We report the short-term results of an alternative treatment for acromioclavicular (AC) dislocation. 36 patients, aged 20 to 58 (mean 36), with Tossy types IV (16) or V (20) AC-injuries were operated on within 1 week after trauma. The majority of patients had sport-related injuries. All patients were engaged in overhead activities, either professionally or for sports. The surgical technique consisted of a double fixation. A processed tendon-graft, either fascia lata or tibialis anterior, was looped around the coracoid process and the distal clavicle in a figure-of-eight and sutured onto itself after reduction of the dislocation. The AC discus was removed if damaged. No attempt at repair of the ligaments was made. The graft was protected for 6 weeks with 2 percutaneously placed acromioclavicular K-wires. In this period pendulum exercises and up to 45° abduction were allowed. 21 patients had an excellent result with painfree function, including full range of motion and strength, at only 3 month postop; another 5 needed 6 months to reach an excellent result. These patients could fully return to their work or sports activities at 3 months postop. 5 developed frozen shoulder syndrome and had a poor result at 3 month postop. These patients recovered well and all had good or excellent results at 8 month postop. 3 patients refused follow up after removal of their K-wires and 2 refused follow up beyond 3 months, at which time their result was good (1/5) or fair (4/5). Although a good to perfect reduction was obtained perop, X-rays showed perfectly maintained reduction in only 12 shoulders. 15 patients had minimal loss of reduction (< 5mm), 7 had < 100% ascension of the clavicle and 2 had > 100% ascension. Complications were rare, with 3 patients having early pin migration or removal due to infection which led to loss of reduction. 3 other patients had minor AC wound problems and another 2 pintract infection; all without further consequences. The use of a processed tendon-graft to reconstruct the coracoclavicular ligaments, protected by 6 weeks of K-wires, appears to be a valuable treatment option for Tossy grades IV and V AC injuries. This technique allows rapid recuperation of full function as well as return to work and sports in the majority of patients

Aims

Distal third clavicle (DTC) fractures are increasing in incidence. Due to their instability and nonunion risk, they prove difficult to treat. Several different operative options for DTC fixation are reported but current evidence suggests variability in operative fixation. Given the lack of consensus, our objective was to determine the current epidemiological trends in DTC as well as their management within the UK.

Aims

The current global pandemic due to COVID-19 is generating significant burden on the health service in the UK. On 23 March 2020, the UK government issued requirements for a national lockdown. The aim of this multicentre study is to gain a greater understanding of the impact lockdown has had on the rates, mechanisms and types of injuries together with their management across a regional trauma service.