Acute surgical treatment of acromioclavicular dislocation type V with a hook plate: superiority to late reconstruction

Abstract

Outcomes for patients with acromioclavicular joint dislocation, Rockwood type V, treated with acute or delayed hook plate surgery were investigated. Patients treated with a hook plate for acromioclavicular joint dislocation, Rockwood type V, were retrospectively evaluated 1 to 8 years after the injury. Of 41 patients, 37 were re-evaluated, 32 in person and 5 by telephone or letter. The acute surgery group comprised 22 patients operated on with a hook plate within 4 weeks after the injury. The delayed surgery group comprised 15 patients, with unacceptable pain or functional disability after a minimum of 4 months of conservative treatment, who were operated on with modified Weaver-Dunn procedure augmented with a hook plate. The evaluation was based on radiographs, registration of activity level, and shoulder function. The median Constant Score was 91 for the acute surgery group and 85 for the delayed surgery group (P=.097). The acutely treated patients had better outcomes according to the median Shoulder Pain and Disability Index (SPADI; P=.006), shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH; P=.002), and Subjective Shoulder Value (P=.032). The acutely treated patients had less pain in their injured shoulder during rest (P=.014) and during movement (P=.005). There was a significant difference in subluxation between the groups in favor of the acute group, shown by weighted radiographs (P=.011), but no significant relation between subluxation on the weighted radiographs and the shoulder function according to Constant Score at follow-up (r(s)=.122, P=.619). Patients treated with acute surgery had a more satisfactory outcome than those with late surgery after failed conservative treatment.