Fijación interna combinada con artroplastia total de cadera en fracturas acetabulares inveteradas complejas en ancianos. Reporte de caso / Internal fixation combined with total hip arthroplasty in complex inveterate acetabular fractures in the elderly. Case report

La fijación interna combinada con artroplastia en pacientes de edad avanzada, está indicada en fracturas acetabulares complejas inveteradas, artrosis preexistente, luxación inveterada, Impactación supero-medial de la cúpula acetabular, la finalidad de la cirugía es lograr la fijación de la columna anterior, columna posterior, lamina cuadrilátera y pared posterior para proporcionar estabilidad adecuada al componente acetabular y restaurar el centro de rotación de la cadera. Debido a la complejidad de estas lesiones, se decide presentar el siguiente caso clínico, que corresponde una paciente femenina de 70 años, quien posterior a traumatismo de baja energía presenta fractura inveterada compleja con patrón en T de Acetábulo de 8 meses de evolución. El Objetivo es: Evaluar los resultados del tratamiento de las fracturas acetabulares complejas en pacientes de edad avanzada con reducción abierta más fijación interna combinada con artroplastia total de cadera. Se realiza en un 1er tiempo: Abordaje Ilioinguinal, ORIF con placa de reconstrucción 3,5 mm para CA, 2do Tiempo: Abordaje de Kocher Langenbeck, ORIF con placa de reconstrucción 3,5 mm para CP y PP. 3er Tiempo: ATC izquierda primaria no cementada, con aporte biológico de injerto óseo autologo. Resultado: Se restableció la integridad de las líneas acetabulares, reducción anatómica según Matta, índice de Harris hip score de 88 puntos. Se concluye que el procedimiento combinado de ORIF mas ATC es el tratamiento ideal de las fracturas acetabulares complejas inveteradas en pacientes de edad avanzada(AU)

Internal fixation combined with arthroplasty in elderly patients is indicated in inveterate complex acetabular fractures, preexisting osteoarthritis, inveterate dislocation, supero medial impaction of the acetabular dome, the purpose of surgery is to achieve fixation of the anterior column (AC), posterior column (PC), quadrilateral plate, and posterior wall (PP) to provide adequate stability to the acetabular component and restore the hip center of rotation. Due to the complexity of these injuries, it is decided to present the following clinical case, which corresponds to a 70-year-old female patient, who, after a low-energy trauma, presents a complex inveterate fracture with a T-pattern of the acetabulum of 8 months of evolution. The Objective is: To evaluate the results of the treatment of complex acetabular fractures in elderly patients with open reduction plus internal fixation (ORIF) combined with total hip arthroplasty (THA). It is performed in a 1st stage: Ilioinguinal approach, ORIF with 3.5 mm reconstruction plate for (CA), 2nd Stage: Kocher Langenbeck approach, ORIF with 3.5 mm reconstruction plate for (CP) and (PP). 3rd Time: Uncemented primary left THA, with biological contribution of autologous bone graft. Result: The integrity of the acetabular lines was restored, anatomical reduction according to Matta, Harris hip score index of 88 points. It is concluded that the combined procedure (ORIF plus ATC) is the ideal treatment of inveterate complex acetabular fractures in elderly patients(AU)

Congenital Knee Dislocation at Birth - An Extraordinary Case of Spontaneous Reduction / Luxação congênita do joelho no nascimento - Um caso extraordinário de redução espontânea

Abstract Congenital knee dislocation (CKD) is a rare malformation characterized by hyperextension deformity of the knee with anterior tibia displacement, present at birth. Rarely reported, CKD might occur as an isolated deformity or commonly associated with musculoskeletal abnormalities, with the most common ones being developmental dysplasia of the hip (DDH) and clubfoot. The etiology is unknown, but CKD has been associated with certain intrinsic and extrinsic factors. Treatment with conservative methods at an early stage is most likely to yield successful results. We report here a rare case of successful spontaneous reduction of CKD in an infant within 24 hours of life.

Resumo A luxação congênita do joelho (LCJ) é uma malformação rara caracterizada por deformidade de hiperextensão do joelho com deslocamento anterior da tíbia, presente ao nascimento. Raramente relatada, a LCJ pode ocorrer como uma deformidade isolada ou comumente associada a anormalidades musculoesqueléticas, sendo as mais comuns a displasia do desenvolvimento do quadril (DDQ) e o pé torto congênito (PTC). A etiologia é desconhecida, mas a LCJ foi associada a certos fatores intrínsecos e extrínsecos. O tratamento com métodos conservadores em um estágio inicial tem maior probabilidade de produzir resultados bem-sucedidos. Relatamos aqui um caso raro de redução espontânea bem-sucedida de LCJ em um bebê nas suas primeiras 24 horas de vida.

Comparison of efficacy of staged versus elective operation for treating acute closed fracture-dislocation of tarsometatarsal joint complex / 中华创伤杂志

Objective:To compare the efficacy of staged versus elective operation for treating acute closed fracture-dislocation of tarsometatarsal joint complex.Methods:A retrospective cohort study was used to analyze the clinical data of 26 patients with acute closed fracture-dislocation of tarsometatarsal joint complex admitted to Tongji Hospital of Tongji University from January 2017 to January 2021, of whom 18 were males and 8 were females, aged 32-52 years [(44.3±5.2)years]. According to the time from injury to admission, 14 patients admitted within 8 hours after injury underwent staged surgical treatment (staged group), and 12 patients admitted more than 8 hours after injury underwent elective surgery (elective group). In the staged group, emergency reduction and temporary internal fixation with K-wire were done under the supervision of a C-arm X-ray machine in the first stage, while after the swelling subsided, open reduction and internal fixation were done for tarsometatarsal joint fracture-dislocation in the second stage. In the elective group, open reduction and internal fixation were performed for tarsometatarsal joint fracture-dislocation on a scheduled basis after the swelling subsided. The operation time, hospitalization time and fracture healing time were recorded. The visual analogue score (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) midfoot score were evaluated before operation, at 1, 6, 12 months after operation and at the final follow-up. The rate of complications was observed after operation.Results:All patients were followed up for 12-24 months [(18.5±3.8)months]. The operation time, hospitalization time and fracture healing time in the staged group were (77.3±5.6)minutes, (14.3±2.2)days and (12.3±1.2)weeks, respectively, significantly shorter than those in the elective group [(101.5±7.5)minutes, (20.3±5.2)days and (14.3±2.2)weeks] (all P<0.01). VAS significantly decreased and AOFAS midfoot score significantly increased in both groups as postoperative time increased (all P<0.05). There were no significant differences in VAS between the two groups before operation, at 12 months after operation or at the final follow-up (all P>0.05). The VAS at 1, 6 months after operation was (4.4±0.8)points and (2.1±0.4)points in the staged group, significantly lower than those in the elective group [(6.0±1.0)points and (3.5±0.6)points] (all P<0.01). There was no significant difference in preoperative AOFAS midfoot score between the two groups ( P>0.05). The AOFAS midfoot score at 1, 6, 12 months after operation and at the final follow-up was (67.6±4.5)points, (75.7±5.2)points, (83.6±2.2)points and (85.9±4.3)points in the staged group, significantly higher than those in the elective group [(60.2±3.9)points, (70.2±3.4)points, (75.4±3.3)points and (78.7±4.4)points] (all P<0.01). The rate of complications was 14.3% (2/14) in the staged group, significantly lower than that in the elective group [33.3% (4/12)] ( P<0.05). Conclusion:Compared to traditional elective surgery, staged surgery for acute closed fracture-dislocation of tarsometatarsal joint complex has the advantages of shortened operation time, hospitalization time and fracture healing time, eary pain relief, improved functional recovery of the foot and reduced postoperative complications.

Classified reduction based on CT two-dimensional images for the surgical treatment of single segment facet joint dislocation in subaxial cervical spine / 中华创伤杂志

Objective:To investigate the efficacy of the classified reduction based on CT two-dimensional images for the surgical treatment of single segment facet joint dislocation in subaxial cervical spine.Methods:A retrospective case series study was made on 105 patients with single segment facet joint dislocation in subaxial cervical spine admitted to Zhengzhou Orthopedic Hospital from January 2015 to October 2022. There were 63 males and 42 females, with the age range of 22-78 years [(47.5±3.6)years]. Preoperative American Spinal Cord Injury Association (ASIA) classification was grade A in 23 patients, grade B in 45, grade C in 22, grade D in 15 and grade E in 0. The classification of surgical approach was based on the presence or not of continuity between anterior and posterior subaxial cervical structures and the movability of the posterior cervical facet joint on CT two-dimensional images, including anterior cervical surgery if both were presented and posterior facet joint resection plus anterior cervical surgery if there was discontinuity between anterior and posterior subaxial cervical structures or posterior facet joint fusion. Reduction procedures were applied in accordance with the type of facet joint dislocation classified based on the position of the lower upper corner of facet joint, including skull traction or manipulative reduction for the dislocation locating at the dorsal side (type A), intraoperative skull traction and leverage technique for the dislocation locating at the top (type B) and intraoperative skull traction and leverage technique with boosting for the dislocation locating at the ventral side (type C). If the dislocation of two facet joints in the same patient was different, the priority of management followed the order of type C, type B and type A. The reduction success rate, operation time and intraoperative blood loss were recorded. The cervical physiological curvature was evaluated by comparing the intervertebral space height and Cobb angle before operation, at 3 months after operation and at the last follow-up. The fusion rate of intervertebral bone grafting was evaluated by Lenke grading at 3 months after operation. The spinal cord nerve injury was assessed with ASIA classification before operation and at 3 months after operation. Japanese Orthopedic Association (JOA) score was applied to measure the degree of cervical spinal cord dysfunction before operation and at 3 months after operation, and the final follow-up score was used to calculate the rate of spinal cord functional recovery. The occurrence of complications was observed.Results:All patients were followed up for 3-9 months [(6.0±2.5)months]. The reduction success rate was 100%. The operation time was 40-95 minutes [(58.6±9.3)minutes]. The intraoperative blood loss was 40 to 120 ml [(55.7±6.8)ml]. The intervertebral space height was (4.7±0.3)mm and (4.7±0.2)mm at 3 months after operation and at the last follow-up, significantly decreased from preoperative (3.1±0.5)mm (all P<0.01), but there was no significant difference in intervertebral space height at 3 months after operation and at the last follow-up ( P>0.05). The Cobb angle was (6.5±1.3)° and (6.3±1.2)° at 3 months after operation and at the last follow-up, significantly increased from preoperative (-5.4±2.2)° (all P<0.01), but there was no significant difference in Cobb angle at 3 months after operation and at the last follow-up ( P>0.05). The fusion rate of intervertebral bone grafting evaluated by Lenke grading was 100% at 3 months after operation. The ASIA grading was grade A in 15 patients, grade B in 42, grade C in 29, grade D in 12 and grade E in 7 at 3 months after operation. The patients showed varying degrees of improvement in postoperative ASIA grade except that 15 patients with preoperative ASIA grade A had partial recovery of limb sensation but no improvement in ASIA grade. The JOA score was (13.3±0.6)points and (13.1±0.6)points at 3 months after operation and at the last follow-up, significantly improved from preoperative (6.8±1.4)points (all P<0.01), but there was no significant difference in JOA score at 3 months after operation and at the last follow-up ( P>0.05). The rate of spinal cord functional recovery was (66.3±2.5)% at the last follow-up. All patients had no complications such as increased nerve damage or vascular damage. Conclusion:The classified reduction based on CT two-dimensional images for the surgical treatment of single segment facet joint dislocation in subaxial cervical spine has advantages of reduced facet joint dislocation, recovered intervertebral space height and physiological curvature, good intervertebral fusion and improved spinal cord function.

Efficacy evaluation of cluster nursing in robot-assisted surgery for the treatment of reducible atlantoaxial dislocation / 中华创伤杂志

Objective:To explore the effect of cluster nursing in robot-assisted surgery for the treatment of reducible atlantoaxial dislocation.Methods:A retrospective cohort study was conducted to analyze the clinical data of 41 patients with reducible atlantoaxial dislocation treated by robot-assisted surgery in Honghui Hospital affiliated to Xi′an Jiaotong University from January 2019 to December 2021, including 28 males and 13 females; aged 18-79 years [(45.2±10.3)years]. Ninteen patients received cluster nursing (cluster nursing group), with operating room nursing team set up on the basis of routine nursing and performed cluster nursing in line with evidence-based medicine. Twenty-two patients received routine nursing (routine nursing group). The operation time, intraoperative blood loss, frequency of intraoperative C-arm fluoroscopy, time of drainage tube placement and chief surgeon′s satisfaction for nursing were compared between the two groups. The degree of pain was evaluated by pain numerical score (NRS) at 12 hours, 24 hours, 48 hours, 72 hours, 1 month and 3 months after operation and at the last follow-up. The neck disability index (NDI) was assessed at 1 day before operation, 1 month after operation, 3 months after operation and at the last follow-up. The complications were observed.Results:All patients were followed up for 12-18 months [(16.7±3.7)months]. The operation time, intraoperative blood loss, frequency of C-arm fluoroscopy and time of drainage tube placement in cluster nursing group were (82.9±10.4)minutes, (105.9±11.8)ml, (3.8±0.6)times and (1.5±0.4)days, while those in routine nursing group were (125.7±12.8)minutes, (208.4±13.8)ml, (9.7±2.3)times and (3.6±0.6)days, respectively (all P<0.01). The chief surgeon′s satisfaction for nursing was 94.7% (18/19) in cluster nursing group and was 68.2% (15/22) in routine nursing group ( P<0.05). The NRS in cluster nursing group was (6.2±0.4)points, (6.0±0.7)points, (4.9±1.1)points, (2.7±0.5)points, (1.9±0.4)points, (1.8±0.4)points and (1.5±0.3)points at 12 hours, 24 hours, 48 hours, 72 hours, 1 month and 3 months after operation and at the last follow-up, while it was (7.6±0.6)points, (6.8±1.2)points, (5.8±1.5)points, (4.2±0.8)points, (3.4±0.7)points, (2.6±0.5)points and (2.2±0.5)points in routine nursing group ( P<0.05 or 0.01). There was no significant difference in the NDI between the two groups at 1 day before operation, but the NDI in cluster nursing group was 20.6±4.5, 14.6±2.8 and 10.7±2.5 at 1 month and 3 months after operation and at the last follow-up, while it was 26.9±4.1, 18.7±3.3 and 13.7±1.7 in routine nursing group (all P<0.01). There was no hematoma, infection or implant-related complications in both groups .Conclusion:For robot-assisted surgery in the treatment of reducible atlantoaxial dislocation, cluster nursing is associated with shortened operation time and time of drainage tube placement, decreased intraoperative blood loss and frequency of intraoperative fluoroscopy, increased chief surgeon′s satisfaction for nursing, reduced pain and accelerated functional recovery.

Transolecranon fracture-dislocation: concepts and functional results of surgical treatment / Fratura luxação transolecraniana: conceitos e resultados funcionais do tratamento cirúrgico

ABSTRACT Objectives: This study aimed to evaluate the functional results of the treatment protocol for the treatment of transolecranon fracture-dislocation, by surgical reduction and osteosynthesis with plate and screws, in patients attended at a referral hospital for orthopedic trauma, with a minimum follow-up period of six months. Methods: Twenty-five individuals treated surgically from January 2014 to November 2018 were selected for a primary observational longitudinal study using questionnaires to assess upper limb and elbow function (DASH and MEPS), quality of life (SF-12), pain (visual analog scale - VAS), and radiographic evaluation in anteroposterior and lateral views of the elbow. Results: Fifteen patients were male, and the mean age was 46.8 years. All participants had their fractures consolidated, with no radiolgraphic signs of implant failure, or degenerative arthritis. Mean range of motion was reduced relative to the contralateral limb: 102.6º for flexion-extension and 132.8º for pronation-supination. The mean MEPS and DASH scores were 89.6 and 16.5 respectively. There was no residual pain in 84% of the cases according to the VAS. Conclusion: The surgical treatment proposed for transolecranon fracture-dislocations showed satisfactory results according to MEPS, DASH scores and quality of life measures. Evidence Level IV; Retrospective observational study.

RESUMO Objetivo: Avaliar os resultados funcionais do protocolo de tratamento da fratura-luxação transolecraniana, por redução cirúrgica e osteossíntese com placa e parafusos, nos pacientes atendidos em hospital de referência para trauma ortopédico, com seguimento mínimo de seis meses. Métodos: vinte e cinco indivíduos tratados cirurgicamente de janeiro de 2014 a novembro de 2018 foram selecionados para um estudo longitudinal observacional primário, utilizando questionários para avaliar a função do membro superior e cotovelo (DASH e MEPS), qualidade de vida (SF-12), dor (visual escala analógica - EVA), e avaliação radiográfica nas incidências anteroposterior e perfil do cotovelo. Resultados: Quinze pacientes eram do sexo masculino e a média de idade foi de 46,8 anos. Todos os participantes tiveram suas fraturas consolidadas, sem sinais radiográficos de falha do implante ou artrite degenerativa. A amplitude média do movimento foi reduzida em relação ao membro contralateral: 102,6º para flexo-extensão e 132,8º para pronossupinação. Os escores médios de MEPS e DASH foram 89,6 e 16,5, respectivamente. Não houve dor residual em 84% dos casos de acordo com a EAV. Conclusão: O tratamento cirúrgico proposto para a fratura-luxação transolecraniana apresentou resultados satisfatórios de acordo com MEPS, escores DASH e medidas de qualidade de vida. Nível de evidência IV; Estudo observacional retrospectivo.

Surgical treatment of acromioclavicular dislocation: hook plate versus suture button / Tratamento cirúrgico da luxação acromioclavicular: laca de gancho versus botão de sutura

ABSTRACT Objectives: We aimed to compare the functional and radiographical outcomes of reconstruction of acute unstable acromioclavicular joint (ACJ) dislocation using Hook Plate (HP) versus Suture Endobutton (SE) fixation techniques. Methods: Forty-six consecutive patients with grade III to V ACJ dislocation according to Rockwood classification who underwent either HP or SE fixation in the period between January 2017 and June 2020 were evaluated. The treatment modalities were divided into either HP or SE fixation. The radiological assessment included standard anterior-posterior (AP) views to evaluate coracoclavicular (CC) distances for vertical reduction. Results: CC distances were grouped as preoperative (CC1), early postoperative (CC2), and late postoperative (CC3). The distance variance between CC2 and CC3 was referred as ΔCC (CC3 - CC2). A statistically significant difference was found in ΔCC between the two groups (p=0.008). ΔCC was significantly higher in the SE group compared to the HP group (p<0.05). The Constant and UCLA Scores of patients in the SE group were found to be significantly higher than in the HP group patients. Conclusion: Clinical outcomes were more satisfactory in patients with acute unstable ACJ dislocation who underwent SE compared to HP procedures, at the end of the first year. Evidence Level IV; Case Series.

RESUMO Objetivo: Nosso objetivo foi comparar os resultados funcionais e radiográficos da reconstrução da luxação instável aguda da articulação acromioclavicular (ACJ) utilizando técnicas de fixação com placa com gancho (HP) versus botão de sutura (SE). Métodos: 46 pacientes com luxação da ACJ de grau III a V, de acordo com a classificação de Rockwood, que foram submetidos à fixação com HP ou SE no período de janeiro de 2017 a junho de 2020, foram avaliados. As modalidades de tratamento foram divididas em fixação HP ou SE. Na avaliação radiológica, foi utilizada a incidência antero-posterior (AP) para avaliação da redução vertical, por meio da medida da distância córaco-clavicular (CC). Resultados: As distâncias CC foram agrupadas em pré-operatória (CC1), pós-operatória imediata (CC2) e pós-operatória tardia (CC3). A variação da distância entre (CC2) e (CC3) foi denominada ΔCC. Uma diferença estatisticamente significativa foi encontrada na ΔCC entre os dois grupos (p=0,008). O ΔCC foi significativamente maior no grupo SE em comparação com o grupo HP (p <0.05). As pontuações de Constant e UCLA dos pacientes do grupo SE foram significativamente mais elevadas do que as dos pacientes do grupo HP. Conclusão: Os resultados clínicos foram mais satisfatórios com a técnica SE em comparação com a HP ao final do primeiro ano. Nível de Evidência IV; Série de casos.

Treatment of iliac fracture combined anterior dislocation of the sacroiliac joint by the "ladder reduction method" / 中华骨科杂志

Objective:To investigate the clinical effect of "ladder reduction method" in the treatment of iliac fracture combined anterior dislocation of sacroiliac joint.Methods:The retrospective analysis was performed on 10 cases of iliac fracture combined anterior sacroiliac joint dislocation admitted to the Affiliated Hospital of Yunnan University from February 2010 to January 2022, among which 5 cases were males and 5 cases were females, aged ranging from 22 to 52 years, with an average age of 38.8 years. All patients were injured in car accidents including 5 cases of C1.2, 3 cases of C2, and 2 cases of C3 fractures according to Tile classification. All patients were treated with the "ladder reduction method" with plate and screw fixation. In the first step, 1-2 Schanz pins were inserted into the iliac crest to control the ilium, and the Schanz pins were appropriately pulled laterally; in the second step, the periosteal stripper was used to pry the reduction between the sacrum and ilium; in the third step, for the patients who still could not be reduced, a 2.5 mm diameter Kirschner wire was placed on the sacrum close to the iliac crest, and a periosteal stripper was inserted between the sacrum and iliac crest, with its tip against the Kirkner wire, and the iliac crest as the fulcrum for pry pulling to separate the two. In the fourth step, the pry was maintained, and then another 2.5 mm diameter Kirschner wire was placed on the sacrum close to the internal margin of the iliac bone. The periosteal stripper was continued to pry between the sacrum and the iliac bone, and the operation was repeated. At the same time, the anterior dislocation of the sacroiliac joint was reduced with traction of the lower limb. Postoperatively, the quality of reduction was evaluated by the Matta score, and the degree of functional recovery after pelvic fracture was evaluated by the Majeed score.Results:Four patients completed the reduction through the first and second steps, and 6 cases of refractory sacroiliac joint anterior dislocation were successfully reduced through the first to fourth steps. The fracture reduction time of 6 patients with refractory anterior sacroiliac joint dislocation was 39.67±3.09 min (range, 35-44 min), with intraoperative blood loss of 300.00±141.42 ml (range, 150-600 ml); in the other 4 cases, the fracture reduction time was 36.75±4.38 min (range, 30-42 min), and the intraoperative blood loss was 225.00±44.30 ml (range, 200-300 ml). All 10 patients were followed up for 12.9±3.7 months (range, 9-20 months). The anterior and posterior pelvic ring fractures were healed in all patients, and the fracture healing time was 12.77±1.62 weeks (range, 10.71-15.28 weeks). At the last follow-up, Matta evaluation was excellent in 5 cases, good in 1 case, and excellent in the other 4 cases. The Majeed scores of 6 cases were 86.50±6.08 points (range, 74-92 points), of which 5 cases were excellent and 1 case was good. The other 4 cases were 81.5±9.39 scores (range, 71-94), of which 2 were excellent and 2 were good.Conclusion:The "ladder reduction method" is a safe, effective and easy-to-operate method for the treatment of iliac fracture combined anterior dislocation of the sacroiliac joint, especially for refractory anterior dislocation of the sacroiliac joint, which can still obtain satisfactory curative effects.

Comparison of therapeutic effects between anatomical reconstruction of the coracoclavicular ligament at the original insertion point and clavicular hook plate fixation in the treatment of acromioclavicular joint dislocation / 中华骨科杂志

Objective:To compare the clinical efficacy of anatomical reconstruction of coracoclavicular ligament at the original insertion point and clavicular hook plate fixation in the treatment of acromioclavicular joint dislocation.Methods:Retrospective analysis was made on the data of 67 patients with acromioclavicular joint dislocation who received surgical treatment in the Department of Orthopaedics of the First Affiliated Hospital of Nanjing Medical University from June 2015 to January 2021. According to the surgical method, they were divided into reconstruction group (using the technique of anatomical reconstruction of coracoclavicular ligament at the original insertion point) and hook plate group (using the clavicular hook plate). There were 37 cases in the reconstruction group, including 26 males and 11 females, aged 47.2±9.6 years (range, 18-65 years), 13 cases on the left and 24 cases on the right. Among the 37 patients, 8 were sports injuries, 14 were falls, 11 were traffic accidents, and 4 were external force injuries. The average time from injury to surgery was 8.3±2.3 days. There were 30 cases in the hook plate group, including 24 males and 6 females, aged 47.4±9.7 years (range, 18-67 years), 12 cases on the left and 18 cases on the right. Among the 30 patients, 7 were sports injuries, 11 were falls, 9 were traffic accidents, and 3 were external force injuries. The average time from injury to surgery was 7.9±2.6 days. The surgical time, incision length, intraoperative bleeding, hospital stay, postoperative coracoclavicular separation ratio, and postoperative complications were compared between the two groups. Constant-Murley score and visual analog scale (VAS) were used to assess the shoulder joint function and pain degree of patients.Results:Both groups of patients were followed up, with a follow-up time of 12.3±0.4 months for the reconstruction group and 12.2±0.5 months for the hook plate group. The operation time (105.8±10.0 min), incision length [12.0 (11.0, 13.0) cm] and hospitalization time (6.8±2.1 d) in the reconstruction group were longer than those in the hook plate group [48.3±4.9 min, 10.0 (10.0, 11.0) cm, and 5.5±2.7 d], while the intraoperative blood loss (75.1±3.9 ml) was less than that in the hook plate group (90.3±6.3 ml), the differences were statistically significant ( P<0.05). The VAS [4.0 (3.0, 5.0), 3.0 (3.0, 3.0), 2.0 (1.0, 2.0) points] and Constant-Murley score (65.4±4.5, 84.9±2.5, 90.1±2.5 points) of the reconstruction group at 3 days, 3 months, and 12 months after surgery were better than those of the hook plate group [5.0 (4.0, 5.0), 4.0 (4.0, 4.0), 3.0 (3.0, 4.0) and 56.9±3.5, 79.6±4.0, 86.8±2.4 points], the difference was statistically significant ( P<0.05). At the last follow-up, there was a statistically significant difference in the separation ratio of coracoclavicular distance between the reconstruction group (0.12±0.08) and the hook plate group 0.22±0.15 ( t=3.25, P=0.002). There was no significant difference ( Z=-0.52, P=0.605) in the separation ratio of acromioclavicular distance [0.16 (0.05, 0.25) and 0.16 (0.04, 0.40)]. In the hook plate group, 6 cases had shoulder joint foreign body sensation and 2 cases had acromioclavicular joint redislocation (both Rockwood type III). Because the shoulder joint function did not affect their daily life, neither patient underwent secondary surgery. And no case of acromioclavicular joint redislocation occurred in the reconstruction group. Conclusion:Compared with the clavicular hook plate fixation, anatomic reconstruction of coracoclavicular ligament at the original insertion point in the treatment of acromioclavicular joint dislocation can reduce the pain of the shoulder joint earlier, which has the characteristics of small trauma, good effect, and reduces the steps of internal fixation removal, and has good clinical curative effect.

The hip in cerebral palsy: surveillance and timely surgical intervention can prevent painful hip dislocation / 中华骨科杂志

Cerebral palsy is the most common childhood-onset neuromuscular disorder creating lifelong physical disabilities. It affects about 1 in 500 neonates with an estimated worldwide prevalence of 17 million. Cerebral palsy is not a specific disease, but a spectrum of clinical symptoms of permanent abnormalities of the development of movement and posture caused by non-progressive disturbances in a developing fetal or infant brain. Various musculoskeletal disorders are caused by cerebral palsy, hip displacement is one of the most common deformities, second only to equinus deformities of the foot and ankle.Based on the review of previous literatures, this paper summarized the pathophysiology, clinical symptoms, relationship with the gross motor functionclassification and orthopedic treatment of hip displacement in cerebral palsy. Hip displacement in cerebral palsy is mainly caused by the lack of normal stress stimulation in the early childhood and the continuous asymmetric muscle tone and muscle strength around the hip joint. Early hip displacement in cerebral palsy is usually asymptomatic, but without timely intervention hip subluxation/dislocation will cause hip pain and hip motion limitation and thus influence the patient's activity ability and increase the difficulty of daily caring. Hip displacement in cerebral palsy is closely related to the gross motor functionclassification, and the higher the classification of gross motor, the greater the risk of displacement, and hip monitoring can significantly reduce the incidence of hip dislocation. Therefore, a consensus has been reached that a standardized hip surveillance programs and timely intervention are important to prevent the occurrence of hip dislocation and pain. The surgical strategies for hip displacement in CP can be divided into three types: preventive surgery, reconstructive surgery and salvage surgery.

Axial instrument strategy for atlantoaxial dislocation with complex artery variation / 中华骨科杂志

Objective:To evaluate the axial instrument strategy for atlantoaxial dislocation with complex vertebral artery variation.Methods:A total of 55 patients with atlantoaxial dislocation who underwent surgical treatment from January 2019 to December 2021 were retrospectively analyzed, including 14 males and 41 females, aged 54.0±12.8 years (range, 22-78 years). Among these patients, 10 patients with unilateral vertebral artery high ride with contralateral vertebral artery occlusion, 30 patients with bilateral vertebral artery high ride with single dominant vertebral artery, 15 patients with bilateral vertebral artery high ride. All patients underwent posterior reduction and internal fixation. Visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score were used to evaluate the postoperative efficacy.Results:All patients completed the surgery successfully with a follow-up time of 14.6±5.5 months (range, 6-24 months). C 2 pedicle screw fixation was performed on the non-dominant side of unilateral vertebral artery high ride and the non-dominant side of bilateral vertebral artery high ride with one dominant vertebral artery (40 vertebraes). The dominant side of unilateral high vertebral artery and bilateral high vertebral artery with one dominant vertebral artery was fixed with C 2 medial "in-out-in" screw (10 vertebraes), C 2 isthmus screw (21 vertebraes), C 2 without screw (9 vertebraes) only extended the fixed segment. For bilateral vertebral artery high ride patients, one side was used C 2 "in-out-in" pedicle screws (right 10 vertebraes, left 5 vertebraes), and the other side was fixed with C 2 medial "in-out-in" screw (8 vertebraes), C 2 isthmus screw (5 vertebraes), C 2 without screw only extended the fixed segment (2 vertebraes). The JOA scores were 8.5±1.8, 13.9±1.3, and 14.4±1.1 preoperatively, 6 months postoperatively, and at the final follow-up, respectively, with statistically significant differences ( F=279.40, P<0.001). JOA at 6 months postoperatively and at the final follow-up was greater than preoperatively, and the differences were statistically significant ( P<0.05), whereas the differences in JOA scores at 6 months postoperatively and at the final follow-up was not statistically significant ( P>0.05). Preoperative, 6 months postoperatively and final follow-up cervical VAS scores were 3.7±1.9, 2.1±0.9 and 1.6±1.0, respectively, with statistically significant differences ( F=39.53, P<0.001). The cervical VAS at 6 months postoperatively and at the last follow-up was less than that before surgery, and the differences were statistically significant ( P<0.05). Cervical VAS scores at 6 months postoperatively were greater than at the last follow-up, with a statistically significant difference ( P<0.05). Conclusion:For patients with atlantoaxial dislocation with complex vertebral artery variation, C 2 lateral "in-out-in" screw, C 2 medial "in-out-in" screw, isthmus screw fixation or C 2 without screw only extended the fixed segment can obtain good clinical efficacy.

Evaluar los resultados funcionales, radiológicos y las complicaciones en el tratamiento quirúrgico de las fracturas acetabulares bilaterales / Functional, radiological results and complications evaluation in the surgical treatment of bilateral acetabular fractures

Las Fracturas Acetabulares bilaterales tienen una incidencia extremadamente baja. El objetivo es evaluar los resultados funcionales, radiológicos y las complicaciones en el tratamiento quirúrgico de las fracturas acetabulares bilaterales. Este estudio se basa en datos de 722 Fracturas de Acetábulo tratadas por el autor principal durante 15 años desde enero de 2005 a septiembre de 2020. Se realizó un estudio descriptivo y retrospectivo. Se incluyeron 13 casos correspondientes al 1,8% del universo. El 72,7% de las fracturas se presentaron por accidentes de tránsito, el 69,3% corresponden a fracturas de patrón asociado en relación con el 30,7% de fracturas de patrón simple. En el 56,5% se realizó abordaje de Kocher Langenbeck. La reducción anatómica se logró en el 92,30%, en el 7,69% la reducción no fue satisfactoria. Para la evaluación funcional se utilizó el HHS, 88,46% reportaron buenos resultados y 11,53% insatisfactorios. Respecto a las complicaciones, 7,69% presentaron osteoartrosis Tönnis II y 7,69% neuroapraxia del nervio ciático izquierdo. Se encontró supervivencia del 100%. El tiempo ideal para la resolución quirúrgica es antes de las 3 semanas. Los resultados radiológicos y funcionales están directamente relacionados al tiempo de fijación, es importante tomar en cuenta que debido a la magnitud de la energía del impacto que se transmite por ambos acetábulos los patrones de fractura que coexisten entre ambas superficies articulares son diferentes, por lo que optimizar la planificación preoperatoria es fundamental(AU)

Bilateral Acetabular Fractures have an extremely low incidence. The objective is to evaluate the functional and radiological results and the complications in the surgical treatment of bilateral Acetabular Fractures. This study is based on a data of 722 acetabulum fractures cases treated by the lead author for over 15 years from january 2005 to september 2020. A descriptive, retrospective study was made. 13 cases corresponding to 1,8% of the universe were included. 72,7% of the fractures occurred due to traffic accidents, 69,3% correspond to associated pattern fractures in relation to 30,7% of simple pattern fractures. In 56,5% the Kocher Langenbeck approach was performed. The anatomical reduction was achieved in 92,30%, in 7,69% the reduction was not satisfactory. The functional result was evaluated according to the HHS, obtaining good results in 88,46% of the cases and unsatisfactory results in 11,53%. Regarding complications, we found 7,69% with Tönnis II osteoarthrosis, 7,69% with neuropraxia of the left sciatic nerve. Successful results with 100% survival were found. The ideal time for surgical resolution is before 3 weeks. The radiological and functional results are directly related to the fixation time. It is important to take into account that due to the magnitude of the impact energy that is transmitted by both acetabulums, the fracture patterns that coexist between both articular surfaces are different, so optimizing preoperative planning is essential(AU)

Eminoplastía con Injerto de Mentón. Una Alternativa de Tratamiento para la Luxación Crónica Recidivante De la Articulación Temporomandibular

La luxación de la articulación temporomandibular (ATM) implica un desplazamiento no autolimitado del cóndilo fuera de sus posiciones funcionales dentro de la fosa glenoidea y vertiente posterior de la eminencia articular. La luxación de la ATM representa el 3 % de todos los casos de articulaciones dislocadas reportadas en el cuerpo. La ATM es más flexible en las mujeres y, por lo tanto, más propensas a luxarse. Las luxaciones crónicas incluyen luxaciones agudas que no son autolimitadas y progresan sin tratamiento, además de las luxaciones crónicas recidivantes, en las que los individuos experimentan múltiples luxaciones como resultado de las actividades cotidianas. Independientemente del subtipo, la luxación crónica se puede manejar mediante modalidades de tratamiento quirúrgico o no quirúrgico. Las intervenciones quirúrgicas/invasivas tienen como objetivo la modificación anatómica de la eminencia, el cóndilo o los tejidos musculo capsulares. Reportamos el caso de una paciente femenina de 75 años de edad, quien ingresa al servicio de Cirugía Oral y Maxilofacial del Hospital de Traumatología y Ortopedia "Dr. Victorio de la Fuente Narváez" del Instituto Mexicano de Seguridad Social de la Ciudad de México por presentar luxación mandibular recidivante del lado izquierdo desde hace 3 años. Se decide realizar eminoplastía con injerto de mentón como tratamiento quirúrgico definitivo para esta condición obteniendo excelentes resultados funcionales hasta después de un año de seguimiento.

Temporomandibular joint (TMJ) dislocation involves a non-self-limited displacement of the condyle out of its functional positions within the glenoid fossa and posterior aspect of the articular eminence. TMJ dislocation accounts for 3 % of all reported dislocated joint cases in the body. The TMJ is more flexible in women and therefore more prone to dislocation. Chronic dislocations include acute dislocations that are not self-limiting and progress without treatment, as well as recurrent chronic dislocations, in which individuals experience multiple dislocations as a result of daily activities. Regardless of the subtype, chronic dislocation can be managed by surgical or non-surgical treatment modalities. Surgical/invasive interventions aim at anatomical modification of the eminence, condyle, or musculocapsular tissues. We report the case of a 75-year-old female patient who was admitted to the Oral and Maxillofacial Surgery service of the Hospital de Traumatología y Ortopedia "Dr. Victorio de la Fuente Narváez" in Mexico City for presenting recurrent mandibular dislocation on the left side for 3 years. It was decided to perform eminoplasty with chin graft as a definitive surgical treatment for this condition, obtaining excellent functional results up to one year of follow-up.

Luxação dorsal complexa da articulação metacarpofalangeana dos dedos longos: relato de caso e revisão da literatura / Complex dorsal dislocation of the metacarpophalangeal joint of the long fingers: case report and literature review

As luxações dorsais da articulação metacarpofalangeana dos dedos são lesões raras, vistas com mais frequência em pacientes jovens, secundárias a trauma por hiperextensão forçada do dedo na mão que estende. São classificadas como simples, quando a redução fechada é possível; ou complexas, quando a redução por métodos fechados não é possível devido à interposição de estruturas periarticulares. É importante distinguir entre uma luxação simples e uma complexa porque sua abordagem e tratamento são diferentes. O objetivo deste estudo é atualizar a abordagem clínica e as diferentes técnicas cirúrgicas utilizadas no tratamento das luxações complexas. Foi realizada uma revisão bibliográfica sobre a luxação dorsal metacarpofalangeana dos dedos longos, excluindo os do polegar, incluindo o Medline (interface PubMed), SciELO e bancos de dados acadêmicos do Google. Todos os artigos revisados concluem que as tentativas de redução incruenta nesses tipos de lesões costumam ser malsucedidas e levar a complicações adicionais. A redução cirúrgica aberta é o método de escolha, permitindo a recuperação anatômica articular com o menor risco de complicações. A imobilização pós-operatória com uma tala de travamento dorsal é recomendada por duas semanas, seguida por reabilitação por terapia ocupacional, esperando-se uma amplitude de movimento normal em seis semanas. A baixa frequência somada ao desconhecimento do médico emergencista ao realizar a manobra de redução pode, muitas vezes, levar à transformação de um simples deslocamento em complexo, tornando-o irredutível e lesionando estruturas adjacentes, por isso, acreditamos ser fundamental conhecer o manejo desta lesão.

Dorsal dislocations of the metacarpophalangeal joint of the fingers are rare injuries that are seen more frequently in young patients secondary to trauma due to forced hyperextension of the finger on the extending hand. They are classified as simple when closed reduction is possible, or complex when reduction by closed methods is not possible given the interposition of peri-articular structures. It is important to distinguish between a simple and complex dislocation because their approach and treatment differ. The objective of this study is to update the clinical approach and the different surgical techniques used in the treatment of complex dislocations. We conducted a bibliographic review on metacarpophalangeal dorsal dislocation of the long fingers, excluding those of the thumb, including the Medline (PubMed interface), SciELO and academic google databases. All the articles reviewed conclude that attempts at closed reduction in these types of injuries are often unsuccessful and often lead to additional complications. Open surgical reduction is the method of choice, allowing joint anatomical recovery with the lowest risk of complications. Postoperative immobilization using a dorsal locking splint is recommended for two weeks followed by rehabilitation by occupational therapy, expecting a normal range of motion at six weeks. The low frequency added to the ignorance of the emergency physician when performing the reduction maneuver can often lead to transform a simple dislocation into a complex one, making it irreducible and injuring adjacent structures, which is why we believe it is essential to know the management of this injury.

Isolated distal pisiform dislocation: Case Report / Luxação distal isolada do pisiforme: Relato de caso

Abstract Isolated pisiform dislocation is a rare lesion with few cases described in the literature. This type of lesion is typically observed in young males and can be easily overlooked at first assessment. Isolated proximal dislocation is more common due to the action of the flexor carpi ulnaris (FCU) muscle. We present the case of a 19-year-old male patient with isolated distal pisiform dislocation after wrist trauma. He underwent open reduction and internal fixation with Kirschner wires with excellent functional outcomes. Although there is no consensual therapeutic method, closed reduction is a first-line treatment for acute presentations. Pisiform open reduction or excision may be performed alternatively or after a failed closed reduction.

Resumo A luxação isolada do pisiforme é uma lesão rara com poucos casos descritos na literatura. Esse tipo de lesão é observado tipicamente em adultos jovens do sexo masculino e pode ser facilmente negligenciada numa primeira avaliação. A luxação proximal isolada é mais comum devido à ação do flexor ulnar do carpo (FUC). Apresentamos o caso de um paciente do sexo masculino, com 19 anos de idade, com luxação distal isolada do pisiforme após traumatismo do punho. O paciente foi submetido a uma redução aberta e fixação interna com fios de Kirschner com excelente resultado funcional. Apesar de não existir um método de tratamento consensual, a redução fechada perfila-se como tratamento de primeira linha na apresentação aguda. Em caso de insucesso ou como método alternativo pode-se optar pela redução aberta ou a excisão do pisiforme.

A clinical study of posterior-medial dislocation of elbow joint / 中华骨科杂志

Objective:To analyze the clinical characters and results of the posteromedial dislocation of elbow.Methods:From January 2014 to March 2016, a retrospective observational study of 15 patients with posteromedial elbow dislocations was performed. There were twelve males and three females, the mean age was 44 years old (23-64 years old). There were fourteen complex dislocations and one simple dislocation. The signs of posteromedial dislocation included changes of carry angle and varus deformity. Dimple signs were found in 8 patients. Conservative treatment was used in two cases (one simple dislocation and one complex disclocation). Operative treatment was performed in the other 13 cases with complex dislocations, in which five were fixed by hinged external fixator due to instability. The ranges of elbow and forearm movement, visual analogue score (VAS) and Mayo elbow performance score (MEPS) were recorded before treatment and at the last visit after average 18 months (17-21 months) of follow-up.Results:Before treatment, the average arc of extension-flexion was 9.3°±1.3° (5°-15°), the average range of forearm pronation was 6.4°±1.4° (0°-10°), supination was 4.3°±1.7° (0°-10°); VAS averaged 8±0.3 scores (7-9 scores); MEPS averaged 15.7±4.3 scores (5-35 scores). At the last follow up, the average arc of extension-flexion was 105°±5.2° (90°-130°), the average range of forearm pronation was 60°±8.5° (20°-80°), supination was 76°±9.5° (20°-90°); VAS averaged 0.4±0.2 scores (0-1 score); MEPS averaged 95.7±2.3 scores (85-100 scores). Significant different was found in all index by paired t test ( P<0.001). No instability of elbow was found in physical and radiology test in all follow-up visit. Conclusion:Posteromedial dislocation of elbow is rare in clinics, closed reduction can be always successful in simple dislocations; open reduction would be necessary in the majority of complex dislocations. However, relatively satisfied clinical results could be achieved.

Research progress of causes and strategies in revision surgery for atlantoaxial dislocation / 中国骨伤

Atlantoaxial dislocation (AAD) is a kind of life-threatening atlantoaxial structural instability and a series of neurological dysfunction caused by common multidisciplinary diseases. The operation risk is extremely high because it is adjacent to the medulla oblongata and the location is deep. With the increase of the number of operations in the upper cervical region, postoperative complications such as failure of internal fixation, non fusion of bone graft and poor prognosis gradually increase.Incomplete primary operation, non fusion of bone graft, infection and congenital malformation are the potential causes. In addition, considering the objective factors such as previous graft, scar formation and anatomical marks changes, revision surgery is further difficult. However, there is currently no standard or single effective revision surgery method. Simple anterior surgery is an ideal choice in theory, but it has high risk and high empirical requirements for the operator;simple posterior surgery has some defects, such as insufficient reduction and decompression;anterior decompression combined with posterior fixation fusion is a more reasonable surgical procedure, but many problems such as posterior structural integrity and multilevel fusion need to be considered.This article reviews the causes and strategies of AAD revision surgery.

Treatment of acromioclavicular joint dislocation with double Endobutton internal fixation assisted by orthopaedic robot / 中华骨科杂志

Objective:To investigate the early clinical effects of orthopedic surgery robot-assisted double Endobutton titanium plate internal fixation in the treatment of fresh acromioclavicular joint dislocation.Methods:Thirty-nine patients with fresh acromioclavicular joint dislocation were included from January 2020 to January 2022. A total of 19 patients were treated with double Endobutton suspension internal fixation assisted by the domestic third-generation orthopaedic surgical robot (TiRobot ? 2.0) Dimensity system. There were Rockwood type III in 11 cases, type IV in 8 cases. Twenty cases were treated with conventional incision double Endobutton internal fixation, with Rockwood type III in 13 cases, type V in 7 cases. The operation duration, blood loss volume, incision length and hospitalization time were compared between the two groups. The following CT parameters of acromioclavicular joint at 2 days and 1 year after operation, distance between distal inferior cortex of clavicle and subacromial cortex, distance between upper and lower endobuttons, horizontal distance between anterior edge of distal clavicle and anterior edge of acromion and diameter of coracoid process and diameter of clavicular tunnel were measured. The visual analogue score (VAS), Constant-Murley shoulder function score and shoulder abduction activity were also evaluated before and at 12 months after operation. Results:The follow-up duration was 10.8±2.4 months in the robot group and 11.5±3.1 months in the routine group. The VAS score of the robot group decreased from 5.3±2.1 to 0.3±0.2 at 12 months after operation ( t=10.46, P=0.014). The Constant-Murley score increased from 55.6±6.4 to 92.0±4.2. The range of shoulder abduction increased from 42.2°±5.4° to 172.6°±6.1° ( t=17.24, P<0.001). The operation duation of the robot group was 74.4±6.6 min, which was longer than that of the conventional group 61.7±7.2 min ( t=5.43, P=0.037). There was no significant difference in VAS score, Constant-Murley score, shoulder abduction activity or CT measurement between the two groups ( P>0.05). During the follow-up, two cases in the robot group had cortical osteolysis on the supraclavicular surface, one case in the conventional group had loss of reduction, one case in the supraclavicular cortical osteolysis, and 4 cases in the cortical defect on the side of the coracoid process tunnel. Conclusion:Orthopedic robot-assisted and conventional incision with double Endobutton titanium plate internal fixation in treating fresh acromioclavicular joint dislocation can achieve satisfied early clinical effects. Accurate establishment of clavicle and coracoid bone tunnel assisted by robot can overcome the defects of bone tunnel deviation in conventional incision operation and can prevent reduction and bone loss. However, robot-assisted and conventional incision Endobutton internal fixation could enlarge bone tunnel.

Radiocarpal fracture dislocations: a new classification and treatment proposal / Fratura-luxação radiocárpica: nova classificação e proposta de tratamento

ABSTRACT Introduction The radiographic and surgical findings, and treatment of radiocarpal fracture dislocations, were analyzed retrospectively in 40 patients. Materials and Methods All patients were classified according to Dumontier´s radiological classification and compared with the surgical findings. Based on this analysis, a new classification and treatment are proposed. Results From 1995 to 2018, 40 patients with radiocarpal fracture dislocation underwent surgery. Thirty-six were males and four were females. The mean age was twenty-four years (range: 18-45). Three dislocations were volar dislocations and 37 were displaced dorsally. Initially, 8 (20%) patients were classified as group I, 29 (72.5%) as group II, and 3 (7.5%) remained unclassified. The main variations occurred in group II. Seven fractures were stable after radial styloid fixation and 6 remained unstable. Sixteen fractures presented articular fragments or an interposed capsule, which prevented anatomical reduction using conservative maneuvers. Conclusion Based in our intraoperative observations and surgical results, we believe that a more detailed classification should be adopted. Level of Evidence IV; Therapeutic Studies; Case Series.

RESUMO Introdução Os achados radiográficos, cirúrgicos e o tratamento das fraturas-luxações radiocárpicas foram analisados retrospectivamente em 40 pacientes. Materiais e Métodos Todos os pacientes foram classificados de acordo com a classificação radiológica de Dumontier e comparados com os achados cirúrgicos. Com base nessa análise, uma nova classificação e tratamento são propostos. Resultados De 1995 a 2018, 40 pacientes com fratura-luxação radiocárpica foram submetidos à cirurgia. Trinta e seis eram homens e quatro mulheres. A média de idade foi de vinte e quatro anos (variação de 18 a 45). Três luxações eram volares e 37 dorsais. Inicialmente, 8 (20%) pacientes foram classificados como Grupo I, 29 (72,5%), como Grupo II e 3 (7,5%), permaneceram sem classificação. As variações principais ocorreram no Grupo II. Sete fraturas permaneceram estáveis depois da fixação da estiloide radial e 6 permaneceram instáveis. Dezesseis fraturas apresentaram fragmentos articulares ou cápsula interposta que impediu a redução anatômica por manobras conservadoras. Conclusões Com base em nossas observações intraoperatórias e nos resultados cirúrgicos, acreditamos que uma classificação mais detalhada deva ser adotada. Nível de evidência IV;Estudos Terapêuticos; Série de casos.

Bifocal Stabilisation of Acute Acromioclavicular Joint Dislocation using Suture Anchor and Temporary K-Wires: A Retrospective Analysis

@#Introduction: The acromioclavicular joint (ACJ) is a major link connecting the upper limb to the torso. The acromioclavicular and coracoclavicular (CC) ligaments help in stabilising the joint. We feel it is prudent to address both these ligament injuries, to achieve optimum result. This study was undertaken to analyse the results of a simple frugal surgical technique we used to deal with this injury considering stabilisation for both these ligaments. Materials and methods: In this retrospective study, skeletally mature patients with Type III, IV or V ACJ dislocations who underwent open reduction and stabilisation of the joint with temporary K-wires, repair of the capsule and augmentation of CC ligaments with suture anchors were included. Clinico-radiological and functional outcome was evaluated. Functional assessment of the upper limb was analysed using the Disabilities of Arm, Shoulder, and Hand Score (DASH), Constant shoulder score (CSS) and Oxford shoulder score (OSS). Results: Clinical and radiological evaluation of the 32 patients who had completed two years from the index surgery, was done. Out of the 37 patients included initially, five were lost in follow-up. Majority of the subjects included were males and type V was the most common injury. Mean pre-operative CC distance on the affected side was 13.92±4.94mm. In the immediate post-operative radiograph, it was 7.63±2.08mm and in the final follow- up was 9.36±2.75mm. Measurements were taken by two independent investigators and inter, and intra-observer reliability were analysed by Interclass correlation coefficient. Excellent functional outcome was noted despite the 1.81±1.50mm average loss of correction. At final followup, mean DASH score was 4.67±4.18, Oxford shoulder score was 44.06±2.44 and Constant shoulder score was 86.37±5.81. The severity of the injury had no significant effect on the functional outcome post our method of stabilisation and rehabilitation. Conclusion: Bifocal fixation restores the multidirectional stability of the disrupted ACJ. Adequate radiological reduction, good functional outcome and simplicity of execution make this technique an undemanding one for use in regular practice.