Hook plate fixation with coracoclavicular ligaments repair and augmentation for management of acute acromioclavicular joint dislocation

Abstract

Background Several surgical techniques and implants have been proposed for the treatment of acute acromioclavicular joint (ACJ) dislocation. The purpose of the study was to assess the results of hook plate fixation combined with coracoclavicular (CC) ligaments repair and augmentation for the management of ACJ dislocation. Patients and methods Between March 2011 and October 2014, 22 patients (15 male and seven female) with ACJ dislocation were treated with open reduction and hook plate fixation with CC ligament repair and augmentation at Benha University Hospital. The inclusion criteria included patients with isolated ACJ dislocation grades III–V according to Rockwood classification. Exclusion criteria were neglected cases greater than 4 weeks, chronic dislocations, open dislocation, and fracture dislocation of the ACJ. The average age of the patients was 31.8±9.7 years, ranging from 18 to 60 years. The right side was affected in 14 patients and the left in eight patients. Functional outcomes were assessed according to range of motion (ROM) and the Constant–Murley scoring system, disabilities of the arm, shoulder and hand (DASH) score, and visual analog scale score for pain. Results The mean operative time was 66 min (50–90 min). The mean follow-up period was 20.3±7.8 months, ranging from 12 to 40 months. In all but one of the 22 cases, the plates were removed after 3–6 months. The mean postoperative shoulder forward flexion was 160.4±15.8°, the extension was 51±8.6°, internal rotation 58.1±11.7°, the external rotation was 68.1±12.7°, and the abduction was 160.4±18.3°. The mean constant score was 94±5.1. The mean DASH score was 8.7±4.8. The mean pain visual analog scale score was 1.2±1. No major complications occurred in this study, except for one case that developed an asymptomatic 1-cm widening of the AC distance after 12 months. No patient developed wound infection, redislocation, AC ligament ossification, or acromion osteolysis over the hook even in the only case of retained plate for 18 months. Conclusion The use of hook plate is a good choice for stabilization of acute ACJ dislocation. When combined with CC ligaments repair and augmentation, the complication rates were low, with good functional outcome.