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MIS: Percutaneous K-wire fixation for AC separation type 3, a prelim i nary report. Peeerachai Dumrongwanich,MD. Chanchit Sangkeaw,MD. Department of Orthopaedic, Police General Hospital, Bangkok, THAILAND.
Peeerachai Dumrongwanich,MD. Chanchit Sangkeaw,MD. Department of Orthopaedic, Police General Hospital, Bangkok, THAILAND.
The treatment of AC joint separation Type III is still controversial between operative and non-operative treatment. Percutaneous K-wire fixation seemed to decrease the problem inherited with ORIF[infection, anesthetic risk, hematoma formation, scar formation, recurrence of deformity, breakage or loosening of sutures, erosion or fracture of the distal clavicle, postoperative pain and limitation of motion, second procedure for removal of fixation, late acromioclavicular arthritis, soft tissue calcification] and minimize discomfort of the conservative treatment [skin pressure and ulceration, recurrence of deformity, wearing the sling or brace for 8 weeks , patient cooperation, less interference with activities of daily living, shoulder and elbow motion, soft tissue calcification, late acromioclavicular arthritis, late muscle atrophy, weakness, and fatigue] .
Twenty-one patients with adequate data were reviewed with the mean follow-up period of 19 weeks (range, 4 – 135 weeks). Painless full range of shoulder motion could be obtained in all patients except one, who had limitation of abduction (150 degrees abduction). The mean Neer’s shoulder score was 94.25 points(range, 50-100 points).
The patient was placed in the lateral decubital position.
C-arm Fluoroscope in inferior & superior oblique view to check position of the K-wires co-related to the model.
Ten patients had tenderness at the prominent K-wires, and the pain were subsided after removal of K-wires. In the early part of the series pin-tract infection occurred in two cases, in which the K-wires had not been buried underneath the skin. One of them the K-wires were left in place until the clinical union was achieved and the infection was resolved after implant removal. The other one the infection was subsided after removal of K-wires and subsequent fusion of the AC-joint. In one case the K-wires migrated medially due to excessive use of affected limb, leading to loss of reduction. Reoperation using three K-wires fixation was performed and the final result was not compromised. Re-separation of the AC-joint after implant removal occurred in one case after resumption of his work as heavy worker. It might be possible that implant removal should be delayed for three months after surgery for heavy worker.
With percutaneous fixation early mobilization of the shoulder could be obtained without increased morbidity from surgical exposure, and the disadvantage of conservative treatment could also be avoided.
The patient was placed in the lateral decubital position under general anesthesia, after the dislocated AC-joint had been closely reduced under image-intensifier control, two K-wires (2.0mm) were inserted into the prominent part of acromial process or scapular spine into the distal clavicle. To prevent medial migration of the pin to the vital organ in the neck region, the K-wires were inserted until they penetrated the cortex of the distal clavicle and lied beneath the skin.
The purpose of the study is to evaluate the efficacy of the percutaneous K-wire fixation in the treatment of AC-joint separation.
The assistant close reduction& Surgeon’s aiming the clavicle between the two fingers.The K-wire was bend and cut under-neath the skin.
The pre and post-operative film showed the separation was reduced and should be protected with a ‘night’ sling.
Conclusion: The preliminary results of the percutaneous K-wire fixation for the AC-joint Separation were encouraged, the technique was safe and cost-effective. .
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