Comparison Between Two Surgical Techniques Acromioclavicular Tension Band Wiring and Coracoclavicular Screw in Acromioclavicular Dislocations

Authors

1 Orthopedic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran

2 Orthopedic Research Center, Shahid Kamyab Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran

3 Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, IR Iran

10.5812/rijm.20336

Abstract

Background: Acromioclavicular (AC) joint dislocations are common in young, active patients and frequently treated in clinical practice. There are many surgical treatments for acro-mioclavicular joint dislocation. The goal of this study was comparing the functional and clinical post-operative results between two urgical techniques, acromioclavicular tension band wiring and coracoclavicular screw in acromioclavicular dislocations. Patients and Methods: 20 patients with Rockwood dislocation type III and more referred to Kamyab Hospital from February 2012 to November 2013. They were assessed in terms of surgical indications. The patients were divided in to two groups and the authors used tension band wiring and screw fixation procedures for each group. Coracoclavicular ligaments were repaired in both techniques. In 1, 6 and 12- month follow-up periods, we assessed clinically the acromiomclavicular stability, articular range of motion, VAST score and Oxford shoulder score with stress radiography. The results were then analyzed statistically. Results: Mean age of the patients was 34 ± 8.1 years and 80% were male. Totally, 17 patients (85%) were type 3 Rockwood and 3 patients (15%) were type 5. Full stability was obtained in all patients by comparing the stress radiography and the post-operative ones. About 50% of patients had Oxford shoulder score (OSS) 42-48. 13 patients (65%) did not complain of any pain and 25% had moderate VAST score (4-7). 17 patients (85%) had range of motion more than 150-180. Using t-Student test, no significant difference in type of Rockwood, articular stability, range of motion, OSS score and VAST SCORE was seen between the two groups (P > 0.05). Conclusions: Bosworth screw and Tension band wiring are both useful procedures in patients with ACJ dislocation, but each should be used in the selected patients with special indications. Both methods had good results during follow-up period. There was not statistically meaningful difference in the articular stability, range of motion, OSS score and VAST SCORE between the two groups (P > 0.05).

Keywords


  1. 1.Costic RS, Labriola JE, Rodosky MW, Debski RE. Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med. 2004;32(8):1929–36.

    1. Rockwood CJ, Williams G. Disorders of theacromioclavicular joint. 2 ed. Rockwood CJ MF editor. Philadelphia: WB Saunders; 1998.
    2. Beim GM. Acromioclavicular joint injuries. J Athl Train. 2000;35(3):261–7.
    3. Ceccarelli E, Bondi R, Alviti F, Garofalo R, Miulli F, Padua R. Treatment of acute grade III acromioclavicular dislocation: a lack of evidence. J Orthop Traumatol. 2008;9(2):105–8.
    4. White B, Epstein D, Sanders S, Rokito A. Acute acromioclavicular injuries in adults. Orthopedics. 2008;31(12).
    5. Bosworth BM. Complete acromioclavicular dislocation. N Engl J Med. 1949;241(6):221–5.
    6. Bannister GC, Wallace WA, Stableforth PG, Hutson MA. The management of acute acromioclavicular dislocation. A randomised prospective controlled trial. J Bone Joint Surg Br. 1989;71(5):848–50.
    7. Dlabach JA, Crockarell JR. Acute dislocations. 10 ed. Canale ST editor. Philadelphia: Mosby Co; 2003.
    8. Thakur AJ. The Elements of Fracture Fixation.New York: Churchill Livingstone Co; 1997.
    9. Galatz L, Hollis R, Williams GR. Acromioclavicular joint injuries. 7 ed. Corurt-Brawn C, Heckman JD, Bucholz. editors. Philadelphia: Lippincott Williams & Wilkins Co; 2010.
    10. Berson BL, Gilbert MS, Green S. Acromioclavicular dislocations: treatment by transfer of the conjoined tendon and distal end of the coracoid process to the clavicle. Clin Orthop Relat Res. 1978(135):157–64.
    11. Sundaram N, Patel DV, Porter DS. Stabilization of acute acromioclavicular dislocation by a modified Bosworth technique: a longterm follow-up study. Injury. 1992;23(3):189–93.
    12. Kovilazhikathu Sugathan H, Dodenhoff RM. Management of type 3 acromioclavicular joint dislocation: comparison of longterm functional results of two operative methods. ISRN Surg. 2012;2012:580504.
    13. Meier AW, Grannis WR, Tanner JB. Acromioclavicular dislocations; Sharifi SR et al. Razavi Int J Med. 2014;2(4):e20336 5 open reduction with screw fixation. Calif Med. 1957;87(4):261–2.
    14. Wei N, Jian-wen G, Zhang B. The effect analysis of 55 cases of typeⅢacromioclavicular dislocation treated surgically. JClin Orthopedic. 2005;5(2):76–9.
    15. Tencer AF, Johnson KD. Biomechanics in OrthopedicTrauma: bone fracture and fixation. 3 edPhiladelphia: JBLippincott Cop; 1994.
    16. Hessmann M, Gotzen L, Gehling H. Acromioclavicular reconstruction augmented with polydioxanonsulphate bands. Surgical technique and results. Am J Sports Med. 1995;23(5):552–6. 18. Jari R, Costic RS, Rodosky MW, Debski RE. Biomechanical function of surgical procedures for acromioclavicular joint dislocations. Arthroscopy. 2004;20(3):237–45.
    17. Cox JS. Current method of treatment of acromioclavicular joint dislocations. Orthopedics. 1992;15(9):1041–4.
    18. Phillips AM, Smart C, Groom AFG. Acromioclavicular Dislocation. ClinOrthop . 1998;353:10–7.
    19. Su EP, Vargas J3, Boynton MD. Using suture anchors for coracoclavicular fixation in treatment of complete acromioclavicular separation. Am J Orthop (Belle Mead NJ). 2004;33(5):256–7.
    20. Rokito AS, Oh YH, Zuckerman JD. Modified Weaver-Dunn procedure for acromioclavicular joint dislocations. Orthopedics. 2004;27(1):21–8.