Fractures were Classified based on the Weber’s system. Pre-operative medial clear space measurement was done by 2 independent observer using PACS measurement tool. Intraoperative details for the method of fixation and the medial soft tissue were analysed. Most common method of fixation is Neutralisation plate for the lateral side. In Weber B type 1/3 rd of the cases had both plate on the lateral side and syndesmotic screw fixation. 2/3rd of them had only plate fixation. In Webers C type, only syndesmotic screw in n=3, Plate and screw n=4, only plate in n=9 cases
Radiological measurement of medial clear space average = 9.08mm, range= 5 –22 mm Less than 50% of the patients only had medial clinical signs. 26.6% had soft tissue (periosteal injury) and only 6.6% had deltoid ligament injury Out come assessment criterias: The failure of fixation or any on going medial symptoms in group A. – one case of failure of fixation. Final clinical assessment with ankle score (Olerud and Molander score.) at 6 months average (between 3–18 months). No significant difference in the score, on follow up.
Medial clear space does not correlate with any degree of medial soft tissue injury. Exploration is indicated if widening persist after lateral side fixation. Routine exploration of the medial side has no long term impact on the clinical outcome.
The mean follow up was 21 and 9 months for group A and B respectively.
Final outcome using the Constant and Murley score. The improvement in the score averaged 42 and 47 points in group A and B respectively Early Post operative pain using visual analogue score (VAS) average of 6 and 3 in group A and B respectively Overall patient satisfaction: 81% in group A and 89% in group B.
Patients with IAC who fails to respond physiotherapy and MUA do well after arthroscopic capsular release with little operative morbidity. Complete normal functional outcome of shoulder is not a prerequisite for patient satisfaction.
