Clinical efficacy of 22 cases of acromioclavicular dislocation associated with coracoid fractures
Objective To explore clinical efficacy of 22 cases of acromioclavicular dislocation(ACD)combined with coracoid fractures(CFs).Methods Totally,22 patients with ACD associated with CFs were admitted to Department of Orthopedics of Yixing People's Hospital from March 2017 to August 2023,of which 15 were males and 7 females with a mean age of 49 years(range,27-67).The causes of injury included traffic accident in 5 patients,falling from electric bikes in 9 patients,fall from height in 6 patients,and hit by a heavy object and crush injury of machine in one patient each.Rockwood classifica-tion of ACD was variation type Ⅲ in 20 patients and variation type Ⅳ in 2 patients.Eyres classification of CF was type Ⅲ A in 12 patients,type ⅣA in 6 patients and type Ⅴ A in 4 patients.Ogawa classification of CF was type Ⅰ in 18 patients and type Ⅱ in no patient.The morphological classification of CF was hinge fractures in 15 patients,translational fractures in 3 patients and avulsion fractures in 4 patients.A total of 10 cases of ACD were given open reduction and internal fixation using clavicular hook plates(CHPs)and CFs were treated conservatively(TC)(CHP+TC),while 12 cases if ACD received open reduction and in-ternal fixation using CHPs and CFs were operated with cannulated screws(CS)(CHP+CS).Reduction and fixation of ACD and CFs,postoperative complications,bone union time of CFs,visual analog scale(VAS)score and Constant score and disabilities of the arm,shoulder and hand(DASH)score at the last follow-up were observed and recorded.Results CHP plus TC in 10 patients:ACD was reduced and fixed satisfactorily.Eyres type Ⅲ A fractures in 5 cases were reduced anatomically,of which hinge fractures in 3 cases and avulsion fractures in 2.A total of 10 cases were followed up with an average of 42 months(range,5-84),the average bone union time of CF was 2.6(range,2-3.5)months.At the last follow-up,the mean score of VAS was 0.4(range,0-2),the average scores of Constant and DASH were 99(range,96-100)and 6(range,0-10),respectively.Acromion osteolysis(AO)in 3 patients,nonunion of CF(CN)in 1 patient,malunion of CF(CM)in 4 patients were found.CHP plus CS in 12 cases:ACD was also reduced and fixed satisfactorily.A total of 8 CFs were reduced anatomically,of which Eyres type ⅢA fractures in 5 cases,type Ⅳ A fractures in 2 and type Ⅴ A fracture in 1,and hinge fractures in 5 and trans-lational fractures in 3.A total of 12 cases were followed up with an average of 37 months(range,13-70),the average bone union time of CF was 2.9(range,2-3.5)months.At the last follow-up,the mean score of VAS was 0.5(range,0-3),the average scores of Constant and DASH were 98(range,96-100)and 6(range,2-10),respectively.AO in 4 patients,CN in 1 patient,CM in 3 patients and screws penetrated the bony borders of coracoid tunnel in 3 patients were observed.All of cases obtained excellent outcomes in ac-cordance with excellent standards of Constant and DASH scores.No complications such as incision infection,subcoracoid impingement syndrome,and recurrent ACD were found in all cases.Conclusion To treat Rockwood variant type Ⅲ and Ⅳ ACD combined with Eyres type Ⅲ-type Ⅴ CF,ACD should be reduced and fixed with CHP firstly,then TC or screw fixation would be determined based on indirect reduction of CF,finally satisfactory effects could be obtained.
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