Zdravniški Vestnik (Dec 2007)
Surgical treatment of dislocated acromioclavicular syndesmolysis remains controversial
Abstract
Background: Operative treatment of acromioclavicular (AC) joint dislocations Allman-Tossy III type is controversial. There are more than 30 types of operative treatments described. At the Department of Traumatology of Celje General and Teaching Hospital (CGTH) we operate the AC joint dislocation by the AC joint opened reduction and fixation using two Kirschner wires and additional figure of eight wire loop over the AC joint. The purpose of the analysis is to evaluate the results of acromioclavicular joint complete dislocation Allman-Tossy III type operative treatment.Patients and methods: In the 2-year period from July 1st 1997, to June 31st, 1999, at the Department of Traumatology of CGTH we operatively treated 59 injured persons with the AC joint dislocation. There were 55 men (93 %) and 4 women (7 %). The average age was 40 years (from 20 to 72 years). 56 (95 %) injured persons had the AC joint injury of Allman-Tossy III type. In first three weeks (early reconstruction) we operated 45 injured persons (76.3 %). The applied material was removed after 8 weeks. 47 (79.7 %) injured persons were re-examined at least one year after the injury (27 months in average; 14–39 months). The results were evaluated according to University of California at Los Angeles (UCLA) scale for the shoulder function evaluation. The impact of factors on a good treatment result was presented by the odds ratio and uni-variant analysis calculation.Results: Out of 47 injured persons re-examined according to the UCLA scale at least one year after the injury there were 17 injured persons (36.2 %) rated with an excellent result (UCLA 34– 35), 22 good (46.8 %) (UCLA 28–33), 5 satisfactory (10.6 %) (UCLA 21–27) and 3 bad (6.4 %) (UCLA 0–20). In total we achieved 83 % of excellent and good results. The injured persons age did not significantly affect the treatment result. Complications occurred in 14 (29.8 %) injured patients. If no complications were occurred the odds ratio for good result was 6.7. 39 % of the injured persons were on the sick leave for more than 4 months. In the injured persons with accident insurance we noticed a longer sick leave status (odds ratio 1.25). The injury did not affect the injured persons employment. The majority of the employed (92.4 %) carried out the same work after treatment as before the injury.Conclusion: By the operative treatment of the AC joint dislocation a good or excellent result is achieved in the majority of the injured persons (83 % in total).
