Subacromial osteolysis following hook plate fixation for acromioclavicular dislocation: a systematic review and meta-analysis.

BACKGROUND: Clavicular hook plates are extensively used in the treatment of acromioclavicular (AC) dislocation. Subacromial osteolysis is a typical complication following hook plate fixation. We performed a systematic review and meta-analysis to determine the incidence of subacromial osteolysis and analyzed the associated characteristics of subacromial osteolysis to guide surgeons. METHODS: PubMed, EMBASE, and Cochrane Library databases were comprehensively searched for relevant literature. We screened the literature based on the eligibility criteria, extracted relevant data and assessed the quality of the included studies. Pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals were calculated by a fixed-effects or random-effects model. Heterogeneity was evaluated by the chi-squared test and I2 statistics. A meta-regression analysis was performed to explore the potential source of heterogeneity. RESULTS: Thirty-two studies met the inclusion criteria. The total pooled incidence of subacromial osteolysis was 29%, and the only covariate that could influence the incidence of subacromial osteolysis was the radiological measurement method (P=0.017). Patients in the hook plate fixation with coracoclavicular (CC) ligament reconstruction group had lower odds of subacromial osteolysis (OR, 2.54, 95% CI 1.54 to 4.18; P < 0.001). There were no significant differences in the Constant-Murley scores at the final follow-up between patients with and without subacromial osteolysis (SMD, -0.17; 95% CI, -0.50 to 0.15; P= 0.294). CONCLUSIONS: Subacromial osteolysis has a relatively high and variable incidence, and the primary factor influencing the reported incidence is the radiological assessment method. The current analysis suggests CC ligament reconstruction as an effective surgical approach for decreasing the incidence of subacromial osteolysis. The presence or absence of subacromial osteolysis did not significantly impact the functional outcomes observed during the final follow-up period.

Surgical treatment of acromioclavicular joint dislocation of Rockwood III/IV: a retrospective study on clavicular hook plate versus arthroscopic TightRope loop titanium button.

PURPOSE: To compare the clinical efficacy of arthroscopic TightRope loop titanium button and clavicular hook plate in the treatment of acromioclavicular joint (ACJ) dislocation of Rockwood III/IV. METHODS: A retrospective analysis of patients with ACJ dislocation in our hospital from January 2018 to December 2020 was conducted. The patients were assigned to be treated with arthroscopic TightRope loop titanium button (TR group) or clavicular hook plate (HP group). The preoperative, intraoperative and postoperative data and imaging findings of the two groups were compared. RESULTS: A total of 58 eligible patients were enrolled in this study. Compared with HP group, TR group had shorter incision length and less blood loss during operation. Postoperative follow-up ranged from 12 to 24 months (mean 15.4 months). At 6 months and 12months postoperatively, compared with HP group, TR group had lower VAS and higher CMS, and the difference was statistically significant. At 12 months postoperatively, compared with HP group, TR group had lower ACJ gap and coracoclavicular joint(CCJ) distance, and the difference was statistically significant.In HP group, there were 3 cases of subacromial impact, 1 case of redislocation, 2 cases of traumatic arthritis and 2 cases of wound infection. There was 1 case of redislocation in TR group. CONCLUSIONS: Compared with clavicular hook plate, arthroscopic TightRope loop titanium button is minimally invasive, safe and effective in the treatment of ACJ dislocation, and has a good trend in clinical application.

Clinical analysis of the acromial height-measuring device combined with new-type clavicular hook plate and standard clavicular hook plate in the treatment of Neer type II distal clavicle fractures.

BACKGROUND: Distal clavicular fracture is a shoulder joint injury that is common in clinical settings and is generally surgically treated using the clavicular hook plate technique with a confirmed curative effect. However, symptoms, such as shoulder abduction limitation, shoulder discomfort, and postoperative joint pain, may occur in some patients. To overcome these problems, after a previous study we developed an acromial height-measuring device and a new type of clavicular hook plate. This study aimed to investigate whether an acromial height-measuring device combined with an improved new-type clavicular hook plate can better reduce the incidence of complications and improve postoperative function. To provide patients with better treatment effects, an acromion gauge and clavicular hook plate are used. METHODS: A retrospective analysis was performed on 81 patients with distal clavicular fractures admitted to our hospital. They were divided into experimental and control groups according to different plates, and the Constant-Murley score, visual analogue scale score, incidence of acromion osteolysis, and incidence of subacromial impingement syndrome were compared. RESULTS: Compared with the standard clavicular hook plate, the acromial height-measuring device combined with the new-type clavicular hook plate in the treatment of distal clavicle fractures has a lower incidence of subacromial impingement syndrome with better postoperative functional recovery and quality of life. CONCLUSIONS: We considered the acromial height-measuring device combined with the new clavicular hook plate to be a safe and promising alternative to distal clavicular fractures.

Comparative analysis of arthroscopic-assisted Tight-rope technique and clavicular hook plate fixation in the treatment of Neer type IIB distal clavicle fractures.

BACKGROUND: The aim of the present study was to compare the clinical efficacy of arthroscopic-assisted fixation using the Tight-rope system and clavicular hook plate fixation in the treatment of Neer IIB distal clavicle fractures. METHODS: We enrolled 48 consecutive patients with Neer IIB distal clavicle fractures who were treated at our institution from February 2016 and August 2020. These patients were divided into 2 groups based on the fixation method (16 cases with Tight-rope system and 32 cases with clavicular hook plate), and demographics and clinical characteristics of patients in different groups were compared. RESULTS: All 48 patients had functional outcome scores of the affected shoulder available at a mean of 23.8 ± 5.1 months, and there was a statistically significant improvement in the constant score, American shoulder and elbow surgeons (ASES) score, visual analogue scale (VAS) score at the end of follow-up (p < 0.001 respectively). However, the smaller length of skin incision, less estimated blood loss and shorter hospital stay were detected in the Tight-rope technique group patients than those of clavicular hook plate group patients (p < 0.001, respectively). Furthermore, the constant score, ASES score and VAS score were significantly improved in the Tight-rope technique group patients than those of clavicular hook plate group patients (p < 0.05, respectively). CONCLUSIONS: Both Tight-rope technique and clavicular hook plate fixation can provide satisfactory clinical and radiological results in the treatment of distal clavicular Neer IIB fracture. However, arthroscopic-assisted fixation using the Tight-rope technique showed better results in terms of length of hospital stay, surgical trauma, clinical scores, and diagnose and treat concomitant glenohumeral pathologies. LEVELS OF EVIDENCE: III, Case-control study Retrospective comparative study.

Comparative Analysis of Clavicular Hook Plate Versus Distal Radius Volar Plate With Coracoclavicular Augmentation for Neer's Type 2b Lateral Clavicle Fractures: A Prospective Study.

Background Clavicle fractures are common injuries in the adult population. The commonest site of fracture in the clavicle is the mid-shaft followed by the lateral end fracture. The anatomy and biomechanics of the lateral end clavicle make it prone to be unstable. Conservative management usually fails due to the deforming forces. Aim Our study evaluates pain relief, functional outcome, and the union rate in unstable lateral end clavicle fracture fixed by two different modalities of operative management, namely clavicular hook plate fixation and distal radius volar plate fixation. Materials and method A total of 60 patients with the unstable lateral end of clavicle fracture were evaluated in this study at a single tertiary care center between August 2015 and September 2021. Half of the patients (30 patients) were managed by open reduction and internal fixation with clavicular hook plate. The remaining half (30 patients) underwent open reduction and internal fixation by distal radius volar plate supplemented with coracoclavicular fixation. All patients were followed up for a mean duration of 20 months. The functional outcome was assessed at regular intervals by Constant score and Disability of the Arm, Shoulder and the Hand (DASH) score for a period of one year. Result There was significant pain relief and improvement in the functional status of patients. The pain relief was significant in the group managed by distal radius volar plate. The decrease in DASH score and increase in Constant score suggests better functional outcomes in these patients. Conclusion Our study highlights the fact that the distal radius volar plate is an excellent alternative to the hook plate in the treatment of unstable lateral third clavicle fractures. The decrease in pain and improved functional outcome stresses the fact that the volar locking plate is the recent most advancement in the fracture fixation of Neer's type ll fractures. The distal radius volar plate is the recent internal fixation technique to manage unstable lateral end clavicle fractures.

[Analysis of the effect of double button plate combined with strengthened anchor in the treatment of acromioclavicular dislocation].

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.

Combination of Clavicular Hook Plate with Coracoacromial Ligament Transposition in Treatment of Acromioclavicular Joint Dislocation.

OBJECTIVE: To evaluate the clinical efficacy of Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate (CHP) combined with coracoacromial ligament transposition for Rockwood III-V dislocation of AC joint, providing an alternative choice for AC joint dislocation treatment. METHODS: Twenty-five patients diagnosed with Rockwood III-V dislocation of acromioclavicular (AC) joint, including 18 males and seven females, aged 43.5 ± 2.4 years old on average, who had undergone open reduction and AO CHP in combination with coracoacromial (CC) ligament transposition between January 2010 and December 2015, were retrospectively analyzed. Among them, 17 cases were diagnosed as type III, five cases were type IV, and three cases were type V. The surgery mainly included three main steps: bone flap incision, drilling in the clavicle, and hook plate fixation and AC joint reposition. The treatment efficacy was evaluated through clinical examinations and imaging studies for the shoulder joint, including gross observation and measuring coracoid clavicle distance (CC-Dist) using orthophoria X-ray before and 1 year after the surgery, and University of California (UCLA) shoulder rating scale. RESULTS: All the patients were followed up three to four times in 18 months (12-24 months) on average, and the UCLA rating results showed that there were 17 excellent cases (68%), five good cases (20%), and three fair cases (12%). The CC-Dist values after the surgery reduced to 9.7 ± 0.7 mm, which was significantly (P < 0.05) lower compared to that before the surgery (15.8 ± 1.6 mm). Most (88%) of the cases showed almost normal joint function and good anatomical arrangement of the acromioclavicular joint, without any secondary dislocation, and for them, 12 ± 2 weeks on average were needed to regain the normal function of shoulder joint movement. CONCLUSION: Due to the stable fixation, fewer complications, and satisfactory therapeutic effect with great clinical value, the combination of AO CHP and CC ligament transposition is expected to be used for treating Rockwood III-V dislocation of AC joint.

Comparison of the Radiological and Functional Results of Tight Rope and Clavicular Hook Plate Technique in the Treatment of Acute Acromioclavicular Joint Dislocation.

Purpose/Aim: Options for surgery for acromioclavicular (AC) joint dislocation vary considerably. This study aimed to examine the functional and radiological results of patients who were operated on using the tightrope (TR) or clavicular hook plate (CHP) technique in the treatment for AC joint dislocation. Materials and methods: The data gathered from 35 consecutive patients who were operated on for AC joint dislocation were analyzed retrospectively in terms of their radiological and functional outcomes. Results: Thirty-two (91.4%) of the 35 patients were male and 3 (8.6%) were female. Thirty (85.7%) patients were classified as Rockwood type 3 and 5 (14.3%) as type 5. Twenty-one patients operated on using the TR technique were categorized as group 1, and 14 patients treated with the CHP technique formed group 2. Functional results were evaluated using the Constant-Murley shoulder scoring system; no statistically significant difference was observed between type 3 and 5 AC separation (p = 0.337). The mean Constant scores of type 3 and 5 injuries were 82.96 and 88.6, respectively. A significant relationship was noted between reduction quality and functional scores (p = 0.006). Postoperative osteoarthritis was seen in 12 (57.14%) patients in group 1 and 7 (50.00%) patients in group 2. In terms of surgery duration, 50.57 minutes in group 1 and 35.71 minutes in group 2 were noted. A statistically significant difference was found between the two groups in terms of surgery duration (p < 0.05). Conclusions: TR and CHP techniques, which do not differ significantly in terms of their clinical results, can be used safely in the treatment of AC separation.

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.

Triple-Endobutton and clavicular hook: A propensity score matching analysis.

We retrospectively analyzed the clinical data of 635 patients with acute acromioclavicular dislocation, who underwent surgery in our hospital between May 2014 and June 2020. Patients were divided into group A (clavicular hook plate) and group B (Triple-Endobutton plates via double-incision). The propensity score analysis using one to one match was performed for comparisons. We obtained 292 matched patients' data. The matched preoperative clinical characteristics were a balance between the two groups. All clinical parameters showed insignificant differences (P > 0.05). Compared with group A, group B has longer operative time (P < 0.001) and more blood loss (P < 0.001); however, the mean incision length (P < 0.001) and length of hospitalization (P < 0.001) were shorter in group B than in the group A. The mean VAS in group B were significantly lower than in group A at each time point (P < 0.001), and the UCLA shoulder score was higher in the group B. The CMS scores were also higher in group B than in group A, including before removal and 12 weeks after removal (P < 0.001). The clinical efficacy of the double-incision Triple-Endobutton plate is better than the clavicular hook plate technology, and achieves anatomical reduction by reconstructing coracoclavicular ligament.

[Clavicular hook plate with coracoclavicular ligament augmentation by suture anchor in the treatment of unstable distal clavicle fractures].

OBJECTIVE: To evaluate the effectiveness of a clavicular hook plate with coracoclavicular ligament augmentation by suture anchor in the treatment of Neer types Ⅱ and Ⅴ distal clavicle fractures. METHODS: Between January 2010 and June 2016, 16 patients with Neer types Ⅱ and Ⅴ distal clavicle fractures were treated with clavicle hook plates and coracoclavicular ligament augmentation by suture anchor. There were 12 males and 4 females with an average age of 45.6 years (range, 14-81 years). The injury mechanism included falling in 10 cases, traffic accident injury in 2 cases, falling from height in 2 cases, and heavy object injury in 2 cases. The Neer classification of clavicle fractures included 2 cases of type Ⅱa, 13 cases of type Ⅱb, and 1 case of type Ⅴ. The injury severity score (ISS) was 6-29, with an average of 11.2. The time from injury to operation was 1-18 days, with an average of 6.4 days. The operation time, intraoperative blood loss, hospitalization stay, fracture healing, and postoperative complications were recorded; the disability of arm, shoulder, and hand (DASH) score, the shoulder joint Constant score, and the Oxford shoulder score (OSS) were used to evaluate the shoulder joint at last follow-up. RESULTS: All operations were successfully completed. The operation time was 50-100 minutes, with an average of 75.6 minutes; intraoperative blood loss was 30-100 mL, with an average of 52.8 mL; hospitalization stay was 4-47 days, with an average of 13.7 days. All patients were followed up 1.2-7.5 years, with an average of 3.5 years. All clavicle fractures healed, and the healing time was 9.4-13.6 weeks, with an average of 11.9 weeks. No fracture nonunion, fracture displacement, failure of internal fixation, or incision infection, etc. occurred. Fifteen patients took out the hook plate after fracture healing and functional recovery, and 1 case refused to remove the hook plate from the second operation because of no obvious discomfort. At last follow-up, the DASH score was 0-13, with an average of 2.2; the shoulder joint Constant score was 90-100, with an average of 96.8; the OSS score was 12-14, with an average of 12.3. CONCLUSION: Clavicular hook plate with coracoclavicular ligament augmentation by suture anchor can help achieve good effectiveness with less postoperative complication in the treatment of Neer types Ⅱ and Ⅴ distal clavicular fractures.

Biomechanical analysis of a novel clavicular hook plate for the treatment of acromioclavicular joint dislocation: A finite element analysis.

BACKGROUND: Clavicular hook plates are frequently used in clinical orthopedics to treat acromioclavicular joint dislocation. However, patients often exhibit acromial osteolysis and peri-implant fracture after hook plate fixation. To solve the above problems, we developed a novel double-hook clavicular plate and used finite element analysis (FEA) to investigate its biomechanical properties. METHODS: A finite element (FE) model was constructed and validated. Then, a double-hook clavicular plate, a single-hook clavicular plate, and an anatomical double-hook clavicular plate was implanted into the acromioclavicular joint and fixed with screws in groups 1, 2 and 3, respectively. Finally, a load was applied, and some indicators were recorded and analyzed. RESULTS: For both the proximal clavicular rotation angle and the distal clavicular displacement, the range of motion in groups 1 and 3 was more than 90% lower than that in group 2. The maximum von Mises stress of the clavicle in groups 1 and 3 was more than 45% lower than that in group 2. The maximum stress of the acromion in group 2 was significantly higher than that in groups 1 and 3, and that in group 3 was less than that in group 1, for both cortical and cancellous bone. CONCLUSIONS: The double-hook clavicular plate could immediately reconstruct the stability of the acromioclavicular joint, effectively reducing the stress of the bone around the clavicle and screws. Additionally, the double-hook clavicular plate could reduce the peak stress of the acromion and produce a more uniform stress distribution.

Comparison of clinical efficacy between arthroscopically assisted Tight-Rope technique and clavicular hook plate fixation in treating acute high-grade acromioclavicular joint separations.

INTRODUCTION: The purpose of this study was to compare the results of arthroscopically assisted reduction of acute acromioclavicular (AC) joint separations with the Tight-Rope technique with results of clavicular hook plate fixation. MATERIALS AND METHODS: The 28 patients with acute high-grade AC joint dislocation were treated with arthroscopic assisted fixation using the Tight-Rope system, the arthroscopic evaluation and treatment of glenohumeral lesions were performed before AC ligament reconstruction. Each Tight-Rope technique group patient was matched with three controls that underwent clavicular hook plate fixation, and preoperation and postoperative visual analogue scale (VAS) and functional recovery (Constant Score) of the shoulder joint was assessed,. Furthermore, the demographics and clinical characteristics were compared between the two groups. RESULTS: All patients had clinical and radiological results available at 2 years or greater (mean: 34; range: 24-72 months), they were statistically significant improvement in the constant score and VAS score at the end of follow-up respectively (P < 0.001). Compared with the clavicular hook plate group, Tight-Rope system group patients were incurred significant statistically lower skin incision, hospitalization time and estimated blood loss (P < 0.001), and the constant score and VAS score at the end of follow-up was significantly higher in the Tight-Rope group (P < 0.001). Patients who underwent clavicular hook plate had a higher incidence of fixation failure [10 cases (11.9%) versus 2 cases (7.1%)] than those of the Tight-Rope system group. CONCLUSIONS: The Tight-Rope technique is advantageous for treating these patients because it is a minimally invasive procedure with low complications and superior clinical outcomes.

To explore the reasonable selection of clavicular hook plate to reduce the occurrence of subacromial impingement syndrome after operation.

BACKGROUND: Acromioclavicular joint dislocation is a shoulder joint injury common in the clinical setting and is generally surgically treated with clavicular hook plate technique with confirmed curative effect. However, symptoms such as shoulder abduction limitation, shoulder discomfort and joint pain postoperatively may occur in some patients. Therefore, this study aimed to explore whether the existing clavicular hook plate can be reasonably selected to reduce the incidence of subacromial impingement syndrome (SIS) and provide a reference for clinical diagnosis and treatment. MATERIALS AND METHODS: Patients with SIS admitted from March 2018 to June 2020 were selected as the experimental group and asymptomatic patients postoperatively, as the control group. The hook end depth and acromial height of the hook plate used in patients were recorded, and the difference between them was calculated. RESULTS: The difference between the hook plate depth and acromial height was 7.500±1.912 mm and 6.563±1.537 mm in the experimental and control groups, respectively, with statistically significant difference (t=3.021, P=0.006). A difference of >0.6 mm as a grouping index is required to perform a single factor analysis, with statistically significant difference (t=3.908, P=0.048). CONCLUSIONS: The occurrence of SIS after placing the clavicular hook plate may be related to the difference between its depth and the acromial height. A difference of >6 mm may be a factor affecting the occurrence of SIS. Pre-imaging measurement of the acromial height can provide suggestions for selecting the type of hook plate intraoperatively.

Comparative analysis of a locking plate with an all-suture anchor versus hook plate fixation of Neer IIb distal clavicle fractures.

BACKGROUND: The coracoclavicular fixation with suture anchors adds stability to type IIb distal clavicle fractures fixed with a plate and screws when loaded to failure. The purpose of this study was to compare the clinical and radiological outcomes between the use of a locking compression plate (LCP) with all-suture anchor fixation and hook LCP fixation of Neer IIb distal clavicle fractures. METHODS: A total of 82 consecutive patients who underwent plate fixation for Neer IIb distal clavicle fractures were included. The subjects were divided into two groups: an LCP with all-suture anchor fixation group and hook LCP fixation group. For clinical assessments, the American Shoulder and Elbow Surgeons score, Korean shoulder score (KSS), and Constant score were recorded. A percentage of the coracoclavicular distance (CCD%) was used to evaluate fracture reduction. Typical reported complications, such as secondary dislocation, implant failure or loosening, peri-implant fracture, acromion osteolysis, stiffness, peri-anchor osteolysis, postoperative acromioclavicular joint arthrosis, nonunion, or delayed union, were also analyzed. RESULTS: There were no differences in the clinical and radiological outcomes at the final follow-up between the two groups. The period for bone union and CCD% showed no significant differences between groups. Stiffness at 3 months after surgery of LCP with all-suture anchor fixation (n = 3, 10.7%) was less than that of hook LCP fixation (n = 17, 31.5%). The complication rate also showed no significant differences between groups. However, LCP with all-suture anchor fixation had anchor-related complications, although it can reduce hook-related complications. CONCLUSION: LCP with all-suture anchor fixation showed satisfactory outcomes in comparison with hook LCP fixation. In Neer IIb distal clavicle fractures, LCP with all-suture anchor fixation is a useful method for the maintenance of reduction, avoiding implant removal, and hook-related complications. However, anchor fixation should be carefully used, especially in osteoporotic patients or patients with underlying diseases. LEVEL OF EVIDENCE: Level III, retrospective study.

Arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation for management of acute acromioclavicular joint dislocation and MRI follow-up study. / å ³èŠ‚é•œä¸‹å–™é”éŸ§å¸¦é‡å»ºæ‚¬åŠå¼å›ºå®šæ²»ç–—æ€¥æ€§è‚©é”å ³èŠ‚è„±ä½åŠMRI随访.

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 P<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.

Comparison of a novel hybrid hook locking plate fixation method with the conventional AO hook plate fixation method for Neer type V distal clavicle fractures.

BACKGROUND: The conventional AO hook locking compression plate (LCP) (Synthes, Solothurn, Switzerland) has only three holes for lateral fragments; therefore it is not suitable for use during the fixation of small-comminuted fragments in some cases. Recently, a novel hybrid hook LCP (TDM, Seoul, Korea) was developed to overcome this limitation. Here, we evaluated the clinical and radiologic outcomes of a novel hybrid hook LCP for Neer type V distal clavicle fractures compared to the outcomes of a conventional AO hook plate. METHODS: Seventy-eight consecutive patients who underwent hook LCP fixation for Neer type V distal clavicle fractures were included. The subjects were divided into 2 groups: the conventional AO hook LCP group and the novel hybrid hook LCP group. For clinical assessments, the American Shoulder and Elbow Surgeons (ASES) score, Korean shoulder score (KSS), and Constant score were recorded. The percentage modified coracoclavicular distance (MCCD %) was used for the evaluation of fracture reduction. Typical reported complications, such as secondary dislocation, implant failure or loosening, peri-implant fracture, acromion osteolysis, postoperative acromioclavicular joint arthrosis, non-union, or delayed union, were also analyzed. RESULTS: There were no differences in the clinical outcomes (ASES, KSS, and Constant scores) between the two groups. Bone union was achieved in a significantly shorter period in the hybrid hook LCP group (13.6±2.0weeks) than in the AO hook LCP group (17.5±4.8weeks, p<0.001). Consequently, the time to implant removal was also significantly shorter in the hybrid hook LCP group (4.0±0.5months) than in the AO hook LCP group (5.4±1.1months, p<0.001). The MCCD% showed no significant differences between the treatment groups. There was no statistically significant difference in the complication rate between the two groups; however, the hybrid hook LCP fixation resulted in a lower prevalence of hook-related complications. CONCLUSION: The hybrid hook LCP fixation showed satisfactory clinical and radiologic outcomes in comparison with the AO hook LCP fixation. The hybrid hook LCP is useful for multiple screw fixation of inferior comminuted fragments in Neer type V distal clavicle fractures. The bone union was significantly shorter; thus, the time to implant removal was also significantly shorter. LEVEL OF EVIDENCE: Level III, Retrospective study.

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.

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.

Results of Treatment of Type 3 Acromioclavicular Joint Dislocation with Three Methods.

BACKGROUND: Rockwood Type III acromioclavicular joint injuries are treated both conservatively and surgically. There is still no consensus on an optimal fixation method. The aim of this study was to evaluate which of the surgical methods used in our Department produces the best outcomes in long-term follow-up. MATERIAL AND METHODS: The study involved 27 patients. Wire cerclage was used in 12 patients, 11 patients were operated on by the Ladermann method, and a hook plate was used in 4 patients. The patients were assessed at a late follow-up visit after a mean of 22 months post-operatively. The Constant Shoulder Scale (CSS), Oxford Shoulder Scale (OSS), and PROMIS v1.2 for the upper limb were used to assess the long-term effects of the treatment. RESULTS: There were no statistically significant differences between the Ladermann method and wire cerclage for the scales applied (p=0.98 at α=0.05). The functional CSS showed a significant advantage of the outcomes of the Lader-mann method and wire cerclage in comparison to the hook plate (p=0.014 and p=0.004, respectively, at α=0.05). The quality of life scales OSS and PROMIS showed no significant difference between the methods. CONCLUSIONS: 1. The outcomes of treatment with the Ladermann method and wire cerclage are excellent and com-parable with regard to both clinical outcomes and the quality of life. 2. The use of a hook plate may substantially contribute to worse clinical outcomes. 3. No considerable difference was found in the quality of life between the different groups, but a study involving a larger number of patients would be necessary for a complete evaluation.