Different treatment strategies for acromioclavicular dislocation injuries: a nationwide survey on open/minimally invasive and arthroscopic concepts

Allemann, Florin; Halvachizadeh, Sascha; Waldburger, Martin; Schaefer, Fritz; Pothmann, Carina; Pape, Hans-Christian; Rauer, Thomas

doi:10.1186/s40001-019-0376-7

Cited by 19 publications

(21 citation statements)

References 26 publications

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“…The number of (surgical) interventions related to CJI in severely injured patients was less in comparison with previous work with an intervention rate of about 30% in our study. Current studies show that the rate of interventions for SCJ and ACJ dislocation is twice as high 2 , 35 . Based on a ratio of SCJ to ACJ dislocation of approximately 1 to 44, these interventions would result in a common surgery rate for CJI of approximately 60% 2 , 9 .…”

Section: Discussionmentioning

confidence: 97%

“…This finding coincides with results concerning CF cases, which were treated surgically four times as often in monotrauma compared to polytrauma patients 10 . The fact that increasing numbers of operations are performed with increasing injury severity is entirely plausible since low-grade CJIs are usually no indication for surgery 35 , 39 .…”

Section: Discussionmentioning

confidence: 99%

“…The accuracy and completeness of data derived from a registry analysis is limited to the precision of the person entering it 9 . In addition, a direct comparison of the common rate of surgery for CJI was not possible due to the different severity levels in the classification, especially for the ACJ dislocation 35 . A classification of the ACJ dislocation according to Rockwood is not possible in the TR-DGU so that the comparison with the literature is only an estimation 50 .…”

Section: Discussionmentioning

confidence: 99%

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Acromioclavicular and sternoclavicular joint dislocations indicate severe concomitant thoracic and upper extremity injuries in severely injured patients

Bakır

Lefering

Haralambiev

et al. 2020

Sci Rep

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Preliminary studies show that clavicle fractures (CF) are known as an indicator in the severely injured for overall injury severity that are associated with relevant concomitant injuries in the thorax and upper extremity. In this regard, little data is available for the rarer injuries of the sternoclavicular and acromioclavicular joints (SCJ and ACJ, respectively). Our study will answer whether clavicular joint injuries (CJI), by analogy, have a similar relevance for the severely injured. We performed an analysis from the TraumaRegister DGU (TR-DGU). The inclusion criterion was an Injury Severity Score (ISS) of at least 16. In the TR-DGU, the CJI were registered as one entity. The CJI group was compared with the CF and control groups (those without any clavicular injuries). Concomitant injuries were distinguished using the Abbreviated Injury Scale according to their severity. The inclusion criteria were met by n = 114,595 patients. In the case of CJI, n = 1228 patients (1.1%) were found to be less severely injured than the controls in terms of overall injury severity. Compared to the CF group (n = 12,030; 10.5%) with higher ISS than the controls, CJI cannot be assumed as an indicator for a more severe trauma; however, CF can. Concomitant injuries were more common for severe thoracic and moderate upper extremity injuries than other body parts for CJI. This finding confirms our hypothesis that CJI could be an indicator of further specific severe concomitant injuries. Despite the rather lower relevance of the CJI in the cohort of severely injured with regard to the overall injury severity, these injuries have their importance in relation to the indicator effect for thoracic concomitant injuries and concomitant injuries of the upper extremity. A limitation is the collective registration of SCJ and ACJ injuries as one entity in the TR-DGU. A distorted picture of the CJI in favor of ACJ injuries could arise from the significantly higher incidence of the ACJ dislocation compared to the SCJ. Therefore, these two injury entities should be recorded separately in the future, and prospective studies should be carried out in order to derive a standardized treatment strategy for the care of severely injured with the respective CJI.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Acromioclavicular and sternoclavicular joint dislocations indicate severe concomitant thoracic and upper extremity injuries in severely injured patients

Bakır

Lefering

Haralambiev

et al. 2020

Sci Rep

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“…Many AC joint reconstruction techniques have been developed over the years. There are more than 162 surgical techniques to treat acromioclavicular joint dislocation [2]. Arthroscopically assisted anatomic reconstruction of the AC joint is a technically challenging procedure.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Acute Acromioclavicular Joint Dislocations Type III and Type V by Rockwood Classification Using a Dynamic Stabilization System under Arthroscopic Control with and without Suture of the Ligaments of the Acromioclavicular Joint

Bezruchenko

2021

HOTP

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Summary. Acute acromioclavicular (AC) joint dislocation is still a challenging task for orthopedic surgeons. Objective: to compare the clinical and radiological results of treatment of patients with acute dislocation of the acromial end of the clavicle who were treated with a dynamic stabilization system with and without suture of acromioclavicular ligaments under arthroscopic control. Materials and Methods. A retrospective analysis of the treatment of 44 patients with acute AC joint dislocations type III and type V by Rockwood classification was performed. The patients were divided into 2 groups: group I – 18 patients (40.9%) who underwent stabilization of the dislocation and fixation of the acromial end of the clavicle using a dynamic stabilization system and suture of the ligaments of the acromioclavicular joint under arthroscopic control; group II – 26 patients (59.1%) who underwent stabilization of the dislocation and fixation of the acromial end of the clavicle using a dynamic stabilization system without suture of the ligaments of the acromioclavicular joint under arthroscopic control. There were 40 male (90.9%) and 4 female (9.1%) patients aged 18–58 years (mean age 32.9±10.1 years). The mean time from injury to surgical treatment was 8.3±3.2 days (from 3 to 17 days). Clinical observation was carried out at an average time of 20.1±3.9 months after surgery (from 12 to 28 months). Clinical outcomes were assessed using the Oxford Shoulder scale, the Constant-Murley scale, and the Acromioclavicular Joint Instability Scoring System. Results. The mean Oxford Shoulder score at the final follow-up on the injured side was 45.8±1.3 points and 46.2±1.3 points (p=0.422) in groups I and II, respectively. The mean Constant-Murley score at the final follow-up on the injured side was 94.6±2.4 points and 91.7±4.2 points (p=0.0134) in groups I and II, respectively. The mean score on the Acromioclavicular Joint Instability Scoring System at the final follow-up on the injured side was 83.8±7.1 points and 78.1±11.8 points (p=0.075) in groups I and II, respectively. No significant complications were observed in both groups. Conclusions. The combination of the arthroscopically assisted technique of reconstruction of the acromioclavicular ligaments using high-strength sutures and fixation of the coracoclavicular ligaments using a dynamic stabilization system provides good long-term clinical results.

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“…Concerning fully ligamentous injuries with severe dislocation (Rockwood type IV-VI) there is consensus that operative treatment is the best option [1]. Whether or not Rockwood type III injuries should be treated operatively remains subject to debate [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Current practice in the management of acromioclavicular joint dislocations; a national survey in the Netherlands

Rooij

Lieshout

Schurink

et al. 2020

Eur J Trauma Emerg Surg

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The aim of this study was to investigate current practice in the management of acromioclavicular joint dislocations in the Netherlands. Methods A 36-item literature-based and expert consensus survey was developed. If available, one orthopaedic and one trauma surgeon for every hospital (n = 82) in the Netherlands was asked to complete the online questionnaire. Only complete data sets were included in the analysis. Descriptive analysis was performed using SPSS. Results Of 149 invited surgeons, 106 (71%) fully completed the survey. The diagnosis of ACJ injury was mainly based on physical examination (91%) and radiographs (95%). The vast majority of patients with ACJ injuries was treated non-operatively. The decision for operative treatment was mainly based on the surgeon's experience and available literature. Patientrelated factors that contributed most to the decision to operate or not, were mainly functional needs and age. Cosmesis and gender contributed less to this decision. Rockwood II and III ACJ injuries were usually treated non-operatively, whereas Rockwood IV and V ACJ injuries were usually treated operatively. For primary and secondary operative treatment, a flexible implant was preferred over rigid fixation techniques. All respondents agreed that nonoperative treatment of Rockwood II ACJ injuries leads to satisfactory results and that secondary operative treatment is only rarely required. Also the majority of patients with Rockwood III ACJ injuries is treated non-operatively, although failure rates are considered higher. Conclusion This survey showed a significant individual variation on diagnosis and treatment strategies among surgeons in the Netherlands. The majority of the Dutch surgeons concern a flexible implant the best available technique for patients who require operative treatment.

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Different treatment strategies for acromioclavicular dislocation injuries: a nationwide survey on open/minimally invasive and arthroscopic concepts

Cited by 19 publications

References 26 publications

Acromioclavicular and sternoclavicular joint dislocations indicate severe concomitant thoracic and upper extremity injuries in severely injured patients

Acromioclavicular and sternoclavicular joint dislocations indicate severe concomitant thoracic and upper extremity injuries in severely injured patients

Treatment of Acute Acromioclavicular Joint Dislocations Type III and Type V by Rockwood Classification Using a Dynamic Stabilization System under Arthroscopic Control with and without Suture of the Ligaments of the Acromioclavicular Joint

Current practice in the management of acromioclavicular joint dislocations; a national survey in the Netherlands

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