ABSTRACT
Background: There are two principles of operative technique for the treatment of acromioclavicular dislocation. One is transarticular of the acromioclavicular fixation of the acromioclavicular joint and the other is coracoclavicular fixation. Both two techniques may or may not include ligamentous repaired. However, both techniques have many complications. Objective: To present a new operative technique which based on extensive studying of anatomy of this particular area. This technique is open reduction and transfixation the lateral end of clavicle to the base of acromion process with single malleolar screw and washer. Study Design: Case report. Setting: Orthopedics department, Faculty of Medicine, Khon Kaen University.Results: The reliability technique was presented by using the aiming device for directing the drill from the clavicle to scapular spine. This technique was done in one patient. This technique provides the ritid and stable fixation of the joint, therefore, the patient can move his shoulder immediately after operation. Conclusion: The new operative technique for acromioclavicular joint dislocation has been presented.
ABSTRACT
Background: Clavicular fracture is a common fracture of the upper extremity. Normally, non-operative treatment is recommended, however, the mal position and shortening of this fracture might affect the shoulder functions. Therefore, many authors recommend operative treatment.Objectives: To evaluate the satisfaction and range of motion on the ipsilateral shoulder of the patients with malunited fracture of the clavicle who were treated at Srinagarind Hospital.Design: This was a retrospective study.Setting: Srinagarind HospitalResults: There were 30 patients, regarded to the range of motion of the shoulder that had an ipsilateral malunion of clavicle. There were 23 men and 7 women. The mean age of the patients was 29.93 year (range 14-56 years). The mean duration between finished treatment and the last follow up was 41.80 weeks (range 5-108 weeks). The right clavicle was fractured in 20 patients (66.67%) and the left clavicle was in 10 pateints (33.33%). The most common site of fractures was the middle third (27 patients, 90%). The rest was the distal third. The most common cause of fractures was traffic accident (26 patients, 86.67%). The figure of eight casts were applied 28 patients (93.33%) and donut splint for the rest 2 patients. The mean time for immobilization was 4.9 weeks (range 2-12 weeks). The mean length of clavicle was 16.03 + 1.44 centimeters (range 13.5-18.5 centimeters). The mean shortening of the malunited clavicle was 0.83 + 0.58 centimeters (range 0-2 centimeters). Twenty-one patients (70%) had equally range of motion of the shoulder bilaterally, nine patients had a difference from the normal shoulder. In the latter group, 8/9 patient had good function status only 1 patient had moderate function status.Conculusion: Regarding the function of shoulder there were 28 patients (93.33%) had good function and the cosmetic results have a median value of 4 (2-5). Seventy percent of the patients had normal range of motion compared with the normal sides.Key words: (1) Clavicle (2) Malunion (3) Shoulder (4) Motion
ABSTRACT
Background : The diagnosis of acromioclavicular (AC) joint injury depends upon primary physical and radiological examinations. Simultaneous views of both AC joints are obtained and measurements compared between injured and uninjured sides. Most commonly, the severity of injury is determined by the relative differences between the widths of the AC joint space, the coracoclavicular (CC) distance, and degree of elevation of the clavicle above the acromion. These parameters are usually used to decide on surgical or conservative treatments. The measurement’s variation can change the treatment options.Objectives : To evaluate the reliability of the current method for measuring the CC distance and introducing the new method of measuring the width of CC distance by using a Mose’s template.Design : Descriptive studySetting : Department of Orthopedic, faculty of medicine, Khon Kaen University.Subjects : The anteroposterior radiograph of both acromioclavicular joints with Zanza technique were used in this study. Twenty radiographs were selected based on the quality of the radiograph. There were 15 male and female patients. The average age of the patients was 25±6 years old (range 20-48). Thirteen patients had right and seven had left AC joint injuries. Two observers were included in this study to evaluate the reliability of the current and new methods.Results : There were thirty-two of 40 pairs (32/40, 80 %, 95% confidence interval 67.61%-92.39%) of measurement by two observers (interobserver reliability) using Mose’s template had the same results. However, the current technique used by two observers had the same results only three of 40 pairs (3/40, 7.5%,95% confidence interval 7.2%-7.8%) of measurements. The intraobserver reliability, for the Mose’s template of the observer I and II, there were 8 of 10 (8/10, 80%, 95% confidence interval 30%-90%) and 6 of 10 pairs (6/10, 60%, 95% confidence interval 30%-90%) of measurements had the same results respectively. For the current technique, however, there were only two of 10 pairs(2/10,20%,95% confidence interval 0-45%) and one of 10 pairs (1/10, 10%,95% confidence interval 1%-29%) of measurements of the observer I and II had the same results respectively.Conclusion : The Mose template technique is a more reliable method of measurement the CC distance in the AC joint injury.