2017 ISAKOS Biennial Congress Paper #100

 

Acute Fixation of Acromioclavicular Separations: An Internal Splint Technique

Alan Zhang, MD, San Francisco, CA UNITED STATES
Joey LaMartina, II MD
Liane Miller, MD, San Francisco, CA UNITED STATES
David Y. Ding, MD
Brian Feeley, MD, San Francisco, CA UNITED STATES
C. Benjamin Ma, MD, San Francisco, CA UNITED STATES

University of California, San Francisco Medical Center, San Francisco, California, UNITED STATES

FDA Status Not Applicable

Summary

The results of our study lend support for a reliable new technique for acute fixation of type IV and V AC joint injuries using an internal splint construct. This technique enables reduction in both the anterior-posterior as well as the superior-inferior planes without need for graft augmentation or rigid implant.

Abstract

Introduction

There is no standard method for surgical treatment of acromioclavicular joint (AC) separation. A number of open and arthroscopic techniques have been described in conjunction with graft augmentation or orthopaedic devices, such as the hook plate or adjustable suture button. However, these devices and techniques can have associated complications, including reoperation for device removal, coracoid fracture, and inadequate reduction. The purpose of this study is to describe an “internal splint” technique without graft augmentation or rigid fixation used to treat acute AC joint injuries.

Methods

A retrospective chart review was performed querying patients treated with the same operative technique for type IV and type V acute (i.e. less than 6 weeks) AC separations from 2006 to 2012 by one of three sports medicine fellowship-trained surgeons at a single institution. The internal splint technique included an open approach with a Saber incision followed by fixation using #5 Fiberwire (Arthrex; Naples, FL) and 5mm Mersilene tape (Johnson and Johnson; New Brunswick, NJ). No soft-tissue graft or rigid implant is needed. Two 3.5mm drill holes are created in the distal clavicle and the fiberwire/mersilene tape construct is passed through each drill hole after looping around the coracoid and tied together to reduce the superior displacement of the distal clavicle. A separate #5 Fiberwire is passed through the distal drill hole on the clavicle to a 2.5mm drill hole in the acromion for reduction in the anterior-posterior plane. Range of motion, strength, and DASH (Disabilities of the Arm, Shoulder, and Hand) scores were obtained for all patients, and post-operative radiographs were reviewed. Patients were also surveyed on the satisfaction of the appearance of their shoulder and if they would undergo the operation again given the same circumstances.

Results

26 patients consisting of 24 males and 2 females (average age 38) underwent the internal splint fixation technique. Average time to surgical treatment from initial injury was 13.7 days and average follow-up was 3.3 years (5 months to 8 years). Two patients had type IV injuries, and 24 had type V injuries. All patients had return of full strength and range of motion after the surgery. All post-operative radiographic films demonstrated good reduction of the AC joint in both the coronal and axial planes. The mean DASH score was 3.4 (0-16.7). 88.5% of respondents were satisfied with the appearance of their shoulder postoperatively. 100% stated that they would have the operation again given the same circumstances. None of the 26 respondents underwent reoperation. One patient reinjured the shoulder 7 years later after falling onto the shoulder, sustaining a distal clavicle fracture.

Discussion/Conclusion:
The results of our study lend support for a reliable new technique for acute fixation of type IV and V AC joint injuries using an internal splint construct. This technique enables reduction in both the anterior-posterior as well as the superior-inferior planes without need for graft augmentation or rigid implant, allowing for healing of the acromioclavicular and coracoclavicular (CC) ligaments.