REVIEW ON ACROMIO CLAVICULAR STABILIZATION PROCEDURES

Abstract

Effectiveness of Surgery for Acromio-clavicular joint dislocation is a controversy. Multitude of highly variable techniques and equally variable results make the choice of surgical procedure difficult. Open Reduction and Internal Fixation (ORIF) (Intra-articular) with Tension Band Wiring(TBW)and K-wire fixation and Modified Weaver Dunn(WD) Procedure (extra-articular) were the two procedures analysed in this study.

Retrospective review of case notes of patients admitted for ACJ stabilization procedure. For each patient pro-forma filled in Conducted Telephone review of the cases and obtained the long term functional out come using Oxford shoulder Scoring System. Compared the functional outcome of various surgical procedures for ACJ Stabilization with the standards

We had eighteen cases of ACJ stabilization over a period of ten years. Eleven WD reconstruction and seven ORIF with TBW. Mean age of the group: thirty-one years. 70% were males. Mechanism of injury was fall in 60%. 77% had Grade three Rockwood ACJ dislocation and rest were grade four. Reason for operative management in majority of them were pain and weakness of shoulder. Most of them had the surgery done between one month and two years from the date of injury. Four out of seven ORIFs had post op complications like wire breakage, impingement and pain. Only two out of eleven Weaver Dunn had pain post operatively. All the four ORIFs which developed post op complications had the metal work removed. Long term functional results by Oxford shoulder score has shown good result in all the patients who had telephone review irrespective of the type of procedure.

WD Reconstruction has got less post operative complications and better short term functional out come compared to ORIF. Four out of seven ORIF patients needed a second surgery for metal work removal. WD Reconstruction, being a soft tissue procedure using biodegradable materials, never required a second surgery. Long term functional results were same for both types of procedures We recommend modified WD for the following reasons: 1. Better short term functional outcome and hence faster recovery. 2. No need for a second surgery. Hence they imposes less financial burden for the hospital as well as the patient Summary: Choice of surgical procedure for Grade three and above Acromio-clavicular joint dislocation is controversial. The extra-articular soft tissue procedures have a faster recovery but long term functional results are similar to that of intra-articular ORIF procedures.