for fixation,and meanwhile ligament coracoclaviculare was restored or acromiocoracoid ligament displaced.Among them,12 patients assisted Kieschner wire fixation.The treatment effect was evaluated using Japanese Orthopaedic Association(JOA)scoring system and acromioclavicular joint dislocation scoring system.Results All patients were followed up 11-23 months(mean,17 months).In the patients without Kieschner wire fixation,JOA shoulder score was 65-95,excellent for 8 cases,good for 9,fine for 1,poor for 1,excellent and good rate was 89.47%(17/19);In the patients with Kieschner wire assisted fixation,JOA shoulder score was 74-97,excellent for 5,good for 4,fine for 3; the excellent and good rate was 75.00%(9/12).With acromioclavicular joint dislocation scoring system,the overall excellent and good rate was 94.74%(18/19),and 91.67%(11/12)respectively.No complication that affected joint function was found.Conclusion Rivets with thread can be used for treating Tossy Ⅱ & Ⅲ dislocation of acromioclavicular joint.This surgical technique is characterized by small operation wound,fewer complications,no secondary operation,and satisfactory treatment effect.     

锁骨钩钢板治疗TossyⅢ型肩锁关节脱位的临床研究

目的比较研究锁骨钩钢板、克氏针张力带及加压螺钉治疗TossyⅢ型肩锁关节脱位的疗效。方法54例TossyⅢ型肩锁关节脱位患者,18例采用锁骨钩钢板、19例采用克氏针张力带、17例采取加压螺钉内固定。依据Kadsson标准回顾性分析比较治疗效果差异。结果术后平均随访12～18个月,锁骨钩钢板组肩关节功能评定优良率为94．44％,优于克氏针张力带组的47．37％及加压螺钉组的58．82％（P〈0．05）。结论锁骨钩钢板在治疗TossyⅢ型肩锁关节脱位上优于克氏针张力带及加压螺钉内固定。     

Stand der Therapie der Schultereckgelenkverletzung Ergebnisse einer Umfrage an Unfallchirurgischen Kliniken in Deutschland

The therapy of acromioclavicular dislocations remains controversial. In particular, for injuries classified as Rockwood/Tossy Type III good results have been reported with different operative techniques as well as with conservative treatment. The objective of this study was to obtain data about the current treatment for Rockwood/Tossy III injuries in German trauma departments. In a countrywide anonymous survey 210 German trauma departments were asked about their diagnostic procedures and their treatment strategies for acromioclavicular injuries. 104 questionaires (49%) were returned and evaluated. In Rockwood/Tossy I/II injuries most clinics recommend conservative treatment (Rockwood/Tossy I/II: 99% / 87%). On the other hand, 84% of the clinics would operate on Type III acromioclavicular injuries – especially in athletes or overhead workers. Although 38 percent of the clinics believe that conservative treatment is equal or better than operative treatment, only 13 percent manage Type III injuries conservatively. For more severe acromioclavicular injuries (Rockwood IV to VI) all clinics recommend an operative treatment. The operative techniques of choice for acromioclavicular injuries are K-wire fixation (37%) or a coraco-clavicular cerclage (32%). Of the latter, 73% use a resorbable material, while the remainder use wires.     

新鲜Tossy Ⅲ型肩锁关节脱位内固定术中喙锁及肩锁韧带处理的病例对照研究

目的：探讨新鲜Tossy Ⅲ型肩锁关节脱位内固定术中喙锁、肩锁韧带的处理方法、并发症和疗效。方法：自2003年7月至2012年5月,对127例新鲜Tossy Ⅲ型肩锁关节脱位患者,采用锁骨与喙突间钢丝固定或锁骨钩状钢板固定术,根据术中是否修复喙锁、肩锁韧带分组。锁骨与喙突间钢丝固定组（A组）63例,修复喙锁、肩锁韧带,男39例,女24例;平均年龄（33.25±8.46）岁（17～59岁）.锁骨钩状钢板固定组（B组）64例,不修复喙锁、肩锁韧带,男41例,女23例;平均年龄（34.10±7.19）岁（19～57岁）.分别从手术时间、术中出血量、术后并发症发生率及疗效方面比较两组治疗效果。结果：根据Karlsson标准,A组63例,优54例,良9例,差0例;手术时间平均（55.90±26.56） min;术中平均出血量（99.80±50.30） ml;1例术后第16周发现钢丝断裂但无肩锁关节再脱位,3例出现切口脂肪液化,1例出现肩关节活动后疼痛,取出内置物后疼痛消失。B组64例,优52例,良12例,差0例;手术时间平均（49.50±23.14） min;术中平均出血量（87.30±46.41） ml;2例出现切口脂肪液化,2例出现肩关节活动后疼痛。全部患者4～9个月后取出内置钢丝或者锁骨钩状钢板,随访9～16个月,无肩锁关节再脱位。两组方法在平均手术时间、术中平均出血量和伤口脂肪液化、感染、肩部疼痛、内固定失效、肩锁关节再脱位等并发症发生率及疗效方面差异均无统计学意义。结论：新鲜TossyⅢ型肩锁关节脱位内固定术中采用锁骨与喙突间钢丝固定或锁骨钩状钢板固定是一种操作简单、创伤小、出血少、疗效确切的方法。术中不修复喙锁、肩锁韧带,不增加手术并发症发生率。     

The operative treatment of fresh ruptures of the acromioclavicular joint (Tossy III)

We give a preliminary report of ten patients with fresh dislocations of the acromioclavicular joint (Tossy III). All ten were operated with suture of the torn ligaments and indirect fixation of the acromioclavicular joint with a monocerclage wire passed around the coracoid process and the clavicle. Removal of metal was done 8 weeks later. None of the wires broke, and there were no problems with wound healing. Control X-rays under stress revealed stable acromioclavicular joints in all cases.     

The operative treatment of fresh ruptures of the acromioclavicular joint (Tossy III)

Summary We give a preliminary report of ten patients with fresh dislocations of the acromioclavicular joint (Tossy III). All ten were operated with suture of the torn ligaments and indirect fixation of the acromioclavicular joint with a monocerclage wire passed around the coracoid process and the clavicle. Removal of metal was done 8 weeks later. None of the wires broke, and there were no problems with wound healing. Control X-rays under stress revealed stable acromioclavicular joints in all cases.     

Die Verletzungen des Akromioklavikulargelenkes

This paper deals with the biomechanics and the injuries of the acromioclavicular joint, which are graded I – III according to Tossy. Incomplete dislocations of the acromioclavicular joint are treated conservatively by immobilisation of the shoulder with Gilchrist’s or Desault’s bandage. Complete dislocations of the acromioclavicular joint should be treated operatively with ligament suture or plasty and temporary fixation of acromioclavicular joint by two drill wires combined with tension band. In postoperative treatment the shoulder should be immobilised for two weeks by Gilchrist’s or Desault’s bandage. After these two weeks all movements should be allowed to 90°. The internal fixation material should be removed six weeks after the first operation. We report the results of 19 complete dislocations of the acromioclavicular joint, treated operatively from 1975 – 1979. 13 patients could be seen in the follow-up examination. In 10 cases the functional result was good, two patients had little restriction of movement. In one case, where the fixation material had been removed only eight weeks ago, the movements of the shoulder were markedly restricted.     

可折断螺钉治疗肩锁关节脱位

目的探讨可折断螺钉治疗肩锁关节脱位（TossyIII型）的疗效。方法1997年7月～2010年7月使用可折断螺钉采用肩关节外侧切口行肩锁关节间内固定治疗25例肩锁关节脱位（Tossy111型）。结果手术时间45～90min,平均70min。术中出血量30～50ml,平均45ml。未发生重要解剖结构的损伤。术后住院7～12d,平均9d。术后6个月关节功能按照Lazzcano标准优25例。25例随访6～23个月,平均11个月,无内固定松动或断裂,可折断螺钉取出后肩锁关节无再次脱位。结论可折断螺钉是治疗肩锁关节脱位（TossyIII型）的一种较好的手术方法。     

Tossy Ⅲ度肩锁关节脱位术后常见并发症

目的：回顾性分析TossyⅢ度肩锁关节脱位术后常见并发症及其防治措施。方法：48例TossyⅢ度肩锁关节脱位患者分别以克氏针张力带内固定（A组）14例、拉力螺钉或钢丝内固定（B组）11例、锁骨钧钢板内固定（C组）23例,分析3类术后发生的并发症,总结产生原因及防治措施。结果：48例患者均获随访,随访时间2个月～3年,平均18个月。A组优8例,良4例,差2例;B组优7例,良3例,差1例;C组优21例,良1例,差1例。术后优秀率A、C组间差异有显著性意义,P〈0．05;A组术后疼痛4例,肩周炎3例,肩锁关节炎3例,内固定失效4例,再次脱位2例;B组术后疼痛3例,肩用炎2例,肩锁关节炎1例,内固定失效3例,再次脱位1例;C组术后疼痛2例,肩周炎2例,肩锁关节炎1例,内固定失效2例,再次脱位l例。术后并发症组间差异无统计学意义（P〉0．05）。结论：选择合适的内固定方式和合理重建喙锁、喙肩韧带是治疗肩锁关节脱位的基本要求。术中对肩锁关节间隙的彻底清理,韧带的确切重建．以及术中切实可靠的坚强固定才是减少并发症的有效手段。     

锁骨钩钢板与克氏针张力带治疗肩锁关节脱位和锁骨远端骨折疗效比较

[目的]比较研究锁骨钩钢板与克氏针张力带治疗肩锁关节脱位和锁骨远端骨折的疗效。[方法]52例肩锁关节脱位或锁骨远端骨折患者，34例采用锁骨钩钢板、18例采用克氏针张力带内固定。回顾性分析比较其手术难易程度、治疗效果及并发症。[结果]术中两组手术难易程度无明显差异，P〉0．05；术后平均随访15个月，锁骨钩钢板组手术并发症发生率为0．0％，肩关节功能评定优良率为97．1％，优于克氏针张力带组的38．9％、72．2％，P〈0．05。[结论]锁骨钩钢板是一种在治疗肩锁关节脱位和锁骨远端骨折上优于克氏针张力带的新方法，值得推广。     

Stabilization of the Dislocated Acromioclavicular Joint with Ligament Suture and Balser Hook Plate

Objective Reduction of dislocation and reconstruction of acromioclavicular joint by suturing the torn capsuloligamentous structures, temporary fixation with a Balser plate. Goal: restitution of form and function of shoulder girdle. Indications Primary acromioclavicular dislocation of Tossy type III or Rockwood type III in physically active patients. Acromioclavicular dislocations with additional muscle injuries of Rockwood type IV-VI. Remote painful dislocations without osteoarthritis. Here, consider patient's physical and occupational requirements. Lateral clavicle fractures with damage to clavicular ligaments. Contraindications Poor local skin condition or wounds. Symptomatic, moderate or severe osteoarthritis of acromioclavicular joint. Elevated surgical risk, poor health. Patient not agreeing to surgery. Cosmetic objections. Surgical Technique Anterior saber cut incision medial to acromioclavicular joint. Notching of insertion of deltoid muscle to expose the acromioclavicular ligaments. Placement of U-sutures in these ligaments. Refixation of intraarticular disk to clavicle with sutures. Selection of plate and subacromial insertion of its hook in close bony contact posterior to acromioclavicular joint. Radiographic control of hook and plate and of acromioclavicular joint. Plate fixation with cortex screws. Tying of the ligament sutures already in situ. Suture of joint capsule and of concomitant soft tissue disruptions. Drain. Wound closure. Results In a prospective study, 57/68 patients (62 men, six women, average age 40.3 [19-84] years) operated between 9/94 and 12/97 could be followed up clinically and sonographically after an average of 24.6 (12-49) months. Implant removal after 12 weeks. A full, painless shoulder mobility was seen in 50 patients. Sonography comparing both shoulders showed an average cranial clavicular subluxation of 0.3 mm and under a 10-kg load of 0.6 mm. Limitation of sports was reported seven times. A good to excellent result was obtained in 50 patients.     

Surgical management of acromioclavicular joint separation with transcutaneous Kirschner wire fixation. Results of follow-up in 45 patients

45 patients were followed up who had undergone surgery because of acromioclavicular separation of the types TOSSY II and TOSSY III during 1983 to 1985. In 44 cases a fresh acromioclavicular separation had been treated via transcutaneous Kirschner wire fixation and in one case a chronic acromioclavicular separation had been treated according to the technique described by Bunnell. the anatomy of the acromioclavicular joint, the pattern of injury as well as the method of surgery with subsequent aftercare measures are described. The good functional final results make transcutaneous Kirschner wire fixation the method of choice as a brief and low-stress procedure, as far as our clinic is concerned.     

Standardisierte sonographische Untersuchung zur Klassifizierung der Instabilität des Schultereckgelenkes

Anteroposterior X-ray views of both acromio-clavicular (AC-) joints with 10 kg weights in each hand are generally accepted for the diagnosis of Tossy I to III AC-joint separations. An analogue diagnosis can be made by standardized ultrasound examination. Ten individuals without AC-instability (Tossy I), eleven with Tossy II- and eight with Tossy III-instability were examined both radiographically and by B-mode ultrasound. AC-joint width was uniformly calculated by using an index (AC-index=AC-joint width of uninjured side/AC-joint width of injured side). The sonographically measured mean AC-index for Tossy I-instability was 1.0; sonographically 0.49 and radiographically measured 0.5 for Tossy II-injury; and sonographically 0.21 and radiographically measured 0.2 for Tossy III-instability. Statistical analysis resulted in significant differences for all mean AC-indices of the three groups (p<0.0001). We conclude that ultrasound examination of AC-joint instability is as reliable as radiographic measurement. Standard X-rays of the shoulder remain mandatory to exclude fractures only. The dicision for operative stabilisation of the AC-joint can be based on the side-effect free and cost-effective ultrasound examination of the grade of AC-joint instability (AC-index<0.3 equivalent Tossy III).     

Central K-wire and PDS-Cord for Acromioclavicular separations – a successful treatment?

Beside the basic question wether a separation of the acromioclavicular joint should be treated operatively or not, the method of operation is discussed in particular. For that reason we investigated our own method of a temporary transfixation of the joint by a centrally drilled K-wire combined with a PDS-augmentation of the coracoclavicular and a suture of the acromioclavicular ligament. Follow up examinations were possible in 57 out of 82 patients which were operated during 5 years. Patients subjective rating and objective follow up and sonographically evaluated joint conditions were scored together. Looking for the range of motion of the shoulder only 5.5% of the patients had a reduction of more than 20 degrees. Out of 12 complications in particular three infections only resulted satisfying by influencing the subjective rating negatively. In 28.1% of patients no durable anatomic reconstruction of the joint was achieved. Score achieved by these patients was significantly lower compared to those with a lasting anatomic reconstruction of the acromioclavicular joint. In conclusion the results confirm our operative regime for separations of the acromioclavicular joint. In literature survey the here described method of operation belongs to the better ones without showing a clear advantage. Nevertheless the method should be modified to decrease the rate of subluxations.     

Biomechanics and comparison of two operative methods of treatment of complete acromioclavicular separation

Sixty-three complete acromioclavicular separations were treated by 2 operative methods. Acromioclavicular wiring gave 73% acceptable results while wire or Dacron coracoclavicular loop gave 94% acceptable results. Complications, especially broken, bent, or backed-out wires were common with acromioclavicular wiring. Of 44 patients treated by acromioclavicular wiring, 5 required late distal clavicle resection and 4 of these had retained menisci. Loop fixation is mechanically superior since the loop is in the direction of the tensile forces. In acromioclavicular wiring, however, the fixation Kirschner wires are subjected to high bending moments. Loop fixation avoids violation of the acromioclavicular joint but does not restrict rotation of the clavicle. The operation is simple to perform and postoperative immobilization is minimal. Woven Dacron may be superior to surgical wire for loop fixation in that unlike wire it does not require removal by a second operation. Woven Dacron may also stimulate coracoclavicular ligament reconstitution.     

线缆套绕喙突与锁骨固定治疗肩锁关节脱位的临床观察

目的：观察线缆套绕喙突与锁骨固定治疗新鲜单侧TossyⅢ型肩锁关节脱位的临床效果。方法回顾分析2007年12月至2016年3月于我院采用切开复位、线缆套绕喙突与锁骨固定治疗新鲜单侧TossyⅢ型肩锁关节脱位的39例病人的临床资料,通过其术后X线片评价其恢复情况,采用Karlsson疗效评价标准对患肩功能进行评定。结果本组病人随访时间为6~60个月,平均为16个月。术后肩关节外观及功能恢复满意,未见线缆断裂和松动的现象。按照Karlsson疗效评价标准对肩关节功能进行评定,其中优30例,良9例,优良率为100%。结论线缆套绕固定喙突与锁骨符合肩锁关节复位固定的生物力学要求,具有疗效好、创伤小、操作简单的优点,是治疗TossyⅢ型肩锁关节脱位的一种有效手术方法。     

锁骨钩钢板治疗锁骨远端骨折脱位的并发症分析

目的：探讨锁骨钩钢板治疗TossyⅢ型肩锁关节脱位和NeerⅡ型锁骨远端骨折术后并发症的原因及其防治方法。方法：2001年1月至2011年12月,采用锁骨钩钢板分别治疗TossyⅢ型肩锁关节脱位246例和NeerⅡ型锁骨远端骨折222例。其中男348例,女120例;年龄21～80岁,平均45．4岁;受伤至手术时间1h-15d,平均30．8h。所有患者受伤前肩关节活动正常。根据Karlsson评定标准,将肩关节功能恢复优良者归为正常组、肩关节功能差者为异常组,对两组肩关节的前屈、后伸、内收、外展和上举进行比较,总结钢板钩撞击肩峰、肩峰下骨质磨损、肩锁关节炎、锁骨应力骨折、肩锁关节向下半脱位、脱钩和断钩的情况。结果：468例均获随访,时间8-48个月,平均12．5个月。按照Karlsson评定标准,优308例,良76例,差84例。两组肩关节前屈、后伸、内收、外展和上举的差异均有统计学意义（P〈0．01）。异常组患者中,41例（8．76％）钢板钩撞击肩峰或位置不佳,12例（2．56％）肩峰下骨质磨损或肩峰下滑囊炎,10例（2．14％）肩锁关节炎和锻炼太晚引起肩痛不适,7例（1．50％）锁骨应力性骨折或钢板内侧端翘起,6例（1．28％）肩锁关节向下半脱位,5例（1．07％）脱钩,3例（0．64％）断钩。结论：锁骨钩钢板是治疗Tossym型肩锁关节脱位和NeerⅡ型锁骨远端骨折的较好方法,术中正确放置钢板钩的位置、适当将钢板钩预弯、修复肩锁关节周围纤维结构以及合理功能锻炼有助于减少并发症的发生。     

Die Stabilisierung des luxierten Schultereckgelenks mit Bandnaht und Balser-Platte

Objective Reduction of dislocation and reconstruction of acromioclavicular joint by suturing the torn capsuloligamentous structures, temporary fixation with a Balser plate. Goal: restitution of form and function of shoulder girdle. Indications Primary acromioclavicular dislocation of Tossy type III or Rockwood type III in physically active patients. Acromioclavicular dislocations with additional muscle injuries of Rockwood type IV–VI. Remote painful dislocations without osteoarthritis. Here, consider patient's physical and occupational requirements. Lateral clavicle fractures with damage to clavicular ligaments. Contraindications Poor local skin condition or wounds. Symptomatic, moderate or severe osteoarthritis of acromioclavicular joint. Elevated surgical risk, poor health. Patient not agreeing to surgery. Cosmetic objections. Sugical Technique Anterior saber cut incision medial to acromioclavicular joint. Notching of insertion of deltoid muscle to expose the acromioclavicular ligaments. Placements of U-sutures in these ligaments. Refixation of intraarticular disk to clavicle with sutures. Selection of plate and subacromial insertion of its hook in close bony contact posterior to acromioclavicular joint. Radiographic control of hook and plate and of acromioclavicular joint. Plate fixation with cortex screws. Tying of the ligament sutures already in situ. Suture of joint capsule and of concomitant soft tissue disruptions. Drain. Wound closure. Results In a prospective study, 57/68 patients (62 men, six women, average age 40.3 [19–84] years) operated between 9/94 and 12/97 could be followed up clinically and sonographically after an average of 24.6 (12–49) months. Implant removal after 12 weeks. A full, painless shoulder mobility was seen in 50 patients. Sonography comparing both shoulders showed an average cranial clavicular subluxation of 0.3 mm and under a 10-kg load of 0.6 mm. Limitation of sports was reported seven times. A good to excellent result was obtained in 50 patients.