Hook plate fixation for acute acromioclavicular dislocations without coracoclavicular ligament reconstruction: a functional outcome study in military personnel

Abstract

The aim of our study was to evaluate the shoulder function after clavicular hook plate fixation of acute acromioclavicular dislocations (Rockwood type III) in a population group consisting exclusively of high-demand military personnel. This prospective study was carried out at a tertiary care military orthopaedic centre during 2012–2013 using clavicular hook plate for management of acromioclavicular injuries without coracoclavicular ligament reconstruction in 33 patients. All patients underwent routine implant removal after 16 weeks. The functional outcome was assessed at 3, 6 and 12 months after hook plate removal and 2 years from the initial surgery using the Constant Murley and UCLA Scores. All the patients were male serving soldiers and had sustained acromioclavicular joint dislocation (Rockwood type III). Mean age of the patient group was 34.24 years (21–55 years). The mean follow-up period in this study was 23.5 months (20–26 months) after hook plate fixation and an average of 19.9 months (17–22 months) after hook plate removal. The average Constant Score at 3 months after hook plate removal was 60.3 as compared to 83.7 and 90.3 at 6 months and 1 year, respectively, and an average of 91.8 at the last follow-up that was approximately 2 years after initial surgery which was statistically significant (p value <0.05). The UCLA Score was an average of 15.27, 25.9 and 30.1 at 3, 6 months and 1 year, respectively, after removal of hook plate which improved further an average of 32.3 at the last follow-up, which was also statistically significant (p value <0.05). Clavicular hook plate fixation without coracoclavicular ligament reconstruction is a good option for acute acromioclavicular dislocations producing excellent medium-term functional results in high-demand soldiers.

Clinical and Radiological Outcomes of Hook Plate Fixation in the Lateral End Fracture of the Clavicle and Acromioclavicular Dislocation

“…Even though the ROM interval after operation is different depending on the surgeon, about 2 to 3 weeks after operation are reported. 3,[9][10][11] Same as other studies, we usually started ROM exercise after 2 weeks postoperatively. However, the ROM just before implant removal was not good even though bony union and reduction were maintained.…”

“…Therefore, many previous studies recommended implant removal after confirming stabilization during the follow-up. 3,5,9) According to Renger et al, 12) after fixation hook plate, 68% of patients had a complication of limited ROM and pain on ROM. In our study, we removed the hook plate at the mean postoperative period of 3.9 months (range, 3-5 months) in acromioclavicular dislocation and 4.2 months (range, 2-6 months) in lateral end fracture of the clavicle.…”

Is Coracoclavicular Reconstruction Necessary in Hook Plate Fixation for Acute Unstable Acromioclavicular Dislocation?

“…Among patients with hook plate xation, 25-50% suffer subacromial osteolysis or erosion [10,[19][20][21], which are the most common complications in hook plate xation. Subacromial osteolysis may result in more postoperative pain, discomfort, and an impaired functional outcome [9,10]. Yoon et al also reported a trend of an inferior functional score in patients with subacromial osteolysis [10], which indicated that greater stress on the hook tip may lead to a greater risk of subacromial osteolysis.…”

“…To date, the optimal surgical technique for ACJ dislocation is still under debate owing to controversy in reported outcomes. In a recent study, hook plate xation was reported to be a popular option that provides rigid xation and promotes nature scaring of the CC ligament, with the advantages of a simpler surgical technique, minimally-invasive access, and early resumption of normal activity [4,[7][8][9]. Despite these advantages, hook plate xation also has disadvantages, which include the need for implant removal surgery, subacromial impingement, subacromial osteolysis, and possible loss of reduction after implant removal, which may lead to complications such as a rotator cuff tear or an acromion fracture in patients with osteoporosis or those with a high activity level [10][11][12].…”

Is coracoclavicular reconstruction necessary in hook plate fixation for acute unstable acromioclavicular dislocation?

“…To date, the optimal surgical technique for ACJ dislocation is still under debate owing to controversy in reported outcomes. In a recent study, hook plate xation was reported to be a popular option that provides rigid xation and promotes nature scaring of the CC ligament, with the advantages of a simpler surgical technique, minimally-invasive access, and early resumption of normal activity [4,[10][11][12]. Despite these advantages, hook plate xation alsohas disadvantages, which include the need for implant removal surgery, subacromial impingement, subacromial osteolysis, and possible loss of reduction after implant removal, which may lead to complications such as a rotator cuff tear or an acromion fracture in patients with osteoporosis or those with a high activity level [13][14][15].…”