Bosworth and modified Phemister techniques revisited. A comparison of intraarticular vs extraarticular fixation methods in the treatment of acute Rockwood type III acromioclavicular dislocations

Abstract

ObjectiveThe aim of this study was to compare the long-term clinical and radiological results of Acromioclavicular (AC) fixation with K-wires (the modified Phemister procedure) and Coracoclavicular (CC) fixation with the Bosworth screw in the surgical treatment of Type 3 AC joint dislocations.MethodsThirty-two patients with complete set of medical records and who received surgical treatment between September 2005 and January 2009 due to acute Rockwood Type 3 AC joint dislocation and properly attended their follow-ups were retrospectively evaluated. Sixteen patients (13 males, 3 females; mean age: 38, range: 24–52 years) were treated with CC fixation with Bosworth screw (Group 1), and the other 16 (12 males, 4 females; mean age: 53.3, range: 38–64 years) with AC fixation using K-wires (Group 2).ResultsThe mean follow-up time was 96 months for Group 1 and 93 months for Group 2 patients (p > 0.05). The mean Constant–Murley score at the final follow-up was 84.7 in Group 1 and 87.3 in Group 2 (p = 0.069). Radiological evaluation of the patients revealed AC arthrosis in 2 and 3 patients in Group 1 and 2, respectively. In Group 2, one patient had a recurrent dislocation, three patients had AC arthrosis and two patients had ossification in the CC ligament (Fig. 2).There was no superficial or deep wound infection in Group 1, while two patients from Group 2 had a superficial wound infection.ConclusionsOur results suggest that both techniques are reliable and provide adequate reduction and similar outcomes in terms of functionality and pain levels, following the reduction of Type 3 AC joint dislocations. With lower rates of wound site infection in the early and AC arthrosis in the late postoperative period, CC fixation method with the Bosworth screw may be a better surgical option than AC fixation method with K-wires.Level of EvidenceLevel III, Therapeutic study.

The frequency of reduction loss after arthroscopic fixation of acute acromioclavicular dislocations using a double-button device, and its effect on clinical and radiological results

“…Rockwood divided AC dislocations into six types and according to current recommendations; types IV through VI are managed by surgical reconstruction and treatment of type III should be individualized based on the patient's demands, activity level and response to conservative treatment. There are several methods used for fixation like K-wires, hook plate, Bosworth screw, Weaver-Dunn and resection of the lateral end of the clavicle, but there is no gold standard procedure [2][3][4]. Recently, arthroscopic techniques have been successfully proposed to treat AC joint dislocations [5][6][7].…”

<p>Optimal Management of Acromioclavicular Dislocation: Current Perspectives</p>

“…Clinical long-term results suggest that the Bosworth screw technique is reliable and provides adequate reduction and similar outcomes in terms of function and pain level when compared to minimally-invasive K-wire fixation. 41 Compared to K-wires the Bosworth screw has shown to be superior in early infection rates and lower rates of AC joint osteoarthritis (intra-vs extraarticular fixation) after 8 years. 41 However, compared to newer suspensory device techniques the Bosworth screw presented with less patient satisfaction and more inconveniences.…”

“…41 Compared to K-wires the Bosworth screw has shown to be superior in early infection rates and lower rates of AC joint osteoarthritis (intra-vs extraarticular fixation) after 8 years. 41 However, compared to newer suspensory device techniques the Bosworth screw presented with less patient satisfaction and more inconveniences. 42 Furthermore, in all patients treated with the Bosworth screw, a second surgical intervention with known associated risks was necessary to remove the implant.…”

The frequency of reduction loss after arthroscopic fixation of acute acromioclavicular dislocations using a double-button device, and its effect on clinical and radiological results

“…Rockwood divided AC dislocations into six types and according to current recommendations; Types IV through VI are managed by surgical reconstruction and treatment of type III should be individualized based on the patient's demands, activity level, and response to conservative treatment. There are several methods used for fixation like K-wires, hook plate, Bosworth screw, Weaver-Dunn and resection of the lateral end of the clavicle, but there is no gold standard procedure [2][3][4]. Recently, arthroscopic techniques have been successfully proposed to treat AC joint dislocations [5][6][7].…”