Modified Phemister procedure for the surgical treatment of Rockwood types III, IV, V acute acromioclavicular joint dislocation

Abstract

Acromioclavicular (AC) joint dislocations are common in young, active patients. In case of surgical indications, Rockwood type IV, type V and selected type III dislocation, we use modified Phemister procedure. At mid-term follow-up, by an average of 35.1 months, we reassessed the records of 14 patients surgically treated for acute AC dislocation from February 2007 to November 2010. In patients with a diagnosis of grade III lesion, indication for surgery was given on the basis of the patient's functional demand. Full recovery was obtained on average 3 months after surgery. Constant Score accounted for 92.7 points, mean Disabilities of the Arm, Shoulder and Hand Score for 3.2 points, and mean Simple Shoulder Test Score for 11.4 points. X-ray findings were partial loss of reduction (9 cases), subclinic re-dislocation (2 cases), calcification (5 cases) and post-traumatic arthritis (2 cases). Modified Phemister is a reliable technique, technically easy, a low learning curve procedure and cheap with low hardware's costs.

Clinical and Radiologic Outcomes of Acute Acromioclavicular Joint Dislocation: Comparison of Kirschner's Wire Transfixation and Locking Hook Plate Fixation

“…14) ACJ fixation technique is a relatively simple surgical option with good outcome reports. 11,[14][15][16] For ACJ fixation, various types of devices are used.…”

Comparison between Trans-articular and Subacromial Stabilization with Ligament Repair for Acute Acromioclavicular Dislocation

“…Postoperative arthritic changes in the acromioclavicular joint are also found after surgical intervention for acromioclavicular joint dislocation [5,6]. Despite the short-term follow-up period, our trans-articular group frequently showed radiographic arthritis of the acromioclavicular joint.…”

“…Traditionally, temporary fixation using Kirschner wires inserted into the acromioclavicular joint with or without additional reconstruction has been utilized for the treatment of acromioclavicular dislocation [5,14]. Phemister [14] stated that a period of 6 weeks to 2 months is required for healing of the ligament, and hence, the wires should be removed 2 months after fixation.…”

“…Acromioclavicular dislocation is a common injury in active patients [1], and numerous treatment options for acromioclavicular joint dislocation have been described [2]. However, loss of reduction [3 -5] and postoperative osteoarth-ritis of the acromioclavicular joint [5,6] are often observed after surgery, and the treatment strategy has not yet been standardized [7]. The main pathology in acromioclavicular joint dislocation is disruption of the suspension mechanism of the clavicle following the rupture of the coracoclavicular ligament [8], with the resultant dislocation causing abnormal kinematics of the shoulder girdle [9,10].…”

Clinical and Radiological Outcomes of Modified Phemister Operation with Coracoclavicular Ligament Augmentation Using Suture Anchor for Acute Acromioclavicular Joint Dislocation

“…Overall, they showed that the Kwire transfixation group had an average increase in ACI of 2.2 mm, CCD of 2.0 mm, and ACD of 1.8 mm upon comparison of the contralateral unaffected shoulder and affected shoulder at the last follow-up. Verdano et al 31) used a modified Phemister technique that combined loop augmentation, coracoclavicular ligaments repair and transarticular stabilization with K-wire for acute AC joint dislocation. In their study, at the time of radiological follow-up, three patients maintained the reduction (21.4%), while nine (64.3%) showed a partial recurrence of the dislocation (<3 mm) and two (14.3%) showed complete re-dislocation.…”