Estudo transversal sobre o tratamento das lesões acrômioclaviculares agudas

Abstract

The objective of the present transversal study is to check how Brazilian orthopedists treat these injuries, their criteria for choosing the treatment, results and complications. Methods: During the 6th Brazilian Congress of Shoulder and Elbow Surgery (CBOC) and the 38th Brazilian Congress of Orthopaedics and Traumatology (CBOT) 507 questionnaires were distributed (148 CBOC and 359 CBOT), with 478 being considered for analysis. Results: Regarding type-I and -II ACIs, most of the respondents use traditional non-surgical methods. On the other hand, for type-IV, V and VI injuries, 475 (99.4%) of the respondents indicate surgical methods. Concerning type-III injuries, there is no consensus in the selection between traditional and surgical treatment for 386 (80.7%) respondents, with the most important factor for selecting a given treatment method being the patient's level of sports practice and age. Conclusion: There is no consensus regarding type-III ACIs, and the selection of the best treatment method is made according to patient's individual characteristics. However, current literature shows a trend towards non-operative methods. Keywords: Acromioclavicular joint/lesions/surgery. Shoulder dislocation. Shoulder.All the authors state no potential conflict of interest concerning this article. 2 described three types of acromioclavicular dislocations based on ligament injuries, physical and X-ray examination, and Rockwood 3 , modified that classification by adding three other types, according to clavicular dislocation degree and orientation. Treatment has been controversial 4-6 , since the first published reports 7 . Over 50 immobilization techniques and over 30 kinds of surgical treatment 8 have been described with variable results. According to Rockwood et al classification, types I and II should be treated by conventional methods, while types IV, V VI should be operated, because they present strong deviations and associated muscle injuries. 9 However, type III dislocations -which are quite frequent -are usually controversial. 9-11The objective of the present study is to check which criteria are adopted by Brazilian orthopaedic doctors when addressing these injuries. METHODOLOGYCongress attendants participated on this study on a volunteer basis, and the questionnaires were randomly distributed among the participants. Questionnaires filled by non-doctors, foreign participants, by those who had previously filled them, or incomplete questionnaires were excluded from this study. 507 participants were interviewed. 359 filled the forms during the 38th Brazilian Congress of Orthopaedics and Traumatology (CBOT) in Fortaleza/ 2006, and 148 responded the questionnaire during the 6th Brazilian Congress of Shoulder and Elbow (CBOC) in Goiânia/ 2006. The number of interviews required for a significant sample combining both congresses is 124 (n= (1.96 x standard deviation / 0.25 standard deviation)^2 = 62), considering a 95% confidence interval and a standard deviation corresponding to four times the sample error . This wa...

Resultados funcionais e radiológicos do tratamento cirúrgico da luxação acromioclavicular aguda com âncoras e fixação clavículo-escapular

“…15 In the patients of the present study, CC anchors were used as the main procedure, and temporary clavicle and scapula fixation, as an auxiliary method. According to Tamaoki et al, 23 in a cross-sectional study with Brazilian orthopedic surgeons regarding the treatment of ACD, in surgical cases of grade III, 63% of the respondents use CC fixation in their patients, while 51% prefer the AC transarticular fixation technique.…”

“…15 Nos pacientes deste estudo, foram utilizadas âncoras CCs como procedimento principal, e a fixação clavículo-escapular temporária como método auxiliar. Segundo Tamaoki et al 23 , em estudo transversal com ortopedistas brasileiros sobre o tratamento de LAC, nos casos cirúrgicos de grau III, 63% dos entrevistados utiliza a fixação CC em seus pacientes, enquanto 51% prefere a técnica de fixação transarticular AC.…”

Evaluation of the Surgical Treatment of Acromioclavicular Joint Dislocation With a New Option for Temporary Fixation of the Acromioclavicular Joint

“…Some authors describe similar results from surgical and nonsurgical treatment of grade III lesions. 25,26 In the only randomized-clinical trial that compared the use of a coracoclavicular screw and transarticular fixation of the ACJ with metallic wires, 23 greater results was shown with the use of metallic wires across the joint. These unfavorable results appear to favor surgical treatment in the acute setting.…”