Treatment of the acromioclavicular joint dislocation with external fixation device
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Treatment of the Acromioclavicular Joint Dislocation with External Fixation Device. Chelnokov A.N. Tyrtseva E.S. Ural Scientific Research Institute of Traumatology and Orthopaedics, Ekaterinburg, Russia. Background.

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Treatment of the acromioclavicular joint dislocation with external fixation device l.jpg

Treatment of the Acromioclavicular Joint Dislocation with External Fixation Device

Chelnokov A.N. Tyrtseva E.S.

Ural Scientific Research Institute of Traumatology and Orthopaedics, Ekaterinburg, Russia


Background l.jpg
Background External Fixation Device

  • To date there has been no consensus about optimal treatment of the traumatic dislocation of the acromio-clavicular joint.


Many treatment modalities for the acj dislocation l.jpg
Many treatment modalities for the ACJ dislocation External Fixation Device

  • From aggressive surgery…


To nonoperative management l.jpg
…to nonoperative management External Fixation Device

  • A Prospective Evaluation of Untreated Acute Grade III Acromioclavicular Separations. T.F. Schlegel. The American Journal of Sports Medicine 29:699-703 (2001):

  • 20 of the 25 patients completed the 1-year evaluation and strength-testing protocol;

  • objective examination and strength testing of the 20 patients revealed no limitation of shoulder motion in the injured extremity and no difference between sides in rotational shoulder muscle strength


Slide5 l.jpg


Material and methods l.jpg

6 monolateral external fixator for closed treatment of complete acromioclavicular dislocations.

10

8

Material and methods

  • 24 patients

    • 14 male

    • 10 female

  • 3,2 days after the injury (0-14)


External fixation l.jpg
External Fixation monolateral external fixator for closed treatment of complete acromioclavicular dislocations.

  • G.S.Sushko, G.A.Ilizarov, 1977, 1979


Surgery and post op period l.jpg
Surgery and post-op period monolateral external fixator for closed treatment of complete acromioclavicular dislocations.

  • 10-30 minutes

  • Regional anesthesia

  • Discharge in 1-2 days

  • Sling for 1-3 days


Duration of fixation l.jpg
Duration of fixation monolateral external fixator for closed treatment of complete acromioclavicular dislocations.

  • 4 weeks for acute cases (fixation within 0-5 days after the injury),

  • 6-8 weeks for delayed admission (6-14 days)

    • In cases of dislocations older 2 weeks => AC and CC ligaments repair by tendon allografts

  • Stability test before hardware removal


  • Results l.jpg
    Results monolateral external fixator for closed treatment of complete acromioclavicular dislocations.

    • Self-care, light housework – 3-5 days

    • Deep infection 0/24

      • 10 patients (42%) sustained skin irritation and serum drainage from acromial wire site only

    • 23/24 healed

      • 1/24: missed acromial wire cut-out => symptomatic instability => AC+CC repair (allo tendons) => uneventful healing

    • 1 year follow up - 15 patients.

      • All restored their pre-injury status

      • Occasional pain in hyperabduction – 3/15


    Rockwood type v injury l.jpg
    Rockwood type V injury monolateral external fixator for closed treatment of complete acromioclavicular dislocations.


    After 6 weeks l.jpg
    After 6 weeks monolateral external fixator for closed treatment of complete acromioclavicular dislocations.


    Result l.jpg
    Result monolateral external fixator for closed treatment of complete acromioclavicular dislocations.


    Neer type ii injury l.jpg
    Neer Type II injury monolateral external fixator for closed treatment of complete acromioclavicular dislocations.


    Follow up 3 year l.jpg
    Follow-up (3 year) monolateral external fixator for closed treatment of complete acromioclavicular dislocations.


    Follow up 3 year19 l.jpg
    Follow-up (3 year) monolateral external fixator for closed treatment of complete acromioclavicular dislocations.


    Follow up 3 years l.jpg
    Follow-up (3 years) monolateral external fixator for closed treatment of complete acromioclavicular dislocations.

    Affected side


    Discussion advantages of the technique l.jpg
    Discussion: Advantages of the technique monolateral external fixator for closed treatment of complete acromioclavicular dislocations.

    • Controllable fixation

      • With ex-fix we control the situation, without it the situation controls us

    • Minimally invasive

      • Fast recovery

      • Good cosmetic effect

    • Minimal time and efforts

    • Short learning curve


    Discussion disadvantages l.jpg
    Discussion: Disadvantages monolateral external fixator for closed treatment of complete acromioclavicular dislocations.

    • Temporary discomfort, decreased quality of life

    • Pin site care, outpatient visits necessary

    • Hardware removal


    Conclusion l.jpg
    Conclusion monolateral external fixator for closed treatment of complete acromioclavicular dislocations.

    • External fixation can be technique of choice for acute cases where operative treatment is indicated


    Thank you l.jpg

    Thank you monolateral external fixator for closed treatment of complete acromioclavicular dislocations.

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