ABSTRACT
The disruption of the acromioclavicular joint is a relatively common injury of the shoulder girdle, often occurring in young athletes. The therapy of third degree injuries (Tossy III or Rockwood III-VI) is still controversial, and several operative techniques are practiced. In a retrospective study, 28 (= 72%) of the total number of 39 cases with a Tossy III disruption operated in our hospital between January 1998 until December 2002 with a hook plate according to Dreithaler were followed up. The average reexamination interval was 3.0 years (range 1.2-5.6 years) after surgery. Special emphasis was laid upon the question, if the hook had any effects on the subacromial space. The study included clinical, sonographic and MRI examinations of both shoulders in direct side-to-side comparison. About 86% of the patients were satisfied with the functional outcome, but only 54% with the cosmetic result. This was mostly due to remaining elevation of the lateral clavicula and heterotopic ossifications around the acromioclavicular joint, which were found in 43% of the patients without any functional deficit. The outcome-scores (DASH, Taft, Constant-Murley) yielded on the whole very good and good results. Instability of the AC-joint under load was found in seven patients, in three of these instability was severe, and two patients had a chronic subluxation with functional impairment.The sonographic investigation revealed no specific lesions of the rotator cuff in any patient. Age related degenerative changes were seen in 46%, however, the accentuation of the operated side was only 14%. In MRI there was no case of a complete rotator cuff tear. Corresponding to the sonographic examination increased numbers of exostoses, heterotopic ossifications, and arthrosis of the AC-joint were observed.
ABSTRACT
INTRODUCTION: While most fractures of the distal radius can be treated successfully by conservative means, some fractures-especially the more complicated fracture types-require surgical fixation. One of the operative techniques is plate osteosynthesis, which can be performed in either a dorsal or a palmar plate position. MATERIALS AND METHODS: This study reports on 122 fractures of the distal radius treated by open reduction and internal fixation with the T-plate, investigating the long-term outcome after an average period of 42.4 months. The follow-up examination contained a subjective, a clinical and a radiological part, and the results were evaluated according to the scores of Stewart and of Castaing with special emphasis on the question of whether palmar or dorsal plating showed any differences in outcome, and if so, what they were. RESULTS: The radiological results (Stewart 1 score; i.e. the anatomical reduction) were "excellent" or "good" in 87.7% of cases. There were significant differences with respect to age, gender and plate position: patients older than 80 years and women had significantly worse results, and dorsal plating was significantly better than palmar plating. The functional outcome (Stewart 2 score) was"excellent" and 'good' in 90.2% of cases. These functional results showed a tendency for dorsal plating to be better, but the differences were not significant. There was a close correlation between the radiological and the clinical findings. With the Castaing score, which combines both functional and radiological outcomes, there were 73.8% perfect and good results. CONCLUSION: This study shows that the majority of patients with problem fractures of the distal radius can be successfully treated by internal fixation using the T-plate. The dorsal approach to the distal radius--in cases where dorsal plating is appropriate--will result in a better anatomical reduction and clinical outcome.
