The Treatment And Analysis Of Epidemiological Features Of The Dislocation Of Acromioclavicular Joint

Objective: This study aims to investigate the epidemiological features of patients with the dislocations of the acromioclavicular joints between January 2003 and December 2007 treated in our hospital. The treatment algorism is collected and analyzed, and the funtional outcomes of the patients are assessed.Methods: The participants include the patients with acute dislocaitons of the acromioclavicular joints managed in our hospital during a seven-year period from January 2003 to December 2009. The items inluding age, gender, injury site and the associated injuries of the patients with acuter acromioclavicular joint dislocations were collected by u sing Picture Archive Communications System (PACS). The radiographs, the computed tomography images (CT) and the Magnetic Resonance Imaging (MRI) were collected. The severity of the acromioclavicular joint dislocations were assessed by applying the commonly used injury classificaitons, such as the Tossy classification and Rockwood classification. Taking the severity of the acromioclavicular joint dislocations and the associated innjures and their severity into consideration, the treatment algorisms were made to provide individual management for each patient. The management can be divided into the conservative treatment and surgical treatment. The surgical treatment include tension band wire fixation of the acromioclavicular dislocation, the application of the hook plate for acromioclavicular joint dislocation and the fixation of the acromioclavicular dislocations by using the cannulated screws. There were two distinct procedures in the management of the acromioclavicular dislocations by using the cannulated screws, the transacromion extra-articular fixaiton and the transarticular fixation. The key procedure of transarticular fixaiton were as follows. The dislocated acromioclavicular joint were reduced after anesthesia took effect. The guider wire was inserted from the lateral clavicle to the acromion under the guidance of the intraoperative fluoroscopy. The cannulated screw was inserted along with the guider wire after the washer was placed through the minimal incision in the shoulder. The key procedure of the transacromion extra-articular fixaiton were similar to that of the transarticular fixation. The different procedure was that the guider wire was inserted from the lateral clavicle across the posterior border of the acromioclavicular joint to the lateral-posterior aspect of the acromion. The length of the guider wire was measured and proper cannulated screws were selceted. The anterior, the superior and the posterior acromioclavicular ligaments and the anterior deltoid fascia insertion as well as the trapezius fascia insertion were all repaired by suturing to bone drill holes with unresorbable sutures. Both the guider wire and the cannulated screws can be inserted from the acromion to the lateral clavicle or inserted from the lateral clavicle to the acromion. If the patients sustained the ipsilateral humoral or clavicular fractures, these fractures were reduced and fixed before the management of the dislocated acromioclavicular joint. The treatment algorism of each patient was collected by using the case retrieval system. The postoperative radiographs were reviewed. The patients were followed up and the functional recovery of the injured shoulder were assessed by referencing the Karlsson grading criteria. The data obtained were statistically analyzed with SPSS12.0 software package (Ridit analysis). P <0.05 was considered as statistical significance.Results: From January 2003 to December 2009, 804 patients visited the outpatient clinic in our hospital because of the presence of the symptoms and signed related to the acromioclavicular joint, who taken the radiographic examinations. Among these patients, 387 were diagnozed as the dislocations of the acromioclavicular joints. There were 280 male and 107 female patients with an average age of 35.93±38.92 years old, including 205 left and 182 right dislocations. The proportion of female patients increased. The high-risk age of all patients was between 31 and 40 years old. The III and V types of acromioclavicular dislocations are the most common type dislocations according to Rockwood classification. The incidence of the dislocations of the acromioclavicular joints was on rise. 128 cases were combined with other parts fractures, including 56 cases of clavicular fractures, 36 cases of rib fractures, 26 cases of scapular fractures and 10 cases of humeral fractures. In the study, 230 patients were administrated into our hospital, including 178 male patients and 52 female patients with an average age of 41.58±26.17 years old. There were 137 cases of left dislocations and 93 cases of right dislocations. The injury mechnism conprised of 123 falls, 80 automobile accidents, 14 tamp injures, 6 strain injures, 5 falls from height and 2 crushed on foot. 94 cases sustained associated fractures, including 47 cases of clavicle fractures, 20 cases of rib fractures, 18 cases of scapular fracture and 9 cases of humeral fractures. 1 patient sustained mild brachial plexus strain injury. The 3 cases with typeⅡdislocations were treated conservatively. 35 cases with typeⅢdislocations were treated conservatively and 36 cases with typeⅢdislocations underwent surgery. The patients with Rockwood type IV, V and VI dislocations were all treated surgically. In total, 38 patients were treated conservatively; 57 patients were managed with Kirshner wire tension band fixation; 120 patients were fixed with hook plates and 15 patients were treated by minimally invasive percutaneous lag screw fixation. Statistical analysis showed that the operation time in the lag screw fixation group was significantly shorter than that of the Kirshner wire tension band group (P<0.05) and the operative time of the hook plate fixation group was longer than the other two surgical groups(P <0.05). The blood loss of the lag screw fixation group was significantly shorter than that of the Kirshner wire tension band group (P<0.05) and the blood loss of the hook plate fixation group was longer than the other two surgical groups(P <0.05). 141 patients were followed up. The excellent and good rates of the functional outcomes of the injured shoulder of the conservative treatment group, the Kirshner wire tension band fixation group, the hook plate fixation group and the lag screw fixation group were 70.59%,77.78%,87.67%,93.33%, repecively and the complication rates of the same four groups were 29.41%, 19.44%, 8.88% and 6.67%, repectively. The funcional outcomes of the four groups were analyzed by using Ridit analysis. The functional outcomes of the patients treated by hook plate fixation were similar to that of the patients treated by lag screw fixation(P> 0.05). The functional outcomes of the patients treated by hook plate fixation and lag screw fixation were better than that treated by Kirschner wire tenison band fixation(P <0.05). The functional outcomes of the patients managed conservatively were poorer than the other patients(P <0.05).Conclusion: This survey suggests that the high-risk age of all patients was between 31 and 40 years old. The proportion of female patients increased and the high-energy injuries The Rockwood types III and V acromioclavicular dislocations caused by high energy trauma are the most common dislocations. The patients with associated fractuers consisted a higher proportion of the study population. In the treatment of acromioclavicular joint dislocation, surgical treatment is better than conservative treatment. Among different surgical options, the hook plate fixation and the minimally invasive percutaneous lag screw fixation can achieve satisfactory results.