Management of type 2 & type 3 acromio-clavicular joint injuries by principles of tension band wiring

Abstract

Introduction: Injuries to the acromioclavicular (AC) joint represent a wide variety of soft tissue disruptions that result in mild pain to significant displacement, chronic pain & changes in shoulder biomechanics resulting in long term morbidity. Main aim is to study the outcome of AC joint dislocation managed by tension band wiring, which is cost effective & also gives excellent results in cases of traumatic AC joint dislocation. Methods: 23 cases of type 2 & 3 AC joint dislocation were selected depending on Rockwood classification for a period of 12 months (January 2019 – December 2019), who all underwent Tension band wiring (TBW) & followed the post-operative protocol accordingly with minimal mobilization to full range of movement, with suture removal on day 12 followed by maximum possible range of movement by 12 weeks onwards. Results: We had majority type 3 AC joint dislocations than type 2 AC joint dislocation, male predominance was seen with major causal factor to be Road traffic accident„ among males & females the dominant limb (i.e., right upper limb)involvement was seen, patients were evaluated at 4, 6 & 12 weeks intervals using CONSTANT score. 17 patients had excellent results with near normal range of shoulder movements, 4 had good results due to mild restriction of movement & pain, 2 had poor results that were due to hematoma & infection in one patient which was treated according to culture sensitivity of the organism & antibiotics, another patient had stiffness & pin migration for which implant removal was done. Following which regular mobilization was started. Conclusion: After conducting this study we arrived at an inference where AC joint injuries do contribute to major morbidity for the patient in view of altered shoulder biomechanics which resulted in loss of shoulder movements & affecting day to day activities. Hence an AC joint injury has to be addressed surgically as early as possible to make patients return to their pre injury status. Tens