Acute highgrade acromioclavicular joint injuries

Authors: Luis Gerardo Natera Cisneros Juan Sarasquete Reiriz

Publish Date: 2016/10/12

Volume: 27, Issue: 3, Pages: 341-350

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Abstract

Surgical indication for acromioclavicular joint ACJ injuries still represents a reason for shoulder and trauma debate In highgrade injuries surgery is advocated because some of the nonoperatively managed patients may have persistent shoulder pain that could make them unable to return to their previous activity It has been shown that many of the patients with highgrade ACJ injuries that are managed nonoperatively involve the development of scapular dyskinesis situation that may result in loss of strength and weakness On the other side it has been widely reported that the period while the hook plate is present involves functional limitations and pain The purpose of this study was to compare the quality of life QoL of patients with acute highgrade ACJ injuries Rockwood grade III–V managed operatively with a hook plate versus the QoL of patients managed nonoperatively 24 months or more after shoulder injuryPatients with acute highgrade ACJ injuries managed operatively hook plate or nonoperatively between 2008 and 2012 were included The QoL was evaluated by means of the Health Survey questionnaire SF36 the Visual Analogue Scale VAS for pain the Disabilities of the Arm Shoulder and Hand DASH questionnaire the Constant score and the Global Satisfaction scale from 0 to 10 assessed at the last followup visit The presence of scapular dyskinesis was assessed Comparison between groups was madeThirtytwo patients were included 11 hook plategroup PLATE group 5 Rockwood III and 6 V and 21 conservativegroup CONS group 4 Rockwood III and 17 V The mean age was 41 19–55 years old for the PLATE group and 38 19–55 for the CONS group p = 0513 The mean followup was 3250 ± 1164 months for the PLATE group and 3477 ± 2198 months for the CONS group p = 0762 The mean results of the questionnaires assessed at the last followup visit were 1 physical SF36 score PLATE group 5370 ± 433 and CONS group 5210 ± 611 p = 0449 2 mental SF36 score PLATE group 5306 ± 610 and CONS group 5699 ± 647 p = 0110 3 VAS for pain PLATE group 145 ± 151 and CONS group 150 ± 179 p = 0943 4 DASH score PLATE group 479 ± 560 and CONS group 583 ± 676 p = 0668 5 Constant score PLATE group 9136 ± 684 and CONS group 9105 ± 735 p = 0908 6 Global Satisfaction PLATE group 800 ± 118 and CONS group 845 ± 173 p = 0449 There was evidence of scapular dyskinesis in 18  2/11 of the patients of the PLATE group and in 524  11/21 of the patients of the CONS group p = 0127Patients with acute highgrade ACJ injuries managed operatively with a hook plate may have the same QoL and selfreported questionnaires than patients with highgrade ACJ injuries managed nonoperatively 24 months or more after shoulder injury If surgery is advocated for this type of injury the orthopedic population must be aware that the hookplate system might not represent the most suitable optionAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards

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