2015 ISAKOS Biennial Congress ePoster #2110

Open Resection of Distal Clavicle. Better Results for Patients With Traumatic Osteolysis

Jouni T. Heikkila, MD, PhD, Asst. Prof., Turku FINLAND
Max Karukivi, MD, Turku FINLAND
Juha Olavi Ranne, MD, Phd, Turku FINLAND
Sakari Y. Orava, MD, PhD, Prof., Naantali FINLAND

Hospital Mehiläinen Turku and Paavo Nurmi Centre University of Turku, Turku, FINLAND

FDA Status Not Applicable

Summary: The patients with symptomatic traumatic osteolysis of distal clavicle gain better results after open distal clavicle resection than the patients with non-traumatic onset of symptoms.

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Abstract:

Introduction

Painful osteolysis of distal end of clavicle can be caused by a contusion injury against shoulder girdle or overuse of the upper extremity. There are two main group of patients presenting osteolysis; contact sports and weight lifting training. In latter group, the acromio-clavucle angle might be important. Conservative treatment i.e. avoiding above mentioned activities, is not always sufficient to control the symptoms and in addition the symptoms tend to recur after returning to sports and training. Operative treatment with open or arthroscopic surgery is indicated if symptoms last for more than 3 months or if they recur after initial conservative treatment. We present retrospectively analyzed results of the patients operated at Hospital Mehiläinen with open resection of distal clavicle.

Methods

43 patients with distal clavicle osteolysis were operated at our hospital from 1995 to 2005. Four patients had both their shoulders operated. Majority of the patients were males; 41 males and two females. Age range was from 16 to 54 years (mean 29). There were 23 competitive and 20 recreational athletes. The etiology of the symptoms was trauma in 22 cases and the symptoms started without previous trauma in 25 patients. Osteolysis was divided into three groups according to its extend; group 1 with osteolysis at corner of clavicle, group 2 with erosion of whole distal end and group 3 with erosion of 10 mm or more. The amount of erosion was assessed in millimetres using plain films. Results were evaluated by objective clinical examination and by subjective patient evaluation 3 to 72 months postoperatively. The average follow-up time was 32 months. The result was classified good if patient returned to the previous level of sports and moderate if the joint symptoms prevented him from strenuous overhead activities, but was painfree during clinical examination.

Operative treatment
Duration of symptoms lasted from 4 to 24 months (mean 9 months). An open approach with resection of 8 mm distal clavicle without antibiotic prophylaxis was performed in all patients. The joint capsule was opened superiorily and resection of clavicle performed using resiprocative saw. The discus was removed and finally superior capsule meticulously sutured. Postoperative sling was used for four weeks and mobilisation according to pain was allowed up to horisontal level. After 4 weeks full range of movement was allowed. All patients underwent postoperative physiotherapy, with emphasis to return full range of movement and the muscle strength of shoulder girdle.

Results

Osteolysis ranged from 3 to 10 millimeters. Larger osteolysis was observed in trauma group than in non-trauma group, 6,5 mm and 5,2 mm respectively. There was a statistically significant correlation between the type and etiology of osteolysis. In the trauma group there was 12,5 % type 1 osteolysis, 62,5 % type 2 and 25 % type 3. In the non-trauma group there were 15 % type 1 and 85 % type 2 osteolysis and none type 3. The extent of osteolysis (groups 1 to 3) did not however direcly affect the result of the operation. However, the etiology of osterolysis affected the result statistically. The results in the trauma group were in good in 91 % and moderate in 9 % of the patients. In the non-trauma group the corresponding figures were 61 % and 39 %.

Conclusion

Open resection of distal clavicle gives better results after traumatic onset of symptoms than after overuse injuries. Even with open resection good results can be achieved in patients with symptomatic osteolysis of distal end of clavicle.