Clinical and Radiologic Outcomes of Acute Acromioclavicular Joint Dislocation: Comparison of Kirschner's Wire Transfixation and Locking Hook Plate Fixation원문보기
Rhee, Yong Girl
(Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University School of Medicine)
,
Park, Jung Gwan
(Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University School of Medicine)
,
Cho, Nam Su
(Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University School of Medicine)
,
Song, Wook Jae
(Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University School of Medicine)
Background: Kirschner's wire (K-wire) transfixation and locking hook plate fixation techniques are widely used in the treatment of acute acromioclavicular joint (ACJ) dislocation. The purpose of this study was to compare the clinical and radiologic outcomes between K-wires transfixation and a lockin...
Background: Kirschner's wire (K-wire) transfixation and locking hook plate fixation techniques are widely used in the treatment of acute acromioclavicular joint (ACJ) dislocation. The purpose of this study was to compare the clinical and radiologic outcomes between K-wires transfixation and a locking hook plate fixation technique. Methods: Seventy-seven patients with acute ACJ dislocation managed with K-wire (56 shoulders) and locking hook plate (21 shoulders) were enrolled for this study. The mean follow-up period was 61 months. Results: At the last follow-up, the shoulder rating scale of the University of California at Los Angeles (UCLA) was higher in patients treated with locking hook plate than with K-wires ($33.2{\pm}2.7$ vs. $31.3{\pm}3.4$, p=0.009). In radiologic assessments, coracoclavicular distance (CCD) (7.9 mm vs. 7.7 mm, p=0.269) and acromioclavicular distance (ACD) (3.0 mm vs. 1.9 mm, p=0.082) were not statistically different from contralateral unaffected shoulder in locking hook plate fixation group, but acromioclavicular interval (ACI) was significant difference. However, there were significant differences in ACI, CCD, and ACD in K-wire fixation group (p<0.001). Eleven complications (20%) occurred in K-wire transfixation group and 2 subacromial erosions on computed tomography scan occurred in locking hook plate fixation group. Conclusions: ACJ stabilization was achieved in acute ACJ dislocations treated with K-wires or locking hook plates. Locking hook plate can provide higher UCLA shoulder score than K-wire and maintain CCD, and ACD without ligament reconstruction. K-wire transfixation technique resulted in a higher complication rate than locking hook plate.
Background: Kirschner's wire (K-wire) transfixation and locking hook plate fixation techniques are widely used in the treatment of acute acromioclavicular joint (ACJ) dislocation. The purpose of this study was to compare the clinical and radiologic outcomes between K-wires transfixation and a locking hook plate fixation technique. Methods: Seventy-seven patients with acute ACJ dislocation managed with K-wire (56 shoulders) and locking hook plate (21 shoulders) were enrolled for this study. The mean follow-up period was 61 months. Results: At the last follow-up, the shoulder rating scale of the University of California at Los Angeles (UCLA) was higher in patients treated with locking hook plate than with K-wires ($33.2{\pm}2.7$ vs. $31.3{\pm}3.4$, p=0.009). In radiologic assessments, coracoclavicular distance (CCD) (7.9 mm vs. 7.7 mm, p=0.269) and acromioclavicular distance (ACD) (3.0 mm vs. 1.9 mm, p=0.082) were not statistically different from contralateral unaffected shoulder in locking hook plate fixation group, but acromioclavicular interval (ACI) was significant difference. However, there were significant differences in ACI, CCD, and ACD in K-wire fixation group (p<0.001). Eleven complications (20%) occurred in K-wire transfixation group and 2 subacromial erosions on computed tomography scan occurred in locking hook plate fixation group. Conclusions: ACJ stabilization was achieved in acute ACJ dislocations treated with K-wires or locking hook plates. Locking hook plate can provide higher UCLA shoulder score than K-wire and maintain CCD, and ACD without ligament reconstruction. K-wire transfixation technique resulted in a higher complication rate than locking hook plate.
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가설 설정
The purpose of this study is to use K-wire transfixation and locking hook plate fixation technique for ACJ stabilization in acute ACJ dislocation patients and retrospectively compare the clinical and radiologic outcomes. We hypothesized that K-wire transfixation and locking hook plate fixation technique both can achieve ACJ rigid fixation, and that anatomical reduction is difficult without coracoclavicular ligament fixation.
제안 방법
Finally, the interobserver reliability and intraobserver reliability were not evaluated. And our study was performed using manually drawn measurements. However we believed that the authors participating in this study had ripe experience and it was easily reproducible.
Anteroposterior radiographs of the affected and contralateral unaffected ACJ in neutral rotation made with the patient in a standing position were obtained immediately postoperatively, each follow-ups and at the latest follow-up examination. Analysis of the immediate postoperative and latest follow-up radiographs included assessment of the following factors (Fig.
Postoperative clinical evaluations were performed regularly on an outpatient basis (at 4 weeks, 6 weeks, 3 months, 6 months, 12 months, and at the last follow-up) and the results at the last follow-up were analyzed. At the time of follow-up, all the patients were evaluated using visual analogue score (VAS) for subjective pain scale and the shoulder rating scale of the University of California at Los Angeles (UCLA) for clinical assessment. Postoperative shoulder ROM including forward flexion, external rotation at the side, internal rotation to the back and abduction were assessed.
Postoperative clinical evaluations were performed regularly on an outpatient basis (at 4 weeks, 6 weeks, 3 months, 6 months, 12 months, and at the last follow-up) and the results at the last follow-up were analyzed. At the time of follow-up, all the patients were evaluated using visual analogue score (VAS) for subjective pain scale and the shoulder rating scale of the University of California at Los Angeles (UCLA) for clinical assessment.
All radiographs were analyzed by two authors who reached a consensus. Reduction loss was decided by comparing ACI, CCD, and ACD in the immediately postoperative and the last follow-up radiographs. Radiologic result of contralateral unaffected side and affected side at the last follow-up was compared to decide whether anatomical reduction was appropriate.
Due to the design characteristics of hook plates, anatomical reduction of superiorly displaced distal clavicle is relatively easy, but it is technically demanding to anatomically reduce the anterior-posterior displacement of clavicle and acromion. So the authors aimed to achieve anatomical reduction and rigid fixation by anteriorly shifting the distal clavicle while using conventional screws at the medial holes of the hook plate, and locking screws for the rest. Known complications of hook plates include subacromial migration and rotator cuff impingement, infection, and reduction loss.
The purpose of this study is to use K-wire transfixation and locking hook plate fixation technique for ACJ stabilization in acute ACJ dislocation patients and retrospectively compare the clinical and radiologic outcomes. We hypothesized that K-wire transfixation and locking hook plate fixation technique both can achieve ACJ rigid fixation, and that anatomical reduction is difficult without coracoclavicular ligament fixation.
Diagnosis of ACJ dislocation was made on the basis of clinical and radiological assessments. The radiological examination was performed for all patients, including anteroposterior, lordotic and stress radiographic views and computed tomography (CT) scan before surgery. According to Rockwood’s classification,12) there were 8 in type III lesions (10%), 15 in type IV lesions (19%) and 52 in type V lesions (70%) (Table 1).
데이터처리
The metrics of both groups were evaluated for normality using Shapiro-Wilk test. Statistical differences of metrics with normal distributions were evaluated using the independent t-test and chi-square test for data that was found to be normal. Nonparametric analysis (Mann-Whitney U test and Wilcoxon signed rank test) was used to compare data found not to be normal.
이론/모형
The metrics of both groups were evaluated for normality using Shapiro-Wilk test. Statistical differences of metrics with normal distributions were evaluated using the independent t-test and chi-square test for data that was found to be normal.
성능/효과
001) (Table 4). In comparison of ACI, CCD, and ACD values of contralateral unaffected shoulder and affected shoulder at the last follow-up, K-wire transfixation group showed significant average increase of ACI by 2.2 mm, CCD by 2.0 mm, and ACD by 1.8 mm. However, while ACI was increased by 2 mm (5.
When comparison was made between the K-wire transfixation group and the locking hook plate group, the difference between unaffected shoulder and affected shoulder was statistically not different in ACI and ACD but CCD showed less difference in the hook plate group than the K-wire group (0.4 ± 0.4 mm vs. 2.2 ± 2.1 mm, p<0.001) (Table 4).
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