1. Chelnokov A.N. Tyrtseva E.S.
Treatment of the Acromioclavicular Joint Dislocation with External Fixation Device
Chelnokov A.N. Tyrtseva E.S.
Ural Scientific Research Institute of Traumatology and Orthopaedics, Ekaterinburg, Russia

2. Background
To date there has been no consensus about optimal treatment of the traumatic dislocation of the acromio-clavicular joint.

3. Many treatment modalities for the ACJ dislocation
From aggressive surgery…

4. …to nonoperative management
A Prospective Evaluation of Untreated Acute Grade III Acromioclavicular Separations. T.F. Schlegel. The American Journal of Sports Medicine 29: (2001):
20 of the 25 patients completed the 1-year evaluation and strength-testing protocol;
objective examination and strength testing of the 20 patients revealed no limitation of shoulder motion in the injured extremity and no difference between sides in rotational shoulder muscle strength

5. Aim of this study was to estimate capabilities of small wire monolateral external fixator for closed treatment of complete acromioclavicular dislocations.

6. Material and methods 24 patients 3,2 days after the injury (0-14)10 8 6
24 patients
14 male
10 female
3,2 days after the injury (0-14)

7. External Fixation
G.S.Sushko, G.A.Ilizarov, 1977, 1979

8. Surgery and post-op period
10-30 minutes
Regional anesthesia
Discharge in 1-2 days
Sling for 1-3 days

9. Duration of fixation
4 weeks for acute cases (fixation within 0-5 days after the injury),
6-8 weeks for delayed admission (6-14 days)
In cases of dislocations older 2 weeks => AC and CC ligaments repair by tendon allografts
Stability test before hardware removal

10. Results Self-care, light housework – 3-5 days Deep infection 0/24
10 patients (42%) sustained skin irritation and serum drainage from acromial wire site only
23/24 healed
1/24: missed acromial wire cut-out => symptomatic instability => AC+CC repair (allo tendons) => uneventful healing
1 year follow up - 15 patients.
All restored their pre-injury status
Occasional pain in hyperabduction – 3/15

11. Rockwood type V injury

13. After 6 weeks

14. Result

15. Neer Type II injury

18. Follow-up (3 year)

19. Follow-up (3 year)

20. Follow-up (3 years)
Affected side

21. Discussion: Advantages of the technique
Controllable fixation
With ex-fix we control the situation, without it the situation controls us
Minimally invasive
Fast recovery
Good cosmetic effect
Minimal time and efforts
Short learning curve

22. Discussion: Disadvantages
Temporary discomfort, decreased quality of life
Pin site care, outpatient visits necessary
Hardware removal

23. Conclusion
External fixation can be technique of choice for acute cases where operative treatment is indicated

24. Thank you