• Clinics in Shoulder and Elbow
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• 제1권2호
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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.

• Clinics in Shoulder and Elbow
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• 제1권1호
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• pp.26-34
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• 1998

The management of acute acromioclavicular dislocations has usually followed the accepted principles of obtaining an anatomical reduction of the joint and maintaining it until soft tissue healing has occurred. So, the preferred treatment for acute acromioclavicular dislocation is controversial. We analysed operatively treated twenty-eight cases for acute acromioclavicular dislocation between February 1994 and January 1997 and reviewed postoperatively to evaluate the results of three different methods. We collected retrospectively the data via clinical history, associated injury, type of injury, radiographic review, Taft score, and final results. Follow up time averaged 14 months. (range, 12 to 21 ) In according to Rockwood's classification, ]7 cases were type Ⅲ, 1 case was type IV, and 10 cases were type V. Ten cases were treated with the modified Phemister method, ten cases with the modified Bosworth method and eight cases with the modified Weaver-Dunn method. ]n patients treated by modified Phemister method, the Taft score was 9.4 points and 8 cases achieved good or excellent results. In patients treated by modified Bosworth method, the Taft score was 9.8 points and 8 cases achieved good or excellent results. In patients treated by modified Weaver-Dunn method, the Taft score was 10.3 points and 7 cases achieved good or excellent results. The overall Taft score was 9.9 points and 23 cases achieved good or excellent results. There were four complications, such as calcification or metallic loosening or breakage of K-wire, but did not influence late results. In conclusions, there was no significant difference of results regarding the different three methods. However, our results indicated that the coracoclavicular ligament reconstruction by transfer of coracoacromial ligament produced better results.

• Clinics in Shoulder and Elbow
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• 제13권1호
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• pp.34-39
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• 2010

목적: 견봉쇄골 관절의 급성 탈구에서 원추인대 기능의 강화를 위한 봉합 나사못을 추가한 변형된 Phemister 술식의 치료 방법을 소개하고 그 결과를 알아보고자 하였다. 대상 및 방법: 14예의 환자를 대상으로 하였으며 Rockwood 제 3형이 11예, 5형이 3예 였고 환자의 평균나이는 45.2세 였다. 변형된 Phemister 술식에 원추인대 기능의 강화를 위한 봉합 나사못을 추가하여 수술하였다. 추시 기간은 평균 14개월이었으며 술 후 임상적 평가는 Weitzman 분류 및 VAS 점수와 Constant 점수, KSS 점수를 사용하였다. 결과: Weitzman 분류상 13예에서 우수, 1예에서 양호로 평가되었고 평균 관절 운동 범위는 전방거상 170.7도, 외전 166.4도, 외회전 68.2도, 내회전 T7 였다. 평균 VAS 점수는 1.9, 평균 Constant 점수는 90.8점, 평균 KSS 점수는 91점이었다. 방사선학적 평가 결과는 모든 예에서 양호한 결과를 얻었다. 결론: 견봉쇄골 관절의 급성 탈구에서 원추인대 기능의 강화를 위한 봉합 나사못을 추가한 변형된 Phemister 술식은 임상적으로 유용한 수술 방법으로 사료된다.

• Clinics in Shoulder and Elbow
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• 제2권2호
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• pp.126-132
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• 1999

Purpose : To evaluate the functional and radiographic outcome of the modified Bosworth method in the surgical treatment of acute type V acromioclavicular joint dislocation. Materials and Methods: From June 1995 to May 1998, 20 patients were operated on for acute and complete acromioclavicular dislocation(Rockwood type V). The operative technique includes fixation of the coracoclavicular joint with Bosworth screw or 6.5mm cancellous screw and imbrication of trapezius and deltoid muscles. The average age was 34 years(range, 19 to 51 years). These 20 patients with an average follow-up of 18months, were evaluated clinically using the UCLA scoring system. Additional radiographical assessment was performed with stress radiographs. Results: Excellent or good clinical results were obtained in 95%(19 cases). And the average coracoclavicular interval ratio was decreased from 3.31(2.2-6.0) to 1.13(1-1.4) in stress radiographs. There were 4 cases of hetero­topic calcification postoperatively but there was no correlation with clinical result. Posttraumatic A-C joint arthritis was developed in one case. In that case, the distal clavicular resection was done under the arthroscopic technique. Conclusion: The severe displacement observed with type V injuries is incompatible with normal shoulder function if the shoulder is left in its displaced position. In type V injuries, significant damage to the deltoid and trapezius musculature and overlying fascia occurs, therefore open reduction and good fixation must be obtained with imbrication of trapezius and deltoid muscles. In our type V acute complete acromioclavicular dislocation, the modified Bosworth technique provides excellent results with a low complication rate.

• Clinics in Shoulder and Elbow
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• 제2권1호
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• pp.8-13
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• 1999

The results of the operative treatment of the Grade III acromioclavicular joint injury is defined by the durability of the reduced joint and free of exertional pain. Several surgical techniques have been applied to reduce and stabilize the joints effectively. Resection of clavicular lateral end and subacromial decompression also could be applied to prevent post-operative arthritic change. Biomechanical studies reveals the role of clavicular elevation and rotation to achieve more than 90 degrees of elevation. It also serves as a attachment site of deltoid and trapezius muscle. The stability and mobility of the both acromioclavicular and coracoclavicular joint are important to get full functional recovery. We modified the methods of coracoacromial ligament transfer described by Weaver-Dunn and by Shoji et a!. to pre­vent pullout of the transferred ligament and to get more improved functional results. Main technical point was harvesting full thickness bone block and fix it through the key-hole to reduce pull out angle.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2003년도 학술대회
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• pp.26-26
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• 2003

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2002년도 학술대회
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• pp.90-90
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• 2002

• 대한관절경학회지
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• 제6권2호
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• pp.171-176
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• 2002

목적 : 저자들은 만성 제 2형 견봉쇄골 관절 탈구에 시행한 관절경하 원위 쇄골 절제술의 효과를 알아보고자 하였다. 대상 및 방법 : 1998년 2월부터 2001년 1월까지 제 2형 견봉쇄골 관절 탈구의 6례를 대상으로 시행하였으며 추시기간은 평균 12개월이었다. 검사의 결과의 평가는 constant-Murray 기능평가법을 이용하였으며 술 전 constant score는 32점 이었다. 결과 : 임상평가 결과 constant score는 술 후 $3\~6$주에서 35점 이었고 3개월은 49점 그리고 6개월에서는 69점으로 증가되었고 전체 환자의 $83\%$에서 만족도를 보였다. 결론 : 만성 제 2형 견봉쇄골 탈구에서 시행한 관절경하 원위 쇄골 절제술은 수기가 쉽고 간단하여 개방성 방법을 통한 광범위한 인대 재건술 또는 오구 쇄골간 고정술에 앞서 시행할 수 있는 방법이라 사료된다.

• Clinics in Shoulder and Elbow
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• 제9권1호
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• pp.60-67
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• 2006

Purpose: The purpose of this study was to compare the method of using coraco-clavicular (C-C) sling with modified Phemister operation by postoperative clinical results, radiologic analysis and complications. Materials and Methods: 33 patients of acromioclavicular joint dislocation were included in this study. Thirteen patients were treated with simple C-C sling method and twenty patients were treated with modified Phemister operation. The assesment of clinical and radiological evaluation were performed and the final results were examined by using the Weitzman's classification. Results: In the final result of C-C sling method group, forward elevation $161^{\circ}$, external rotation $70^{\circ}$, internal rotation T8 level, Visual Analogue Scale (VAS) 83.3 points were checked. In modified Phemister operation group, forward elevation $155^{\circ}$, external rotation $67^{\circ}$, internal rotation T6 level, VAS 83.8 points were checked. In coracoclavicular distance of C-C sling method group, pre-operation 12.82 mm and last follow up 8.37 mm were checked. In modified Phemister operation group, pre-operation 12.8 mm and last follow up 7.7 mm were checked. In functional evaluation by the Weitzman criteria, C-C sling group had excellent 8, good 1, fair 1 and modified Phemister group had excellent 13, good 4, fair 3. Conclusion: C-C sling method would be the better than the Modified Phemister operation because of short operation time and smaller skin incision.

• Clinics in Shoulder and Elbow
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• 제19권3호
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• pp.149-154
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• 2016

Background: The purpose of this study is to compare clinical and radiological outcomes between trans-acromial fixation with Kirschner's wire (K-wire) and AO locking hook plate fixation for acute acromioclavicular (AC) joint dislocation. Methods: This study included 61 patients who underwent either closed reduction and trans-acromial fixation with K-wire (group A, 23 patients) or open reduction and internal fixation with AO locking hook plate (group B, 38 patients). Pain on a visual analogue scale (VAS) score, the University of California Los Angeles (UCLA) shoulder score, the American Shoulder and Elbow Surgeons (ASES) score, and active range of motion (ROM) were used in the functional evaluation. For radiological evaluation, coracoclavicular distance (CCD) was measured on both clavicular anteroposterior view and compared between groups. Results: At one-year follow-up, no significant differences in VAS pain score, UCLA shoulder score, ASES score, and active ROM were observed between groups, despite five cases (22.7%, 5/23) of complication in group A. The side-to-side difference between normal and affected CCD was $2.4{\pm}2.2mm$ in group A and $0.2{\pm}0.7mm$ in group B. This difference showed a statistical significance between groups (p<0.001). Conclusions: For the treatment of acute AC joint dislocation, the K-wire trans-acromial fixation group showed a significantly greater CCD than the AO locking hook plate group. In addition, during the follow-up period, much higher incidence of complication related to implant was observed in the trans-acromial fixation group. Although clinical outcomes between groups were not significantly different, these results should be interpreted carefully.