1. 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. 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… 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 29:699-703 (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. Aim of this study was to estimate capabilities of small wire monolateral external fixator for closed treatment of complete acromioclavicular dislocations.

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

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

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

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

10. Results Self-care, light housework – 3-5 days Self-care, light housework – 3-5 days Deep infection 0/24 Deep infection 0/24 –10 patients (42%) sustained skin irritation and serum drainage from acromial wire site only 23/24 healed 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. 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)

20. Follow-up (3 years) Affected side

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

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

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

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