Acromioclavicular Joint, Dislocation, Surgical Procedures, Operative
Conditions
Keywords
Acromioclavicular Joint, Dislocation, Trials, Randomized Clinical, Surgical Procedures, Operative
Brief summary
The purpose of this study is to compare the long-term clinical and radiological results of operative and conservative treatment of Tossy type 3 acromio-clavicular dislocation.
Detailed description
The optimal treatment of Rockwood type 3 AC joint injuries is still controversial. This controversy results from the low level of evidence of the early literature and the evaluation of all AC joint injuries with a type I through III classification system. There are no prospective randomized controlled long-term studies on the treatment of Tossy type 3 AC dislocation using primary repair and minimal pin fixation. In this study, the non-surgical treatment consisted of immobilisation of the injured AC-joint in a Kenny-Howard-type splint for four weeks. The surgical treatment consisted of an open reduction and fixation of the AC joint with two smooth Kirschner wires (2 mm in diameter) across the AC-joint. The K-wires were bent at the proximal ends, with suturing of the superior AC ligament.
Interventions
PROCEDURENon-surgical group
The non-surgical treatment consisted of immobilisation of the injured AC-joint in a Kenny-Howard-type splint for four weeks. The patient was encouraged in mobilisation of the elbow several times per day and the mobilisation of the shoulder with pendulum type movements were initiated four weeks after the injury. Active mobilisation of the shoulder was allowed six weeks after the injury.
PROCEDURESurgical group
The surgical treatment was accomplished within two days after the injury, and it consisted of an open reduction and fixation of the AC joint with two smooth Kirschner wires (2 mm in diameter) across the AC-joint. The K-wires were bent at the proximal ends, with suturing of the superior AC ligament. The position of Kirschner wires was confirmed during the operation using C-arm transillumination. The articular disc of AC joint was removed if it was damaged. Postoperative care consisted of immobilisation of the AC joint in a sling, (Polysling, body band) for four weeks and the mobilisation of the shoulder started four to six weeks later in a similar manner as in the non-operative group.
Sponsors
Kuopio University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Patient with Tossy grade 3 AC-dislocation was recruited between the years 1989 and 1991 at Kuopio University Hospital for a randomized controlled study * A written informed consent.
Exclusion criteria
* Not written informed consent
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Presence of delayed surgical procedure to treat the AC joint dislocation pathology | from 18 to 20 years |
Secondary
| Measure | Time frame |
|---|---|
| UCLA score | 18-20 years |
| Constant score | 18-20 years |
| Oxford score | 18-20 years |
| Grading of the AC dislocation using Rockwood classification (3-6) | 18-20 years |
| AC joint width in the middle of the joint (mm) | 18-20 years |
| Distance between proc. coracoideus and clavicle (coracoclavicular interspace) in Zanca projection, compared to non-injured side(mm) | 18-20 years |
| Osteolysis of clavicle (none, mild, moderate, severe) for follow-up radiographs | 18-20 years |
| Presence of calcification of CC ligaments (yes/no) | 18-20 years |
| Osteoarthrosis using modified Kellgren-Lawrence classification for follow-up radiographs | 18-20 years |
| Other pathologic condition of the shoulder (eg. osteoarthrosis of the glenohumeral joint, elevation of the humerus, calcific deposits of cuff) and the description of it | 18-20 years |
| The source (mechanism) of the AC dislocation injury (eg. falling, collision | 0 day |
| Patient age at the time of injury (years) | 0 day |
| Simple Shoulder Test (SST) | 18-20 years |
| Patient length (cm) | 18 - 20 years |
| Occupation | 18 - 20 years |
| Grading of the work (light, heavy work, retired) | 18 - 20 years |
| Presence of other pathologic conditions or operative treatments for the shoulder, AC joint or other part of shoulder, description of it | 18 - 20 years |
| Larsen score | 18-20 years |
| Instability experiences of the AC joint (none, sometimes = less than 10 times a year, often = more than 10 times year) | 18-20 years |
| Pain (VAS, cm) related to instability experience of AC joint | 18-30 years |
| Range of motion of the shoulder (flexion, abduction, horizontal adduction, degrees | 18-20 years |
| Palpation of the AC joint (normal, prominent but stable, unstable) | 18-20 years |
| Pain of palpation (no or yes) | 18-20 years |
| Cross arm test (pain in AC joint, no/yes) | 18-20 years |
| Other pathologic findings of the shoulder in the clinical examination and the description of it | 18-20 years |
| Patient weight (kg) | 18 - 20 years |
Countries
Finland
Outcome results
None listed