Surgical treatment of chronic acromioclavicular joint dislocation with autogenous tendon grafts.

BACKGROUND: Conservative treatment of acromioclavicular (AC) joint dislocation is not always successful. A consequence of persistent AC joint dislocation may be chronic pain and discomfort in the shoulder region as well a sensation of constant AC joint instability and impaired shoulder function. Stabilization of the AC joint may reduce these sequels. MATERIALS AND METHODS: Due to chronic AC joint dislocation, 39 patients in our hospital underwent coracoclavicular (CC) ligament reconstruction with autogenous semitendinosus and gracilis tendons between May 2005 and April 2011. We examined 25 patients after a mean of 4.2 years. The outcomes were Constant shoulder Score (CS), Disabilities of the Arm, Shoulder and Hand (DASH), pain (Visual Analog Scale, VAS), cross-arm test, stability of the AC joint, and complications. The follow-up visits included anteroposterior and axillary radiographs. RESULTS: Mean CS was 83 in the injured shoulder and 91 in the uninjured shoulder (p = 0.002). Mean DASH was 14. In 14 patients, the AC joint was clinically stable; pain was minor. In radiographs, osteolysis of the lateral clavicle and tunnel widening were markedly common. Fracture of the coracoid process occurred in 5 patients, and 3 suffered a fracture of the clavicle; 2 had a postoperative infection. CONCLUSIONS: Anatomic reconstruction of CC ligaments showed a moderate subjective outcome at the 4-year follow-up. After surgery, almost half the AC joints failed to stabilize. Lateral clavicle osteolysis and tunnel widening were notably common complications.

Surgical treatment of Rockwood grade-V acromioclavicular joint dislocations: 50 patients followed for 15­22 years.

BACKGROUND AND PURPOSE: Long-term outcome after surgery for grade-V acromioclavicular joint dislocation has not been reported. We performed a retrospective analysis of functional and radiographic outcome 15-22 years after surgery. PATIENTS AND METHODS: We examined 50 patients who were treated at our hospital between April 1985 and December 1993. Various methods of stabilization were used: K-wires (n = 36), 4.5-mm screw (n = 12), or biodegradable screw (n = 2). Osteosynthesis material was removed after 6-8 weeks. Mean follow-up time was 18 (15-22) years. Outcomes were assessed with the Constant shoulder (CS) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, the simple shoulder test (SST), the Copeland shoulder impingement test, the cross-arm test, pain, stability of the AC joint, and complications. From radiographs, we evaluated AC and glenohumeral (GH) arthrosis, osteolysis of the lateral clavicle, and alignment of the clavicle with the acromion. RESULTS: Mean values were 90 (75-100) in CS score, 5.1 (0-41) in DASH score, and 11 (2-12) in SST. There was no statistically significant difference in CS score between the injured shoulder and the uninjured shoulder. The AC joint was clinically stable in 42 patients. In 38 patients, the clavicle alignment with the acromion was normal in radiographs. Lateral clavicle osteolysis (10 patients) appeared to be associated with permanent AC joint dislocation. INTERPRETATION: Surgery with a temporary fixation for acute grade-V AC joint dislocation leads to successful long-term functional results. Only minor disability occurred in some patients.

Sling compared with plate osteosynthesis for treatment of displaced midshaft clavicular fractures: a randomized clinical trial.

BACKGROUND: Few randomized controlled trials have compared operative with nonoperative treatment of clavicular fractures. METHODS: Patients with displaced midshaft clavicular fractures were randomized either to nonoperative treatment with a sling or to operative treatment with a stainless steel 3.5-mm reconstruction plate. Outcome measures were the Constant shoulder score, DASH (Disabilities of the Arm, Shoulder and Hand) score, pain, fracture-healing, and complications. The null hypothesis was that the Constant and DASH scores would not differ between the groups at the one-year follow-up evaluation. RESULTS: In accordance with the power analysis, we included sixty patients in the study; thirty-two were randomized to the nonoperative group and twenty-eight to the operative group. We found no difference in the Constant score (p = 0.75), the DASH score (p = 0.89), or pain (p = 0.98) between the groups at the one-year follow-up evaluation. All fractures in the operative group healed, but six nonunions (24%) occurred in the nonoperative group. CONCLUSIONS: One year after a displaced midshaft clavicular fracture, nonoperative treatment resulted in a higher nonunion rate but similar function and disability compared with operative treatment.

Arthrosis of glenohumeral joint after arthroscopic Bankart repair: a long-term follow-up of 13 years.

HYPOTHESIS: The purpose of the study was to establish radiologic and clinical occurrence of glenohumeral arthrosis after arthroscopic Bankart repair. MATERIALS AND METHODS: Between January 1994 and December 1998, an arthroscopic Bankart repair was performed in 187 patients at our institution. We were able to assess clinical and radiologic glenohumeral arthrosis in 72 of the 101 patients who met the inclusion criteria (74 shoulders) (71%) after a 13-year follow-up. An additional 9 patients were interviewed by telephone. Radiologic arthrosis was evaluated with the Samilson-Prieto classification and clinical arthrosis with an arthrosis-specific quality-of-life questionnaire (Western Ontario Osteoarthritis of the Shoulder test). In addition, functional impairment was assessed with the Constant score and subjective satisfaction with a questionnaire. RESULTS: Radiologic arthrosis was diagnosed in 50 of 74 shoulders (68%), with 40 (80%) of them classified as mild. The mean score on the Western Ontario Osteoarthritis of the Shoulder questionnaire was 280 points (85% of the best possible score), which is considered relatively good. The mean Constant score was 78 points, and 75% of the patients were extremely satisfied or satisfied with the final results of operative treatment. DISCUSSION: The radiologic evaluation and self-assessment of the patients imply that the incidence of glenohumeral arthrosis after arthroscopic Bankart repair is quite common but the symptoms are generally mild and comparable to nonoperative treatment. CONCLUSION: Arthrosis rarely causes more than minor subjective symptoms or a minor objectively perceived disadvantage during 13 years' follow-up.

Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year.

BACKGROUND: Proximal humeral fractures, particularly in osteoporotic patients, remain an unsolved problem as regards the durability of the osteosynthesis. The AO/ASIF group has developed a new technique which aims to preserve the biological integrity of the humeral head and secures the reduction using multiple locking screws with angular stability (Philos), thus allowing an early mobilization. PATIENTS AND OUTCOME: We retrospectively reviewed the complications and functional outcome after a minimum follow-up of 1 year in 72 patients treated with this new method. 2 fractures failed to unite, and 3 patients developed an avascular necrosis of the humeral head. In addition, 2 implant failures were observed due to a technical error. According to the Constant score, the functional outcome was acceptable even in elderly patients. INTERPRETATION: The Philos method appears to be safe and can be recommended for the treatment of proximal humeral fractures in patients with poor bone quality.

Operative treatment of type C intercondylar fractures of the distal humerus: results after a mean follow-up of 2 years in a series of 18 patients.

We reviewed the results of internal fixation in a series of 18 patients (mean age, 44.4 years; SD, 19.1 years; range, 16-81 years) with type C intraarticular fractures of the distal humerus after a mean follow-up of 24.7 months (range, 10-41 months; SD, 9.3 months). An excellent or good result was observed in 10 patients (56%), according to the rating system of the Orthopaedic Trauma Association. All patients younger than 40 years (n = 8) had an excellent or good result, whereas those rates were found in only 2 of 10 patients older than 50 years. Low range of elbow motion (extension-flexion) and, consequently, inferior postoperative score were also correlated to male sex, the triceps-splitting approach, and immobilization exceeding 3 weeks. When stability of the humeral columns is achieved and the articular platform is reconstructed, satisfactory results can be obtained, even in comminuted supracondylar fractures. However, age over 50 years, poor bone quality, and open fracture are correlated with increased risk for an inferior postoperative result. Early mobilization, when possible, and the use of an olecranon osteotomy are recommended.