The aim of this review is to address controversies in the management of dislocations of the acromioclavicular joint. Current evidence suggests that operative rather than non-operative treatment of Rockwood grade III dislocations results in better cosmetic and radiological results, similar functional outcomes and longer time off work. Early surgery results in better functional and radiological outcomes with a reduced risk of infection and loss of reduction compared with delayed surgery. Surgical options include acromioclavicular fixation, coracoclavicular fixation and coracoclavicular ligament reconstruction. Although non-controlled studies report promising results for arthroscopic coracoclavicular fixation, there are no comparative studies with open techniques to draw conclusions about the best surgical approach. Non-rigid coracoclavicular fixation with tendon graft or synthetic materials, or rigid acromioclavicular fixation with a hook plate, is preferable to fixation with coracoclavicular screws owing to significant risks of loosening and breakage. The evidence, although limited, also suggests that anatomical ligament reconstruction with autograft or certain synthetic grafts may have better outcomes than non-anatomical transfer of the coracoacromial ligament. It has been suggested that this is due to better restoration horizontal and vertical stability of the joint. Despite the large number of recently published studies, there remains a lack of high-quality evidence, making it difficult to draw firm conclusions regarding these controversial issues. Cite this article: Bone Joint J 2013;95-B:1595–1602

Treatments of Chronic Acromioclavicular joint dislocation are controversial. Many procedures have been described in the past for the management of them. Treatment modalities have changed with increasing understanding of the nature of the problem, patient expectations and the biomechanics of the joint. Aim. To assess the functional outcome of the chronic AC joint dislocations treated by modified Weaver-Dunn procedure combined with Acromioclavicular joint augmentation. Material and methods. We treated 54 patients with chronic AC joint dislocation by modified Weaver-Dunn procedure with additional AC joint augmentation. We used tight rope system in 20 patients, Mersilene tape in 22 patients and no 5 Ethibond in 12 patients. Results. This Study was done between Jan 2003 to Jan 2012. Mean follow up was 20 months, mean age of the patients was 35, and male to female distribution was 48:6. We assessed them clinically and radio logically during their follow up. All patients were back to their occupation. 80% are back to their pre injury sporting activity level. The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 10.2 points. One patient had a failure of augmentation device. Conclusion. Our study shows that chronic symptomatic AC joint dislocations, (Rockwood types III to V) Managed with modified modified Weaver-Dunn procedure with augmentation are showing good short term results. Significant improvement in the patient satisfaction, early return to work and radiological appearance

Treatments of Chronic Acromioclavicular joint dislocation are controversial. Many procedures have been described in the past for the management of them. Treatment modalities have changed with increasing understanding of the nature of the problem, patient expectations and the biomechanics of the joint. To assess the functional outcome of the chronic AC joint dislocations treated by modified Weaver-Dunn procedure combined with Acromioclavicular joint augmentation. We treated 54 patients with chronic AC joint dislocation by modified Weaver-Dunn procedure with additional AC joint augmentation. We used tight rope system in 20 patients, Mersilene tape in 22 patients and no 5 Ethibond in 12 patients. This Study was done between Jan 2003 to Jan2012. Mean follow up was 20 months, mean age of the patients was 35, and male to female distribution was 48:6. We assessed them clinically and radio logically during their follow up. All patients were back to their occupation. 80% are back to their pre injury sporting activity level. The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 10.2 points. One patient had a failure of augmentation device. Our study shows that chronic symptomatic AC joint dislocations, (Rockwood types III to V,) Managed with modified modified Weaver-Dunn procedure with augmentation are showing good short term results. Significant improvement in the patient satisfaction, early return to work and radiological appearance

The aim of our study was to assess, for the first time in a large study, whether there are radiological features of the acromioclavicular joint (ACJ) which vary with age or between genders and side. Clinical experience suggested that there was no clear correlation between the radiological features and symptoms arising from the ACJ. Therefore we also aimed to test the null hypothesis that there are no consistent radiological features which correspond with the need for surgical excision of the ACJ. We analysed 240 shoulder radiographs, divided into male and female, left and right shoulders, and decades from 20 to 80 years inclusive. At the ACJ the presence of sclerosis, osteophytes, cysts and lysis were recorded, and the width of the joint measured. These same parameters were assessed on the pre-operative radiographs for a group of 100 patients by a blinded observer. Fifty had undergone ASD (arthroscopic subacromial decompression), and 50 ASD with ACJ excision. These two groups were age matched. Statistical analyses were performed. There was no statistical difference between any of the parameters for gender or side however with increasing age there was a significantly increased incidence of joint space narrowing and increased features of osteoarthrosis. When comparing the matched ASD and the ACJ excision groups it was found that the presence of medial sclerosis (p = 0.016) and superior clavicular osteophytes (p = 0.016) were more common in the ACJ excision group. We concluded that there is a change in the radiological features of the ACJ with increasing age but not between sides or gender. The null hypothesis is upheld. Only 2 parameters, namely medial acromial sclerosis and superior clavicular osteophytes, are radiological features which correlate with a symptomatic acromioclavicular joint. These have poor sensitivity and specificity and therefore should not be used as a test

The aim of our study was to assess, for the first time in a large study, whether there are radiological features of the acromioclavicular joint (ACJ) which vary with age or between genders and side. Clinical experience suggested that there was no clear correlation between the radiological features and symptoms arising from the ACJ. Therefore we also aimed to test the null hypothesis that there are no consistent radiological features which correspond with the need for surgical excision of the ACJ. We analysed 240 shoulder radiographs, divided into male and female, left and right shoulders, and decades from 20 to 80 years inclusive. At the ACJ the presence of sclerosis, osteophytes and cysts were recorded, and the width and angle of the joint measured. These same parameters were assessed on the preoperative radiographs for a group of 100 patients by a blinded observer. Fifty had undergone ASD (arthroscopic subacromial decompression), and 50 ASD with ACJ excision. These two groups were age matched. Statistical analyses were performed. There was no statistical difference between any of the parameters for gender or side however with increasing age there was a significantly increased incidence of acromial sclerosis and joint space narrowing. When comparing the matched ASD and the ACJ excision groups it was found that the presence of medial sclerosis of the acromium (p = 0.016) and superior clavicular osteophytes (p = 0.016) were more common in the ACJ excision group. We concluded that there is a change in the radiological features of the ACJ with increasing age but not between sides or gender. The null hypothesis has been rejected. The presence of either medial sclerosis of the acromium, and superior clavicular osteophytes, are radiological features which correlate with a symptomatic acromioclavicular joint

Acromioclavicular joint injuries are one of the most common injuries in the shoulder girdle complex. Surgical management is considered based on patient profile, level of activity, pain, and classification of injury. To date, a vast array of surgical techniques have been proposed and described in the literature, a possible reason being that the optimal solution is still uncertain. The aim of this study is to determine the efficacy of an alternative surgical technique. This study is a retrospective case series of 80 patients that have been operated by a single surgeon over a period of 6 years. A novel surgical technique, the ‘BiPOD method’, was applied where a synthetic artificial ligament (LARS®) is used to reconstruct and reduce the acromioclavicular joint. The technique is done in a reproducible manner, where a single continuous artificial ligament is used to reduce and reconstruct both, the coracoclavicular and acromioclavicular ligament complexes to achieve bidirectional stability. Patients were followed-up postoperatively, either clinically where possible or telephonically. The Acromioclavicular Joint Instability Score (ACJI) and radiographic measurements were used to determine the clinical and surgical outcome of the surgery. Radiographic parameters, measuring the reduction of the coracoclavicular- and acromioclavicular joint, were analysed and documented. The results showed marked improvement in both, the coracoclavicular distance and acromioclavicular distance. Clinically, using the ACJI scoring system, the patients reported substantial improvement in pain and function. Complications were recorded but were insignificant. The BiPOD surgical technique, making use of an artificial LARS® ligament, has proven acceptable outcomes in the surgical management of acromioclavicular joint dislocations

Intra-articular punctures and injections are performed routinely on patients with injuries to and chronic diseases of joints, to release an effusion or haemarthrosis, or to inject drugs. The purpose of this study was to investigate the accuracy of placement of the needle during this procedure. A total of 76 cadaver acromioclavicular joints were injected with a solution containing methyl blue and subsequently dissected to distinguish intra- from peri-articular injection. In order to assess the importance of experience in achieving accurate placement, half of the injections were performed by an inexperienced resident and half by a skilled specialist. The specialist injected a further 20 cadaver acromioclavicular joints with the aid of an image intensifier. The overall frequency of peri-articular injection was much higher than expected at 43% (33 of 76) overall, with 42% (16 of 38) by the specialist and 45% (17 of 38) by the resident. The specialist entered the joint in all 20 cases when using the image intensifier. Correct positioning of the needle in the joint should be facilitated by fluoroscopy, thereby guaranteeing an intra-articular injection

In an osteological collection of 3100 specimens, 70 were found with unilateral clavicular fractures which were matched with 70 randomly selected normal specimens. This formed the basis of a study of the incidence of arthritis of the acromioclavicular joint and the effect of clavicular fracture on the development of arthritis in the ipsilateral acromioclavicular joint. This was graded visually on a severity scale of 0 to 3. The incidence of moderate to severe arthritis of the acromioclavicular joint in normal specimens was 77% (100 specimens). In those with a clavicular fracture, 66 of 70 (94%) had arthritis of the acromioclavicular joint, compared to 63 of 70 (90%) on the non-injured contralateral side (p = 0.35). Clavicles with shortening of 15 mm or less had no difference in the incidence of arthritis compared to those with shortening greater than 15 mm (p = 0.25). The location of the fracture had no effect on the development of arthritis

Introduction: Acromioclavicular (AC) joint injuries are common in both the sporting and working populations. Most injuries are grade I in severity and settle with an appropriate non-operative treatment program. Arthroscopic soft tissue debridement of the AC Joint without excising the distal clavicle, is a bone sparing procedure that, to our knowledge, has never been reported in the literature. This paper is a retrospective review of patients with chronic recalcitrant AC joint injuries, who underwent arthroscopic soft tissue debridement of the AC joint. Materials and Methods: Fourteen patients underwent arthroscopic AC joint soft tissue debridement. All patients had failed a non-operative treatment program including physiotherapy, anti-inflammatory tablets and corticosteroid injections. All patients had been symptomatic for a minimum of four months prior to surgery. The surgery involves a glenohumeral joint arthroscopy, subacromial bursoscopy and AC joint arthroscopy. Excision of the torn AC joint meniscus, AC joint synovectomy and soft tissue clearance were performed in all cases. Surgery was performed as a day-only procedure. Results: Ten out of fourteen patients obtained good pain relief and a corresponding increase in function. One patient was lost to follow-up. One patient subsequently underwent an open AC joint reconstruction for chronic instability. Five patients had previously undiagnosed SLAP tears. Conclusion. Arthroscopic soft tissue debridement for recalcitrant AC joint injuries gave good results in 77% of cases. Arthroscopy of the glenohumeral joint in patients with presumed isolated AC joint disease is important as there is a significant proportion of patients who have associated significant superior labral tears. Soft tissue arthroscopic AC joint debridement allows quick post-operative rehabilitation, an early return to sport and work and avoids having to excise bone from the distal clavicle. Arthroscopic AC joint debridement is contraindicated in patients who have grade II or grade III AC joint instability

Injuries to the acromioclavicular joint are common but underdiagnosed. Sprains and minor subluxations are best managed conservatively, but there is debate concerning the treatment of complete dislocations and the more complex combined injuries in which other elements of the shoulder girdle are damaged. Confusion has been caused by existing systems for classification of these injuries, the plethora of available operative techniques and the lack of well-designed clinical trials comparing alternative methods of management. Recent advances in arthroscopic surgery have produced an even greater variety of surgical options for which, as yet, there are no objective data on outcome of high quality. We review the current concepts of the treatment of these injuries

Aim: The purpose of this study was to evaluate the results after arthroscopic treatment of traumatic AC joint dislocation using a Bosworth screw. Method: 18 Patients with acute AC Joint dislocation type Rockwood 3 were arthroscopically treated with temporary transfixation using a 7.0mm cannulated titanium screw of the clavicle to the coracoid process. The coracoid process is arthroscopically visualized and a drill guide for tibial anterior cruciate ligament positioning is used to exactly place the screw into the coracoid process. The screws were removed after 8 weeks. Patients were followed using a prospective study using the Constant Score after 3, 6, 12 and 24 months. Results: 17 Patients were completely evaluated. One screw slipped out of the coracoid process 3 days after surgery requiring revision surgery. No screw breakage was observed. There were no other operation conditioned complications. Constant score showed a mean of 94,7 at last follow up. At follow up, no patient hat a redislocation without weight bearing. With 10kg weight a mean clavicular elevation of 1,8mm was observed. All remaining patients were satisfied with the functional and cosmetic result. Discussion: There is some controversy about the surgical treatment of acute traumatic AC joint dislocation type Rockwood 3. Most open surgery techniques have the disadvantage of a poor cosmetic result or a difficult and dangerous hardware removal, because the scar of the AC joint capsule that is supposed to stabilize the clavicle has to be opened. The Bosworth screw technique does not touch the AC joint at all, but the open procedure has poor cosmetic outcome. It is also important to use a large screw to ensure proper hardware stability to avoid hardware failure. Our technique might be an alternative for the operative treatment of acute AC joint instability, because it is safe and all anatomical structures remain intact in case revision surgery with i.e. arthroscopic AC joint resection and ligamentoplasty is necessary

Because there is little in the literature about specific presentation and examination methods for acromioclavicular (AC) joint pathology, we aimed to define and identify the most reliable tests. We identified and examined 30 patients with probable AC joint pathology. We then excluded eight patients who experienced no pain relief after local Lignocaine infiltration, and examined 22 patients, two of whom had bilateral shoulder problems. There were 15 complaints of AC joint pain, 13 of anterior pain, five of posterior pain and five of lateral pain. Pain radiated anteriorly in 14 patients, posteriorly in two, laterally in three and to the cervical region in three. Pain increased with weight-bearing in 18 shoulders, on elevation in five, on activities of daily living in six, at night or on being lain on in 11, and on reaching across the body in three. Clinical examination revealed swelling in seven shoulders and AC joint prominence in seven. There was local tenderness in 21 shoulders and there were crepitations in four. The forced cross-body test produced pain in 22 shoulders. In 22 shoulders, elevation was less than 60°. Jobe’s test was positive in 20, the Speed’s test in 19, O’Brien’s test in 15, the compression test in 15, the distraction test in 13. A painful arc was present to 160° in 13 shoulders. There was neck tenderness in 13 patients. Associated conditions included two cases of shoulder arthritis, six of impingement, two rotator cuff tears, two cases of biceps tendinitis and two of cervical pathology. Radiological changes were evident in 19 AC joints, 13 shoulder joints and 11 cervical spines. On ultrasonography, pathology was resent in 10 of 15 cases. The most common symptoms were pain with weight-bearing, elevation and lying on shoulder. Anterior and posterior pain was the most common. The most common clinical findings were local tenderness, pain on elevation and the forced cross-body test, positive Jobe’s and Speed’s tests. Because no test is 100% accurate, the whole clinical presentation must be taken into account. Local infiltration of the AC joint is extremely helpful

Acromioclavicular joint is an integral component of Shoulder Complex and common site of injury particularly for athletes involved in sports such as Football, Cricket, Rugby and Shotput. Acromioclavicular Injuries are often neglected and goes untreated especially in low demand patients. Classic surgical techniques are associated with high complication rates. This is a prospective study from 2015–2017 wherein 32 patients with Acute grade 3, 4, 5, 6 Acromioclavicular joint dislocations, were operated with Minimally Invasive Double Tunnel Anatomical Coraco-clavicular Ligament Reconstruction (DT-ACCLR) with Tightrope Suspensory fixation. Clinical Outcomes were evaluated with Visual Analog Scale, Constant functional scale, Start of Movement, Return to Work, Satisfaction index and Coraco-clavicular distance over 12 months. Mean follow-up was 14 ± 3.8 months. Visual analog scale and Constant scores revealed significant advancements 0 ± 0.5 (range, 0–2) and 95 ± 3 (range, 92–98) scores at 12 months respectively. The coraco-clavicular distance significantly reduced from 23 ± 2.4 mm to 8 ± 0.5 mm. Mean return to work by 7 days. 98.6% patients were satisfied with surgical results. We conclude that DT-ACCLR is simple and creative surgical technique which provides stable, reliable and painless AC joint. The patients can move the shoulder same day and return to Work by 5–7days and Sports 3–4 weeks

Acromioclavicular joint (ACJ) dislocations is a common disorder amongst our population for which numerous techniques have been described. It is thought that by using this novel technique combining a CC and AC repair with a reconstruction will result in high maintenance of anatomical reduction and functional results. 12 consecutive patients ACJ dislocations were included. An open superior clavicular approach is used. Firstly, the CC ligaments are repaired after which a CC reconstruction is performed using a tendon allograft. Secondly, the AC ligaments are repaired using an internal brace construct combined with a tendon allograft reconstruction (Figure 1). The acute:chronic ratio was 6:6. Only IIIB, IV and V AC-joint dislocations were included. The Constant-Murley Score improved from 27.6 (8.0 – 56.5) up to 61.5 (42.0 – 92.0) at 12 months of follow up. Besides one frozen shoulder from which the patient recovered spontaneously no complications were observed with this technique. The CCD was reduced from 18.7 mm (13.0 – 24.0) to 10.0 mm (6.0 – 16.0) and 10.5 mm (8.0 – 14.0) respectively 12 weeks and 12 months postoperatively. There is some evidence, suggesting to address as well as the vertical (coracoclavicular (CC) ligaments) as the horizontal (acromioclavicular (AC) ligaments) direction of instability. This study supports addressing both entities however comparative studies discriminating chronic as acute cases should be conducted to further clarify this ongoing debate on treating ACJ instability. This study describes a novel technique to treat acute and chronic Rockwood stage IIIB – IV ACJ dislocations with promising short-term clinical and radiological results. This suggests that the combined repair and reconstruction of the AC and CC ligaments is a safe procedure with low complication risk in experienced hands. Addressing the vertical as well as horizontal stability in ACJ dislocation is considered key to accomplish optimal long-term results

Aims: Most of the orthopaedic literature on os acromiale (OA) is focused on corresponding clinical implication, such as impingement syndrome and rotator cuff tear; whilst, although it is present in 8% of subjects, scarce information is reported on the causes that may predispose to it. Our aim is to investigate whether the origin of OA is related to position of AC joint. Methods: The acromions of 211 volunteers (control group) and 33 subjects, respectively, without or with OA have been radiographically (axillary view) classiþed in accordance to the Edelson and Taitzñ method. The latter distinguishes the acromion in three types on the basis of the distance between the anterior aspect of the acromion and AC joint. Out of 33 subjects with os acromiale, 11 were shoulder painless. We have compared among them the frequencies of the types of acromion observed in the two investigated cohorts. Results: Half (52.1%) of the acromions of the control group had the articular facet for the AC joint on the acromion tip whilst in 45.4% facet was tip distally located. On the other hand, out of 33 subjects with OA, 18.1% and 81.1% had, respectively, AC joint lying on or distally to the acromion tip. Conclusions: Our data suggest that the longer is the distance of AC joint from the anterior edge of the acromion, the higher is the possibility that an OA origin

The aim of this study was to establish a classification system for the acromioclavicular joint using cadaveric dissection and radiological analyses of both reformatted computed tomographic scans and conventional radiographs centred on the joint. This classification should be useful for planning arthroscopic procedures or introducing a needle and in prospective studies of biomechanical stresses across the joint which may be associated with the development of joint pathology. We have demonstrated three main three-dimensional morphological groups namely flat, oblique and curved, on both cadaveric examination and radiological assessment. These groups were recognised in both the coronal and axial planes and were independent of age

Management of highly displaced acromioclavicular joint (ACJ) injuries remain contentious. It is unclear if delayed versus acute reconstruction has an increased risk of fixation failure and complications. The primary aim of this was to compare complications of early versus delayed reconstruction. The secondary aim was to determine modes of failure of ACJ reconstruction requiring revision surgery. A retrospective study was performed of all patients who underwent operative reconstruction of ACJ injuries over a 10-year period (Rockwood III-V). Reconstruction was classed as early (<12 weeks from injury) or delayed (≥12 weeks). Patient demographics, fixation method and post-operative complications were noted, with one-year follow-up a minimum requirement for inclusion. Fixation failure was defined as loss of reduction requiring revision surgery. 104 patients were analysed (n=60 early and n=44 delayed). Mean age was 42.0 (SD 11.2, 17–70 years), 84.6% male and 16/104 were smokers. No difference was observed between fixation failure (p=0.39) or deep infection (p=0.13) with regards to acute versus delayed reconstruction. No patient demographic or timing of surgery was predictive of fixation failure on regression modelling. Overall, eleven patients underwent revision surgery for loss of reduction and implant failure (n=5 suture fatigue, n=2 endo-button escape, n=2 coracoid stress fracture and n=2 deep infection). This study suggests that delayed ACJ reconstruction does not have a higher incidence of fixation failure or major complications compared to acute reconstruction. For those patients with ongoing pain and instability following a trial of non-operative treatment, delayed reconstruction would appear to be a safe treatment approach

Dislocation of the acromioclavicular joint is a relatively common injury and a number of surgical interventions have been described for its treatment. Recently, a synthetic ligament device has become available and been successfully used, however, like other non-native solutions, a compromise must be reached when choosing non-anatomical locations for their placement. This cadaveric study aimed to assess the effect of different clavicular anchorage points for the Lockdown device on the reduction of acromioclavicular joint dislocations, and suggest an optimal location. We also assessed whether further stability is provided using a coracoacromial ligament transfer (a modified Neviaser technique). The acromioclavicular joint was exposed on seven fresh-frozen cadaveric shoulders. The joint was reconstructed using the Lockdown implant using four different clavicular anchorage points and reduction was measured. The coracoacromial ligament was then transferred to the lateral end of the clavicle, and the joint re-assessed. If the Lockdown ligament was secured at the level of the conoid tubercle, the acromioclavicular joint could be reduced anatomically in all cases. If placed medial or 2 cm lateral, the joint was irreducible. If the Lockdown was placed 1 cm lateral to the conoid tubercle, the joint could be reduced with difficulty in four cases. Correct placement of the Lockdown device is crucial to allow anatomical joint reduction. Even when the Lockdown was placed over the conoid tubercle, anterior clavicle displacement remained but this could be controlled using a coracoacromial ligament transfer. Cite this article: Bone Joint J 2015;97-B:1657–61

Aims. To compare radiographic failure and re-operation rates of anatomical coracoclavicular (CC) ligament reconstructional techniques with non-anatomical techniques after chronic high grade acromioclavicular (AC) joint injuries. . Patients and Methods. We reviewed chronic AC joint reconstructions within a region-wide healthcare system to identify surgical technique, complications, radiographic failure and re-operations. Procedures fell into four categories: (1) modified Weaver-Dunn, (2) allograft fixed through coracoid and clavicular tunnels, (3) allograft loop coracoclavicular fixation, and (4) combined allograft loop and synthetic cortical button fixation. Among 167 patients (mean age 38.1 years, (standard deviation (. sd. ) 14.7) treated at least a four week interval after injury, 154 had post-operative radiographs available for analysis. . Results. Radiographic failure occurred in 33/154 cases (21.4%), with the lowest rate in Technique 4 (2/42 4.8%, p = 0.001). Half the failures occurred by six weeks, and the Kaplan-Meier survivorship at 24 months was 94.4% (95% confidence interval (CI) 79.6 to 98.6) for Technique 4 and 69.9% (95% CI 59.4 to 78.3) for the other techniques when combined. In multivariable survival analysis, Technique 4 had better survival than other techniques (Hazard Ratio 0.162, 95% CI 0.039 to 0.068, p = 0.013). Among 155 patients with a minimum of six months post-operative insurance coverage, re-operation occurred in 9.7% (15 patients). However, in multivariable logistic regression, Technique 4 did not reach a statistically significant lower risk for re-operation (odds ratio 0.254, 95% CI 0.05 to 1.3, p = 0.11). Conclusion. In this retrospective series, anatomical CC ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure. . Take home message: Anatomical coracoclavicular ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure. Cite this article: Bone Joint J 2016;98-B:512–18

This prospective, randomized, controlled trial compares patient outcome after non-operative care versus open reduction and tunneled suspension device fixation (ORTSD) for grade III or IV acromioclavicular joint disruptions. Sixty patients aged between sixteen and thirty-five years with an acute grade III or IV AC joint disruption were randomized to receive ORTSD fixation or non-operative treatment. Functional assessment was conducted at six weeks, three months, six months, and one year using the Disabilities of the Arm, Shoulder and Hands (DASH), Oxford Shoulder Scores (OSS) and Short Form (SF-12). Reduction was evaluated using radiographs. Complications were recorded, and an economic evaluation performed. There was no significant difference in DASH or OSS at one year between non-operative and ORTSD groups (DASH score, 4.67 versus 5.63; OSS, 45.72 versus 45.63). Patients undergoing surgery had inferior DASH scores at 6 weeks (p<0.01). Five patients who failed non-operative management subsequently received surgery. Overall cost of treatment was significantly greater after ORTSD fixation (£796.22 vs £3359.73 (p<0.01)). ORTSD fixation confers no functional benefit over non-operative treatment at one year. While patients managed non-operatively generally recover faster, a significant group remain dissatisfied following non-operative treatment requiring delayed surgical reconstruction