Analysis of the effect of double button plate combined with strengthened anchor in the treatment of acromioclavicular dislocation / 中国骨伤

OBJECTIVE@#To evaluate the efficacy and prognosis of double button plate combined with strengthened anchor technique and clavicular hook plate internal fixation for complete acromioclavicular joint dislocation.@*METHODS@#From July 2017 to September 2020, a total of 42 patients with acromioclavicular joint dislocation treated by surgery were choosen as study objects and divided into observation group (21 cases) and control group (21 cases). In the observation group, there were 14 males and 7 females, aged 21 to 63 years old, with an average of (45.05±8.70) years old. In the control group, there were 16 males and 5 females, aged 25 to 68 years old, with an average of(45.00±9.44) years old. The patients in the observation group were treated with double button plate combined with strengthened anchor technique, whereas those in the control group received clavicular hook plate internal fixation. The two groups were compared in terms of operating time, intraoperative blood loss, postoperative hospital stay, shoulder pain(visual analogue scale, VAS) score, shoulder function Constant-Murley score and postoperative complications.@*RESULTS@#There was no significant difference between the two groups in intraoperative blood loss or postoperative hospital stay(P>0.05). The operating time of double button plate combined with strengthened anchor technique group (65.24±5.36) min was significantly longer than that of the clavicular hook plate group (48.81±4.72) min, and the difference was statistically significant (P<0.05). There was no significant difference in shoulder function or pain degree between the two groups before operation (P>0.05). After 1 month, 3 months and 6 months, the Constant-Murley score of the observation group was 73.29±2.15, 85.43±1.47, 93.86±1.24 separately, which were significantly higher than those of the control group;and the VAS score was 2.76±0.62, 1.71±0.64, 0.57±0.51 separately, which were significantly lower than those of the control group (P<0.05). One instance of shoulder discomfort was found in the observation group, while 5 cases of shoulder pain, 2 cases of restricted shoulder mobility, and 1 case of subacromial bone absorption were found in the control group. In both group, there was no loss of reduction.@*CONCLUSION@#In the treatment of complete acromioclavicular joint dislocation double button plate combined with strengthened anchor technique achieves favorable clinical result. Internal fixation does not need to be removed. The recovery of shoulder joint function and pain relief are superior than clavicular hook plate internal fixation, which is more worthy of clinical promotion.

A Comparison of Outcome after Fixation of Unstable Lateral Third Clavicle Fractures, with Clavicular Hook Plate versus Precontoured Anatomical Locking Plate.

Lateral end clavicle fractures are of three types (Neer type- I, II, & III). In Neer Type-II, the fractures are very unstable due to damage to the coracoclavicular (CC) ligament. So, it is always treated surgically. This comparative cross-sectional prospective study compares the outcome after internal fixation of these fractures with clavicular hook plate and precontoured anatomical locking plate.METHODSThirty-two (32) patients attending the OPD and ER of R.G. Kar Medical College, Kolkata, having Neer Type-II fractures, were treated surgically within three weeks of injury using either clavicular hook plate (17 patients) or precontoured anatomical locking plate (15 patients) and then systematically reviewed. The relevant literature of the two fixation methods were studied to note union, infection, hardware prominence, implant failure, metaphyseal fracture and other complications. Constant-Murley score was also used for evaluation.RESULTSIn our study, with both the fixation modalities, union was achieved in all cases by three months. No impingement was noted. Patients having fixation with precontoured anatomical locking plate had better scores and returned earlier to better function than the other group (p value <0.0001).CONCLUSIONSPrecontoured anatomical locking plate might be a better option which provides better functional outcome.

Arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation for management of acute acromioclavicular joint dislocation and MRI follow-up study / 中南大学学报(医学版)

OBJECTIVES@#To explore the safety and effectiveness of arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation to manage the acute acromioclavicular joint dislocation.@*METHODS@#From January 2016 to December 2017, 18 cases of acute acromioclavicular joint dislocation were carried out with arthroscopic reconstruction of coracoclavicular ligament by double Endobutton plate suspensory fixation. Anteroposterior view X-ray plain radiographs were obtained on the second day, 6 months and 12 months after the surgery, MRI was performed in 1 year after operation. Meanwhile, subjective and objective scoring were obtained by Vsual Analogue Scale (VAS), Rating Scale of the American Shoulder and Elbow Surgeons (ASES) and University of California at Los Angeles Shoulder Rating Scale (UCLA).@*RESULTS@#All patients were followed up for 12 to 30 months (an average of 18 months). There was no patient with infection, neurovascular injury, loosening and breakage of internal fixation, re-dislocation of acromioclavicular joint, clavicular fracture, coracoid process fracture, etc. Postoperative X-ray showed that all acromioclavicular joints were completely relocated. The follow-up of MRI after 1 year showed no obvious dislocation of acromioclavicular joint and good recovery of acromioclavicular space. Postoperative shoulder joint function, VAS, ASES, UCLA and acromioclavicular distance were significantly improved compared with those before surgery, with statistically significant differences (all <0.05).@*CONCLUSIONS@#Arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation to manage the acute acromioclavicular joint dislocation has the advantages of minimal invasive, rapid functional recovery and less complications and satisfactory early clinical results.

Meta-analysis of the effect of double endobutton and clavicular hook plate on the treatment of acromioclavicular dislocation / 中国组织工程研究

OBJECTIVE: Because the double Endobutton plate has more advantages than the clavicle hook plate in the treatment of acromioclavicular joint dislocation, and the trauma is small; it does not need to be removed through secondary surgery. Thus, it has been widely used in clinical practice in recent years. Meta-analysis was used to investigate whether there were differences in the treatment of acromioclavicular dislocation between double Endobutton plate and clavicle hook plate so as to provide effective guidance for clinical treatment. METHODS: The database Cochrane library, PubMed, EBSCO, CNKI, VIP and Wanfang were searched from the database inception to January 2020. All the literatures related to the treatment of acromioclavicular dislocation with double Endobutton plate and clavicle hook plate were collected. The literatures were selected according to the inclusion and exclusion criteria to extract the data and to carry out the relevant analysis. The literatures that meet the requirements were screened out. The quality of the selected relevant literatures was assessed. All outcome indicators were analyzed by RevMan 5.3 software. RESULTS: (1) A total of 38 articles were included, and the total number of cases was 2 199, of which 1 035 cases were in the double Endobutton plate group and 1 164 cases were in the clavicle hook plate group. (2) The results showed that the double Endobutton plate group was superior to the clavicle hook plate group in the excellent and good rate [RR=1.19, 95%CI(1.13, 1.26), P < 0.000 01], operation time [MD=10.54, 95% CI(6.09, 15.00), P < 0.000 01], intraoperative blood loss [MD=-14.83, 95%CI(-20.54,-9.13), P < 0.000 01], hospitalization time [MD=-1.44, 95%CI(-2.65,-0.23), P=0.02], incision length [MD=-2.87, 95%CI (-3.60, -2.14), P < 0.000 01], hospitalization cost [MD=-2 442.10, 95% CI(-4 466.34, -417.86), P=0.02], shoulder pain after operation [RR=0.34, 95%CI(0.22, 0.53), P < 0.000 01], visual analogue scale score [MD=-0.85, 95% CI(-1.28, -0.41), P=0.000 2], final Constant-Murley score at 6 months postoperatively [MD=8.82, 95%CI(1.91, 15.72), P=0.01; MD=6.66, 95%CI(4.46, 8.86), P < 0.000 01]CONCLUSION: The treatment of Rockwood III type and above acromioclavicular joint dislocation with double Endobutton plate is superior to that clavicular hook plate. It has the advantages of short operation time, less intraoperative blood loss, less trauma, short hospitalization time and less cost, and good functional recovery of shoulder joint after operation.

Endobutton plate versus clavicular hook plate for acromioclavicular joint dislocation / 中华创伤骨科杂志

Objective To compare Endobutton plating and clavicular hook plating for acromioclavicular joint dislocation.Methods The clinical data of 46 patients with acromioclavicular joint dislocation were retrospectively analyzed who had been treated at Department of Orthopaedics,The Seventh Affiliated Hospital to Sun Yat-Sen University from October 2015 to December 2017.They were 35 men and 11 women,aged from 18 to 60 years (mean,36.3 years).All dislocations were unilateral,involving the left side in 20 cases and the right side in 26.By the Rockwood classification of dislocations,there were 18 cases of type Ⅲ,24 cases of type Ⅳ and 4 cases of type Ⅴ.Of them,22 were treated with clavicular hook plating and 24 with Endobutton plating.The 2 groups were compared in terms of operation time,incision length,intraoperative blood loss,operation cost,visual analogue scale (VAS) and Constant-Murley scores.Results The 2 groups were comparable because there were no significant differences between them in the general clinical data before operation (P ＞ 0.05).The Endobutton plating group was significantly better than the hook plating group in the incision length (5.3 ± 0.6 cm versus 8.0±1.7 cm) and intraoperative blood loss (101.0±12.3 mL versus 135.0±8.1 mL),but significantly poorer than the latter in the operation cost (RMB 21,343 ±965.2 yuan versus RMB 16,849 ±919.7 yuan) (all P ＜ 0.05).The Endobutton plating group was also significantly superior to the hook plating group in the VAS scores (2.3 ±0.8 versus 3.6 ±0.9) and Constant-Murley scores (96.2 ±4.4 versus 89.3 ±5.2) at 6 months after operation (both P ＜ 0.05).Conclusion In the treatment of acromioclavicular joint dislocation,Endobutton plating may lead to better functional recovery of the shoulder,better pain relief and freedom from secondary surgical removal of the implant.

Meta-analysis on effect of endobutton plate and clavicular hook plate in the treatment of acromioclavicular joint dislocation / 局解手术学杂志

Objective To systematically evaluate the clinical effects of endobutton plate and clavicular hook plate in the treatment of ac-romioclavicular joint dislocation. Methods The clinical study on endobutton plate and clavicular hook plate in the treatment of acromiocla-vicular joint dislocation was subjected to computer search for CNKI,VIP,WangFang Data,PubMed,EMbase and The Cochrane Library input before July 2017. Two reviewers independently screened literature,extracted data and assessed the risk bias of included studies and then Rev-Man 5. 3 software was used to perform meta-analysis. A total of 10 studies were conducted with 725 patients. Results After operation of the patients who underwent endobutton plate,the Constant score was higher [MD=8. 55,95％CI (7. 82, 9. 29),P<0. 01] with shorter opera-tion time [MD=4. 94, 95％CI 4. 30 to 5. 59,P< 0. 01],less bleeding (MD= -1. 93,95％CI -2. 63 to -1. 22,P<0. 01],and shorter hospital stay [MD= -0. 39, 95％CI -0. 70 to -0. 09,P=0. 01],respectively. Conclusion The treatment of acromioclavicular joint dis-location with type III by endobutton plate has the advantages of shorter operation time,less intraoperative bleeding,quick recovery of shoulder function,and shorter hospital stay.

Clinical and Radiological Outcomes of Acute Acromioclavicular Joint Dislocation: Comparison of Hook Plate Fixation with Single Tight Rope Technique

BACKGROUND: This study was conducted to compare the clinical and radiological outcomes of the locking hook plate fixation (HP) technique and the single tight rope (TR) technique applied for acute high-grade acromioclavicular (AC) joint separations. METHODS: Between 2009 and 2014, 135 consecutive patients with acute AC joint separation Rockwood types III, IV, and V were subjected to surgical reconstruction. One hundred fourteen patients (84.4%) were available for retrospective evaluation. Of them, 62 and 52 were treated using the single TR group and clavicular HP group techniques, respectively. The visual analogue scale, Constant, American Shoulder and Elbow Surgeons (ASES), and Taft scores were used for clinical assessment. Postoperative shoulder range of motion was also assessed. An anteroposterior radiograph of the coracoclavicular distance (CCD) was obtained to evaluate the radiographic signs of recurrence. RESULTS: The TR group patients had better Constant, ASES, and Taft scores than the HP group patients. The loss of reduction in terms of the CCD did not differ between groups. Subacromial osteolysis was observed in 34.6% of the cases in the HP group. However, there were no significant differences in the clinical outcomes between the patients with and without osteolysis in the HP group. Subcoracoid osteolysis, drill tunnel widening, and metal displacement were observed in 3.2%, 22.6%, and 4.8% of the cases in the TR group, respectively. CONCLUSIONS: The single TR technique was relatively more effective at treating acute high-grade AC joint injuries than the HP fixation technique (level of evidence: therapeutic; retrospective comparative study, Level III).

Efficacy of anatomical locking plate combined with anchor nail in the treatment of Neer Ⅱ distal clavicle fracture / 中国综合临床

Objective To observe the efficacy of anatomical locking plate combined with anchor nail internal fixation and clavicular hook plate in the treatment of Neer Ⅱ distal clavicle fracture and their impact on shoulder function.Methods Eighty patients with Neer Ⅱ distal clavicular fracture treated in the Eighth People's Hospital in Shanghai from January 2015 to December 2016 were divided into observation group and control group,each group 40 cases.The observation group was treated with anatomical locking plate combined with anchor nail,the control group was treated with clavicular hook plate.The efficacy,operation time,intraoperative blood loss,fracture healing time,postoperative hospital stay,shoulder function score and incidence of complication were observed in the two groups.Results The excellent rate was in the observation group was higher than that in the control group (97.50%(39/40) vs.80.00%(31/40),χ2=2.477,P0.05);the fracture healing time in the observation group was longer than that of the control group ((23.65±2.19) w vs.(26.9±3.46) w,P<0.01).The shoulder joint Constant-Murley score in the observation group was (86.02±5.19) points,control group (68.46± 6.94) points,the difference was statistically significant (P<0.01).Observation group showed 2 cases of pain around acromion,the incidence rate of complications was 5.00%(2/40);7 cases in the control group had pain around acromion,2 cases suffered from impingement syndrome and 1 cases had delayed union,the incidence rate of complications was 25.00% (10/40).Conclusion Anatomical locking plate combined with anchor nail internal fixation is effective in the treatment of Neer II distal clavicle fracture.It has the advantages of fast fracture healing,good functional recovery of shoulder joint and less complications.

Clinical and Radiological Outcomes of Acute Acromioclavicular Joint Dislocation: Comparison of Hook Plate Fixation with Single Tight Rope Technique

BACKGROUND: This study was conducted to compare the clinical and radiological outcomes of the locking hook plate fixation (HP) technique and the single tight rope (TR) technique applied for acute high-grade acromioclavicular (AC) joint separations. METHODS: Between 2009 and 2014, 135 consecutive patients with acute AC joint separation Rockwood types III, IV, and V were subjected to surgical reconstruction. One hundred fourteen patients (84.4%) were available for retrospective evaluation. Of them, 62 and 52 were treated using the single TR group and clavicular HP group techniques, respectively. The visual analogue scale, Constant, American Shoulder and Elbow Surgeons (ASES), and Taft scores were used for clinical assessment. Postoperative shoulder range of motion was also assessed. An anteroposterior radiograph of the coracoclavicular distance (CCD) was obtained to evaluate the radiographic signs of recurrence. RESULTS: The TR group patients had better Constant, ASES, and Taft scores than the HP group patients. The loss of reduction in terms of the CCD did not differ between groups. Subacromial osteolysis was observed in 34.6% of the cases in the HP group. However, there were no significant differences in the clinical outcomes between the patients with and without osteolysis in the HP group. Subcoracoid osteolysis, drill tunnel widening, and metal displacement were observed in 3.2%, 22.6%, and 4.8% of the cases in the TR group, respectively. CONCLUSIONS: The single TR technique was relatively more effective at treating acute high-grade AC joint injuries than the HP fixation technique (level of evidence: therapeutic; retrospective comparative study, Level III).

Comparative study on double Endobutton plate and clavicular hook plate for repair of Tossy grade Ⅲ acromioclavicular dislocation / 中华创伤杂志

Objective To compare the outcome of double Endobutton plate versus clavicular hook plate (CHP) in treatment of Tossy grade Ⅲ acromioclavicular dislocation.Methods A cohort of 82 patients with Tossy grade Ⅲ acromiocavicular dislocation treated between January 2010 and August 2012 were reviewed retrospectively.Based on the treatment choices,the patients were divided into double Endobutton group (36 cases) and CHP group (46 cases).Operative situation,in-hospital parameters,and postoperative visual analogue scale (VAS) of the shoulder,shoulder abduction-rise or anteflexionrise,Constant-Murley shoulder score as well as complications were evaluated.Results There were no statistical differences between the two groups in aspects of operation time,intraoperative blood loss,and length of stay.Mean time to return to work was (13.1 ± 1.4) weeks in double Endobutton group,shorter than (15.5 ±2.6) weeks in CHP group (P ＜0.01).No statistical difference was observed for postoperative complications between the two groups.At postoperative 12 months,VAS was lower in double Endobutton group [(2.1 ± 0.7) points] vs CHP group [(2.9 ± 0.8) points,P ＜ 0.05],but abductionrise and anteflexion-rise were higher in double Endobutton group [(138.6 ± 15.7) °,(140.3 ± 17.6) °] vs CHP group [(91.7 ±8.4)°,(96.7 ± 10.5)°,P＜0.05].Conclusion To treat Tossy grade Ⅲ acromioclavicular dislocation,double Endobutton plate is associated with less shoulder pain,quicker recovery,better shoulder function restoration compared with CHP and there is no need for a second surgery to remove it.

Analysis the therapy effect of clavicular hook plate on Neer Ⅱ distal clavicle fractures and tossy Ⅲ acromioclavicular joint dislocation / 中国综合临床

Objective To investigate therapy effect and its clinical complications of the clavicular hook plate internal fixation for the treatment of Type Neer Ⅱ distal clavicle fracture and tossy Ⅲ acromioclavicular joint dislocation.Methods Twenty-two patients of Neer Ⅱ distal clavicle fracture and 16 patients of Tossy Ⅲ acromioclavicular joint dislocation were selected as our subjects.All patients were hospitalized and treated by using clavicular hook plate fixation form August 2007 to Februay 2012.The clinical effect and complications were analyzed retrospectively.Results All patients were showed the primary healing in terms of incision.Of all patients,30 cases were being following up,and follow-up periods was 6.0 to 18.0 months (average of (10.45 ±3.78) months).All patients underwent implant removal surgery at postoperative 6-14 months.No refracture or acromioclavicular joint separation again occurred.Four patients were with complications,of which,2 patients were clavicular hook plate decoupling at 7 days or 3 weeks after operation; One patient occurred clavicle stress fracture at more than 3 months after operation.All mentioned 3 cases were treated with re-operation.1 patient was with shoulder abnormal sound after operation and abnormal sound disappear after internal fixation removed.The shoulder functions were evaluated according to University of California-Los Angeles (UCLA) score system at before and after clavicular hook plate was taken out.The scores of pain and function of the shoulder,forward lateral flexion range were significant difference between before and after clavicular hook plate removed ((7.90 ±1.20) vs.(9.20±1.03),t =-2.327,P=0.045;(8.00±0.94) vs.(9.40 ±0.97),t=-3.280,P=0.001 ; (4.00 ±0.47) vs.(4.70 ± 0.48),t =-4.583,P =0.001).After the hook plate was removed,all shoulder functions showed improvement.The overall efficacy was excellent in 15 cases,good in 13 cases,and poor in 2 cases,and the recovery of excellent and good rate were 93.33％.Conclusion The clinical efficacy is well in terms of using clavicular hook plate internal fixation to treat Type Neer Ⅱ distal clavicle fracture and Tossy Ⅲ acromioclavicular joint dislocation.Prevention and treatment of complications should paid more attention.

Clinical Study of Treating Acromioclavicular Joint Dislocation Associated with Distal Clavicular Fracture by Clavicular Hook Plate / 中国康复理论与实践

@#Objective To discuss the treatment of acromioclavicular joint dislocation associated with clavicular distal end fracture and remedial means.Methods 28 cases of acromioclavicular joint dislocation associated with clavicular distal end fracture were treated with clavicular hook plate.28 patients included 4 cases of Allman's type Ⅰ,14 cases of type Ⅱ,10 cases of type Ⅲ.Classification of fracture included 9 traverse cases,14 oblique cases,3 comminuted cases,and 2 avulsion cases.There were 24 acute injury cases,4 obsolete injury cases.3 cases were open fractures.1 case was not successful by conservative management.After operation,early rehabilitation was emphasized and following-up was performed.The therapeutic effect was assessed with Karlsson standard.Results 28 patients were followed up for an average of 14.6 months(6～26 months).According to Karlsson standard:17 cases got A level,8 cases got B level,3 cases got C level.The rate of excellence was 89.3%.Conclusion Acromioclavicular joint dislocation associated with clavicular distal end fracture is not steady fracture and complicated with many ligaments avulsion often.Effective internal fixation on time and ligament repaired is necessary.

Comparison between the effect of clavicular hook plate and Kirschner wire fixation in the acromioclavicular joint dislocation and the distal clavicle fracture / 中国矫形外科杂志

0.05);According to average 15 months follow-up,the complication rate was 0 and the excellent rate of shoulder fuction was 97.1% in the cases fixed with CHP,both were better than those of the cases fixed with K-wire of 38.9% and 72.2% respectively(P

Clinical analysis on treatment of lateral clavicular fracture and acromioclavicular joint dislocation with clavicular hook plate / 中国医师进修杂志

Objective To analyze the effect of clavicular hook plate(CHP) in treating distal clavicular fracture and acromioclavicular joint dislocation. Methods Eighteen patients with distal clavicular fracture(NeerⅡ) and acromioclavicular joint disclocation(Tossy Ⅲ) were treated by CHP. Results Sixteen patients were observed after operation,according to Lazzcano curative effect standard, fifteen cases were excellent, take 93.75 percent,1 case was good, with 6.25 percent, the excellent and good rates were 100.00 percent. The phenomenon such as the steel plate fracture,loose,escape hook and acromioclavicular joint re-dislocation were not happened. Conclusion CHP is an effective,scientific and convenience way for distal clavicular fracture and acromioclavicular joint dislocation,it worth being promoted.

Treatment of dislocation of acromioclavicular joint and/or fracture of distal clavicle using AO clavicular hook plate / 中华创伤骨科杂志

Objective To evaluate the clinical effects of AO clavicular hook plates in treatment of dislocation of acromioclavicular joint and/or fracture of distal clavicle in comparison with traditional means. Methods A retrospective analysis was done to compare the outcomes and complications between the treatment of dislocation of acromioclavicular joint and/or the fracture of distal clavicle by AO clavicular hook plates and the treatment by conventional devices (e.g. Kirschner’s wire, wire-cerclage, bolt, et al). Results 40 cases were followed up for 12 to 20 months and the average time was 14 months. According to Lazzcano’s criterion, the rate of excellent and fine of the clinical outcomes of the 2 groups was 100%and 78.6%respectively. After statistical Chi-square test, P=0.025. Therapeutic outcomes and complications of the former were obviously better than the latter. Conclusion Since AO clavicular hook plates display advantages of rigid fixation, non-invasion into articular surface, and possibility of early functional exercise in the treatment of acromioclavicular dislocation and fractures of distal clavicle, they are worthy of recommending.

Treatment of distal third fracture of clavicle with AO clavicular hook plate / 中华创伤骨科杂志

Objective To study the outcome of distal third clavicular fracture treated with AO clavicular hook plate. Methods From May 2001 to May 2003, 14 cases of fresh distal third clavicular fracture (Neer typeⅡ) were treated with AO clavicular hook plate in our hospital. Results All the cases obtained satisfactory results. No infection, nonunion, ineffective internal fixation, or loosening or breakage of the plate occurred. Conclusion The treatment of distal third clavicular fracture with AO clavicular hook plate is an effective surgical method.

Treatment of acromioclavicular dislocation (Tossy Ⅲ ) with AO clavicular hook plate / 中华创伤骨科杂志

Objective To study the clinical effect and necessity of removing internal fixation after treatment of acromioclavicular dislocation (Tossy Ⅲ ) with AO clavicular hook plate. Methods From October 2001 to October 2004, 31 patients with acromioclavicular dislocation (Tossy Ⅲ ) were treated with AO clavicular hook plate and were followed up. All of their broken acromioclavicular joints were sutured and the clavicular insertions of deltoid and trapezius muscles were repaired. The coracoclavicular ligaments were sutured for only 9 patients. Their shoulder functions before and after taking out of the internal fixation were assessed by Constant and Murley evaluation and compared. Results 24 patients were followed up from 4 to 40 months after operations (averaging 22 months). There were no loosening or breakage of internal fixations. The plates were removed 12 to 27 months postoperatively (averaging 18 months) in only 9 patients. No redislocation occurred after taking out of the plates. The scores of shoulder joint function were 76.5? 8.6 and 99.5? 1.0 (P