• Clinics in Shoulder and Elbow
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• v.1 no.1
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• pp.128-131
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• 1998

Fracture of the clavicle and dislocation of the acromioclavicular joint occur commonly as separate injuries. However, complete acromioclavicular dislocation with an ipsilateral clavicle fracture is quite rare. We experienced a case of acromioclavicular joint dislocation associated with fracture of clavicle and brachial plexus injury treated by open reduction and internal fixation.

• Clinics in Shoulder and Elbow
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• v.8 no.2
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• pp.88-96
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• 2005

Purpose: To compare and analyze the outcome of primary clavicular lateral end resection method and conventional acromioclavicular (AC) joint reduction method in type III AC dislocation patients over 45 years. Materials and Methods: This study was performed on selected 24 cases of type III AC dislocation patients, over 45 years of age, operated at our hospital from 1998 to 2002. Group I consist of 12 patients who underwent primary clavicular lateral end resection methods (average age: 54.3 years$(45{\sim}72)$). Group II consist of 7 patients using Bosworth methods and 5 patients using Phemister methods (average age: 54.4 years$(45{\sim}71)$). Clinical outcome was evaluated by Weaver and Dunn method. Radiological results were compared by measuring coracoclavicular distance between normal and injured side. Results: As clinical outcome, good was 10 cases(83%); fair 2(17%) in Group I, and good 6(50%); fair 3(25%); poor 3(25%) in Group II. In contrast, the difference of coracoclavicular distance was not statistically significant between two groups before or after surgery, and last follow up. At the last follow up, there was no special correlation between the difference of coracoclavicular distance and clinical outcome. Conclusion: We considered that primary clavicular lateral end resection may be effective for prevention of arthrosis in AC joint in type III AC dislocation patients over 45 years.

• Clinics in Shoulder and Elbow
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• v.1 no.2
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• pp.175-179
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• 1998

The acromioclavicular joint is commonly affected by traumatic and degenerative conditions. Most injuries are due to direct trauma, such as a fall on the shoulder. Although there is general agreement on treatment of type I, Ⅱ, Ⅳ, V and VI acromioclavicular injuries, the treatment of type Ⅲ injuries remains controversial. Sixty patients, ranging in age from 19 to 57 years(average, 32), were evaluated an average of 57.5 (range, 13 to 96) months after surgical reconstruction for Rockwood type Ⅲ Ⅳ, V acromioclavicular dislocation. Phemister method (47 cases), Bosworth (3 cases), Weaver and Dunn method (10 cases) were used to correct displacement. An increase of the coracoclavicular distance of the injured shoulder over the normal shoulder was average 7.1㎜ at initial, average l㎜ on postoperatively, and average 2㎜ at follow-up. Overall, 54 of 60(90%) patients achieved satisfactory results. Degree of increase of the coracoclavicular distance has no inliluence to clinical results.

• Clinics in Shoulder and Elbow
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• v.15 no.2
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• pp.143-147
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• 2012

A triple disruption of the SSSC, an extremely rare injury, has been reported by only a few authors. We present a patient who had sustained a triple disruption of the SSSC: coracoid and scapular spine fractures, and an acromioclavicular joint separation. Treatment consisted of an anatomical restoration of the SSSC, with maintenance of the acromiohumeral and coracohumeral distances; this was achieved by open reduction and internal fixation of the fractures and of the separation. Six months after surgery, the injured shoulder was asymptomatic, with full range of motion. Five years after surgery, at the final follow-up, the function of the SSSC had been restored to the patient's complete satisfaction.

• Clinics in Shoulder and Elbow
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• v.11 no.2
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• pp.172-176
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• 2008

Purpose: The proper surgical methods for treating acromioclavicular joint dislocation is still controversial. New methods should provide better early motion with sufficient strength. Materials and Methods: We performed arthroscopic stabilization using TightRope$^{(R)}$ (Arthrex, Inc, Naples, FL) in 10 cases of acromioclavicular joint dislocation between April, 2007, and December, 2007, and followup for a minimum of 10 months. We performed radiologic evaluation by comparing the clavicle anteroposterior radiograph with the contralateral one. Clinical evaluation was made for pain, function, and range of joint motion by Imatani's methods. Results: In clinical evaluation, 6 cases were excellent, 3 cases were good, and 1 case was poor. In radiologic evaluation, 9 cases were excellent and 1 case was poor. Redislocation occurred in 1 case. Conclusion: During short-term followup, 9 of 10 patients who underwent arthroscopic stabilization using TightRope$^{(R)}$ had excellent results in Imatini tests and radiologic evaluation, except 1 patient with redislocation.

• Clinics in Shoulder and Elbow
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• v.9 no.2
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• pp.196-201
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• 2006

We report two cases of migration of K-wires from the acromioclavicular joint to the neck. A 73-year-old man complained of right shoulder pain for one month and had undergone orthopedic surgery because of acromioclavicular joint dislocation about 27 years earlier. Another 56-year-old man complained of left shoulder pain and neck pain for 5 years and had undergone orthopedic surgery because of acromioclavicular joint dislocation about 25 years earlier. In both cases, we took X-rays to look for the cause of shoulder pain and discovered broken and migrated K-wires in the neck. We removed the K-wires from the trapezius muscle and the paraspinal muscle respectively. K-wire fixation technique is simple and effective but should be followed up with X-rays periodically. In addition, we should warn patients of the possibility of migration of K-wire. And it is desirable for us to avoid using K-wire near major neurovascular structures like the sternoclavicular joint and the clavicle.

• Clinics in Shoulder and Elbow
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• v.9 no.2
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• pp.189-195
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• 2006

Purpose: To analyze the result of the accurate open reduction of acromioclavicular (AC) joint and pin fixation, coracoclavicular (CC) screw fixation without CC ligament repair for AC joint injuries. Materials and Methods: Between January 2000 and December 2003, seventeen cases with at least one year follow-up among twenty-one cases underwent operation for AC-CC ligament injuries. A transverse incision approximately 5 cm in length was made over the clavicle, and the AC joint was reduced accurately. Under the image intensifier, a cannulated screw and washer were inserted for the CC ligament. Two Steinman pins were inserted for the AC joint and the AC ligament was repaired with nonabsorbable suture. Gentle passive range of motion was begun postoperative 2 weeks. The pins were removed at $6{\sim}8$ weeks and the screw was removed at $10{\sim}12$ weeks. The results were evaluated by a distance between AC and CC joints on plain films and ASES score at last follow-up. Results: At the last follow-up, there was no limitation of motion and average ASES score was 96($86{\sim}100$ points). There was no failure showing over 5 mm difference of distance compared to opposite side on the plain films. Seven cases had the skin damages and local infection due to pin migration and three cases showed the loosening of CC screw. Conclusion: We could have satisfactory results by accurate reduction of AC joint and simple pins and screw fixation for AC-CC ligament injuries.

• Clinics in Shoulder and Elbow
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• v.2 no.1
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• pp.1-7
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• 1999

Purpose : There has been considerable controversy as to the method of the treatment of acute acromioclavicular joint dislocation classified to type III injury. The purpose of this study is to compare the conservative and operative treatment of the type III acute acromioclavicular joint dislocation in terms of clinical and radiological results. Materials and Methods: We treated 31 cases of acute, type III acromioclavicular joint dislocation, 17 cases were treated by operative methods and 14 patients by conservative treatment, and 1 year minimum follow-up was done from January 1990 to January 1996. We used UCLA Shoulder Rating Scale for clinical results. And for the radiological results coracoclaviclar distance were measured. We used Fisher's exact test for statistical analysis of results between the two treatment methods. Results: Fifteen(88.2%) of seventeen patients in operative treatment and eleven(78.6%) of fourteen patients in nonoperative treatment were rated excellent or good on the UCLA rating scale. In radiographic evaluation, the average coracoclavicular distances of preoperative state, immediate postoperation(or postreduction) and last follow-up were as follows. In operative cases, it was 1.75±0.21mm, 1.14±0.24mm and 1.33± 0.22mm respectively. In nonoperative cases, it was 1.65±0.14mm, 1.26±0.26mm, and 1.42±0.27mm respectively. Conclusion : This study demonstrated that there was no significant difference in clinical and radiological results between the operative and nonoperative treatment groups. So, nonoperative treatment is recommended for acute type III acromioclavicular dislocation as general rule.

• Clinics in Shoulder and Elbow
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• v.9 no.2
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• pp.155-161
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• 2006

Purpose: To compare the clinical and radiological results between the modified Weaver-Dunn method and modified Phemister method in the acute acromioclavicular joint dislocation. Materials and Methods: We reviewed 19 patients who were treated for the acute acromioclavicular joint dislocation from 2001 to 2002. 10 patients were operated with the modified Weaver-Dunn method (group A) and the others with modified Phemister method (group B). The classification of preoperative injury was analyzed by using the Rockwood system, the clinical assessment of preoperative and postoperative by the modified UCLA rating scale and the radiological assessment by simple x-ray. Results: With the modified UCLA rating scale, group A showed 5 cases(50%) of excellent and 5 cases(50%) of good, group B showed 4 cases(44.4%) of excellent and 5 cases(55.6%) of good. In the radiologic findings of the coracoclavicular distances, group A was 16.2 mm at preoperative, 8.8 mm at postoperative, 9.7 mm at last follow-up and group B was 12.9 mm, 6.7 mm and 7.9 mm respectively. Postoperatively there were no complications such as surgical wound infection and failure of Kirschner wires. Conclusion: Both the modified Weaver-Dunn and modified Phemister methods have shown satisfied clinical and radiologic results, and there was no difference in these result between two groups (p>0.05).

• Clinics in Shoulder and Elbow
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• v.1 no.2
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• pp.180-185
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• 1998

There has been considerable controversy as to the treatment method of dislocation of the acromioclavicular joint, so various operative treatment modalities have been suggested. We analyzed the results of 40 patients with acromio­clavicular dislocation, in whom twenty patients were treated by modified Phemister method and 20 patients by modified Weaver-Dunn method above follow-up two years. The purpose of this study was to compare the clinical results of two operative methods. According to Weitzman criteriae for clinical results, 12 cases were excellent, six cases good and two cases fair in modified Phemister method. But in modified Weaver-Dunn method, ten cases were excellent, eight cases good, one case fair and one case poor. In radiological result, coracoclavicular distance was measured at preoperative, postoperative and last follow-up period. The modified Phemister method was 6.lmm, 1.5mm and 2.4mm respectively, and the modified Weaver-Dunn method 7.8mm, 2.lmm and 2.5mm respectively. The complications were two cases of heterotopic ossification, one case of inadequate fixation and one case of K-wire breakage in modified Phemister method, and two cases of early fixation loss and one case of heterotopic ossification in modified Weaver-Dunn method. We obtained that the clinical, functional and radiological results showed no significant difference in two methods. The modified Phemister method was effective treatment for old patients in acute injuries due to short operation time and simple technique. The modified Weaver-Dunn method, as a reconstructive operation that reduces various complications for young and active male patients, was also good for getting the stability of coraco­clavicular ligament through clavicular bony union.