Acute dislocation of the acromioclavicular joint. Traumatic anatomy and the importance of deltoid and trapezius

Lizaur, A.; Marco, Luca Di; Cebrian, R

doi:10.1302/0301-620x.76b4.8027149

Cited by 75 publications

(48 citation statements)

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“…Most injuries are related to falls onto the shoulder and to repetitive use of the shoulder, such as heavy labor and athletics. Lizaur et al 5 advocate the use of two 1.8-mm percutaneous Kirschner wires to stabilize the joint, and they emphasize repair of the damaged deltoid and trapezius. These pins can be inserted from the lateral edge of the acromion through the joint and into the clavicle or from the joint out through the acromion and then back across the joint into the clavicle.…”

Section: Discussionmentioning

confidence: 99%

K wire: a lethal implant

Ram

Vijayaraghavan

2015

Int J Sci Rep

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Pins used to stabilize the acromioclavicular joint have a colourful, interesting history of migrating into remote, life threatening locations such as lungs, spinal cord, the neck, posterior to the carotid sheath and the pleura or close to it. 35 year male 3 year post op K wire fixation acromioclavicular joint came with history of pain in neck was diagnosed with broken K wire in neck. Even though K wire fixation and tension band wiring is one of the modes of treating acromioclavicular dislocation K wire fixation should be kept as the last resort while planning the treatment. Complications of K wire migration can be lethal. Hence K wiring in acromioclavicular joint should be done with utmost caution. Keywords: K wire, Acromioclavicular dislocation, Tension band wiring

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Section: Discussionmentioning

confidence: 99%

K wire: a lethal implant

Ram

Vijayaraghavan

2015

Int J Sci Rep

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“…Operative treatment for Rockwood III injuries should be reserved for young adults with a high demand for shoulder function [43,44]. Such a procedure depends on the accuracy of the implant placement to avoid complications such as infections [44], K-wire migration into the lung, heart or great …”

Section: Discussionmentioning

confidence: 99%

“…Another possible complication is early acromioclavicular degeneration, which may not be caused by articular perforation of the K-wires as it has also been reported after conservative treatment and coracoclavicular fixation [43,51].…”

mentioning

confidence: 93%

Navigated versus conventional transfixation of AC joint injuries: Feasibility and accuracy

Stübig

Jähnisch

Petri

et al. 2013

Computer Aided Surgery

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Objective: Transfixation of the acromioclavicular (AC) joint is a well-established technique for treating Rockwood IV to VI lesions. However, several complications, including pin breakage or pin migration due to incorrect placement, have been reported in the literature. A cadaveric study was performed to investigate whether the use of 3D navigation might improve the accuracy of AC joint transfixation. Methods: Seventeen transfixations of the AC joint (8 non-navigated, 9 navigated) were performed minimally invasively in cadaveric shoulders. For the navigated procedures, a 3D C-arm (Ziehm Vision FD Vario 3D) and a navigation system (BrainLab VectorVision) were used. Reference markers were attached to the spina scapulae, then a 3D scan was performed and the data transferred to the navigation system. Two Kirschner wires (K-wires) were placed either freehand under fluoroscopic control (in the non-navigated group) or with the use of a navigated drill guide. Radiological analysis was performed with OsiriX software, measuring the distance of the K-wires from the center of the AC joint. For statistical analysis, Student's t-test was performed, with the significance level being set to p < 0.05. Results: The maximum distance of the K-wires from the center of the AC joint was 5.4 AE 1.1 mm for the freehand nonnavigated group and 3.1 AE 1.6 mm for the navigated group (p ¼ 0.0054). The minimum distance of the K-wires from the AC joint center was 3.0 AE 0.6 mm for the freehand group and 1.6 AE 0.6 mm for the navigated group (p ¼ 0.0002). The radiation time was significant lower for the freehand group (41.25 AE 20.4 seconds versus 79.5 AE 13.3 seconds for the navigated group, p ¼ 0.004). There was no statistical difference between the groups with respect to the time required for surgery (11.25 AE 3.6 min for the freehand group and 12.6 AE 4.6 min for the navigated group; p ¼ 0.475). In the freehand group, the AC joint was penetrated by both K-wires in 87.5% of the procedures, compared to 100% in the navigated group. Both K-wires were placed completely intraosseously in the clavicula in 50% of the procedures in the freehand group, compared to 88% in the navigated group. Conclusion: Three-dimensional navigation may improve the accuracy of AC joint transfixation techniques. However, the radiation time is increased when using the navigated procedure, while the overall operation time remains comparable. Nevertheless, a 3D C-arm with a variable isocentric design is recommended for the acquisition of the shoulder scans.

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“…25-52% of these occur during sporting activities, and are one of the most common shoulder injuries seen in orthopedic traumatology [10,13,14,19]. For injuries type Rockwood III-VI, surgical treatment has been proposed by several authors [1,2,6,7,11,12].…”

Section: The Problemmentioning

confidence: 99%