Acromial End Research Articles

Clavicle Morphometry for Sexual Dimorphism and Bilateral Asymmetry: Radiographic Assessment

The clavicle, modified long bone, presents morphological and bilateral variations. This may be due to genetic factors, hormones, or environmental and occupational influences. Anthropometric studies in clavicle of Nepalese population using radiograph has not been reported to best of our knowledge. This study, aimed to determine the sexual dimorphism and bilateral asymmetry of clavicle in Nepalese Population using Postero-Anterior Chest X Ray. Chest x-rays with normal and clearly visible both clavicles of 1260 Nepalese adults (591 male, 669 female), aged above 20 years were utilized. Inbuilt software "Computed Radiography Fuji Computer System 7" was used for measurements (in centimeter) of sternal head length, acromial end length, mid shaft diameter and length of clavicle. Demarcating point and identification point were calculated. Patients having history of clavicles fractures in the past were excluded. All the parameters in male is greater than female which is significant except Length/Mid Shaft Diameter. Similarly, all the parameters of right clavicle is significantly greater than left clavicle in both sexes except Sternal Head Length and Mid Shaft Diameter. Demarcating point calculated from length of the clavicle (right >16.17, left >16.10 for male and right <11.20, left <10.65 for female) and Mid Shaft Diameter (right >1.33, left >1.38 for male and right <0.66 and left <0.67 for female) are important parameters to determine sex. Conclusions:The clavicle shows significant sexual dimorphism and bilateral asymmetry in Nepalese population. The result of this study is helpful to anthropologist and forensic medicine.

The value of the shape of the arrangement of the articular surfaces of the clavicle and acromion for the mechanism: both the dislocation of the acromial end of the clavicle and its fracture

Objective. To prove the dependence of a fracture or dislocation of the acromial end of the clavicle on the features of the shape of the arrangement of the articular surfaces of the clavicle and acromion.&#x0D; Materials and methods. We conducted anatomical studies on 50 unfixed and unopened corpses of people of both sexes and aged 20 to 60 years. Among them, there were 35 men and 15 women. At the same time, we observed three forms of variability in the arrangement of the articular surfaces of the acromion and clavicle.&#x0D; Results. We studied the radiological forms of the location of the articular surfaces of the clavicle and acromion in 50 patients with a collarbone fracture and in 50 patients with dislocation of the acromial end of the clavicle from 20 to 55 years old, among them 30 were men, 20 women. In all cases, the trauma mechanism was indirect. A certain relationship was revealed between the frequency of a fracture or dislocation and the form of arrangement of the articular surfaces of the acromion and clavicle. Clavicle fracture more often (78.0%) occurred with a vertical arrangement of the articular surfaces of aroma and clavicle.&#x0D; Conclusion. Anatomical and clinical-radiological studies have shown the dependence of the fracture or dislocation of the acromial end of the clavicle on the peculiarities of the arrangement of the articular surfaces of the clavicle and acromion.

Variation in number and position of nutrient foramen of clavicle – A morphological study in western Rajasthan

Introduction: The clavicle is a modified long bone. It is the most important bone for transmission of weight from upper limb to the axial skeleton. It supports the shoulder so that the arm can swing clearly away from the trunk. Materials and Methods: The study included 102 adult clavicles 52 right sides and 52 left side which were obtained from the department of the Anatomy Dr. S.N. Medical College Jodhpur. The age and sex of the clavicles were not determined. All the bones were grossly observed for the number, location and direction of the nutrient foramina. The data were collected and morphologically analysed. Results: In our Present study Nutrient foramina were present in 50 clavicles (Right) and 44 clavicles (left). Out of which single foramina in 41 clavicles (Right) and 36 clavicles (Left), double foramina in 9 clavicles (Right) and 6 clavicles (left) and three foramina in 2 clavicles (Left). Absence of nutrient foramina were found in 2 clavicles (Right) and 8 clavicles (Left). Maximum number was present in the medial 2/3 and on the posterior surface of 46 bones (Right) and 34 Bones (Left). All foramina were directed towards the acromial end. Conclusion: The knowledge of nutrient foramina in clavicles is important for surgical procedures such as bone grafting and in microsurgical vascularized bone transplantation. Keywords: Nutrient foramina, Clavicle, Bone graft.

Anatomy of clavicle in the Indian population and its applicability in pre-contoured plating.

Fractures of the clavicle are traditionally treated non-operatively, but with the increase of high-energy trauma, there has been an increase in the operative management of these fractures. Controversy exists on the type of fixation for middle third clavicle fractures. The anatomically pre-contoured plates are low-profile mechanically sound plates which do not cause much soft tissue irritation. To characterise the clavicular morphology through computerised tomography and determine the applicability of pre-contoured plates for our population. In this study, the mean total length was 145.31mm and the apex of superior clavicle bow was located 38.15mm from the acromial end, thereby giving a zone of 107.16mm for plating. In the 107.16mm of platable zone, the zone of ideal fracture location was 43.16mm. Superior anterior plates had a good fit in 89.3% of the CT subset, whereas superior plates had a good fit in only 71.6% of the population. Superior anterior pre-contoured clavicle plates have approximately 98% good to fair compatibility for clavicles in the South Indian population without any need for further intra-operative moulding.

Histovariability in human clavicular cortical bone microstructure and its mechanical implications.

The human clavicle (i.e. collarbone) is an unusual long bone due to its signature S-shaped curve and variability in macrostructure observed between individuals. Because of the complex nature of how the upper limb moves, as well as due to its complex musculoskeletal arrangement, the biomechanics, in particular the mechanical loadings, of the clavicle are not fully understood. Given that bone remodeling can be influenced by bone stress, the histologic organization of Haversian bone offers a hypothesis of responses to force distributions experienced across a bone. Furthermore, circularly polarized light microscopy can be used to determine the orientation of collagen fibers, providing additional information on how bone matrix might organize to adapt to direction of external loads. We examined Haversian density and collagen fiber orientation, along with cross-sectional geometry, to test whether the clavicle midshaft shows unique adaptation to atypical load-bearing when compared with the sternal (medial) and acromial (lateral) shaft regions. Because fractures are most common at the midshaft, we predicted that the cortical bone structure would show both disparities in Haversian remodeling and nonrandomly oriented collagen fibers in the midshaft compared with the sternal and acromial regions. Human clavicles (n=16) were sampled via thin-sections at the sternal, middle, and acromial ends of the shaft, and paired sample t-tests were employed to evaluate within-individual differences in microstructural or geometric properties. We found that Haversian remodeling is slightly but significantly reduced in the middle of the bone. Analysis of collagen fiber orientation indicated nonrandom fiber orientations that are overbuilt for tensile loads or torsion but are poorly optimized for compressive loads throughout the clavicle. Geometric properties of percent bone area, polar second moment of area, and shape (Imax /Imin ) confirmed the conclusions drawn by existing research on clavicle macrostructure. Our results highlight that mediolateral shape changes might be accompanied by slight changes in Haversian density, but bone matrix organization is predominantly adapted to resisting tensile strains or torsion throughout and may be a major factor in the risk of fracture when experiencing atypical compression.

МРТ-семиотика вывиха акромиального конца ключицы

Objective To develop magnetic resonance imaging (MRI) protocol for assessing acromioclavicular joint (ACJ) in patients with dislocation of the acromial end of the clavicle, grading severity of injury after trauma and evaluating outcome of surgical treatment. Material and methods MRI was performed for 15 patients with ACJ injury before and after treatment. Based on MRI findings patients were subdivided into three groups depending on the degree of ACJ injury. Results In addition to radiography MRI yields important findings on a complex of pathological changes in ligaments, muscles and subcutaneous tissues. The imaging showed edema and a partial-thickness injury to the trapezius muscle (n=7), swollen subcutaneous tissue (n=15), a glenoid labral tear (n=4) and a rotator cuff injury (n=7). Conclusion MRI has been particularly effective in characterizing ACJ injuries and associated changes in the bone and soft tissues. The capabilities of MRI in visualization of soft tissues have made this imaging modality invaluable in the assessment of outcomes of the dislocation of the acromial end of the clavicle.

Kirschner Wire Migration into SpinaL Canal after Acromioclavicular Joint Fixation (Literature Review and Clinical Case)

Fracture and migration of metal implants is a well-known issue which is especially relevant for actively loaded zones with a high amplitude of physiological movements. The authors analyzed 17 publications dedicated to Kirschner wire migration into the spinal canal after fixation of acromioclavicular joint (ACJ) injury. The present paper contains literature review and own clinical case of the authors. The authors generalize the conceptions of migration causes, surgical tactics and prevention recommendations. The key reason of fracture and migration of Kirschner wires during fixation of ACJ injury is the instability of implants, trans-articular wire insertion during fixation of reduced dislocation of acromial end of the clavicle, insufficient immobilization and untimely implants removal after removal of immobilization. Implants migration into the spinal canal is the indication for their surgical removal irrespective of clinical signs. In the majority of studied publications authors described posterior approach or lateral approach aligned with the migration direction. No grafting techniques for dura mater defects were present in the studied literature. The authors of the current paper justify a surgical procedure for removal of migrated implant using a combined posterior and lateral approach on the own clinical case. The choice of procedure algorithm results from the need for prophylaxis of secondary spinal cord lesion and liquorrhea during removal of migrated implants from spinal canal.

Aneurysmal bone cyst of the clavicle: a series of 13 cases

Aneurysmal bone cyst (ABC) is a benign but locally aggressive bone tumor occurring most commonly in the first 2 decades of life. The clavicle is a rare location for tumors, and ABCs of the clavicle have been sparsely described in the literature. We present the largest known series of ABCs of the clavicle to describe this rare condition. Patients were identified retrospectively from an orthopedic oncology database to obtain demographic, diagnostic, and treatment information. A literature search was performed to identify all English language reports of ABC of the clavicle. We identified 13 patients with ABC of the clavicle, 77% of which were in the acromial end. Most patients (77%) presented with pain or swelling or both. The initial treatment in 11 patients was by curettage, with or without allograft bone packing, and 1 underwent resection/reconstruction of the lateral clavicle. Seven patients (58%) had 1 or more recurrences at an average of 6 months, for which 2 were treated with partial resection of the clavicle. ABC of the clavicle is a rare condition that we found to occur most frequently in the acromial end of the bone. Most patients were initially treated with curettage and showed a higher rate of recurrence than in other locations. The unique anatomy of the clavicle makes resection a feasible and very functional option, especially if the coracoclavicular ligaments can be preserved. However, the potential resulting deformity may cause patients to opt for a less aggressive and, consequently, less effective treatment method.

The distributed pattern of the neurovascular structures around clavicle to minimize structural injury in clinical field: anatomical study.

The aim of this study was to determine the location and distribution pattern of neurovascular structures superior and inferior to the clavicle by detailed dissection. Fifteen adult non-embalmed cadavers with a mean age of 71.5years were studied. For measurements, the most prominent point of the sternal end of the clavicle (SEC) on anterior view and the most prominent point of the acromial end of the clavicle (AEC) were identified and divided five equal sections before dissection. A line connecting the SEC and AEC was used as a reference line. The surrounding neurovascular structures were investigated. The supraclavicular nerve was mainly distributed in the second and the third sections (distribution frequency: 41.30% and 30.43%, respectively) from AEC. Branches of the thoracoacromial artery were mainly distributed in the second, third, and fourth sections (distribution frequency: 21.15%, 26.92%, and 28.85%, respectively). Branches of the subclavian vein were mainly distributed in the third and fourth sections (distribution frequency: 23.26 and 30.23%, respectively). Distribution frequency of subclavian vein, subclavian artery, and brachial plexus ranged from 31.3 to 57.5%. When the clavicle was divided into five sections, there was relatively little distribution of neurovascular damage in the first section or the fifth section. This study reveals the average location of subclavian vein with artery and brachial plexus. Results of this study could be used as reference during surgery.

NUTRIENT FORAMEN;

Objectives: To study the nutrient foramina of the dried human clavicle with respectto their position, number and direction for clinical interest. Study Design: Cross sectional study.Setting: Anatomy Department Faisalabad Medical University Faisalabad. Period: Six monthsfrom July to December 2017. Material and Methods: 60 dried human clavicles taken frombone bank of Anatomy Department Faisalabad Medical University Faisalabad. The foraminawere studied according to their location, and number and direction. The foramina index wascalculated using Hughes Formula by measuring the average total length and average lengthof foramina from sternal end of the clavicle. Results: The nutrient foramen was observed in all60(100%) of the clavicle. Single foramen was present in 22 (36.6%) clavicle and double foramenin 30(50%) clavicle. Triple and quadruple foramen in 6(10%) and 2(3.3%) clavicles respectively.The 34 left clavicles posses single foramen 12 (41.1%), double foramen 14(35.2%) while tripleand quadruple are 6(17.6%) and 2(5.8%) respectively. Total 26 right clavicles had 10 (38.4%)single foramen and 16(61.5%) double foramen. Total number of foramen in all 60 clavicleswere 108 of which 61.1% are located on posterior surface of the clavicle, 27% were found oninferior surface and rest 11.1% were on anterior surface. The clavicle having more than oneforamina are 28 out of which 64.2% was having both inferior and posterior foramina, 21.4 % wasanterior and posterior while 14.28% was located on triple sites anterior, inferior and posterior.We also found 90% of foramina were present on middle 1/3 and 10% on lateral 1/3. 98.3% ofthe foramina were directed to acromial end while rest 1.7 % to sternal end. The mean length offoramina from sternal end is 7.46 cm and mean maximum length of the clavicle was 14.51cm.The mean foramina index was 51.41. Conclusion: It is concluded from the study that most ofthe foramina are located on middle 3rd of the clavicle the commonest site of the fractures of thebone. Most of the foramina are located on the posterior surface denoting its blood supply fromthe neighboring blood supply. The knowledge of the foramina and its blood supply is importantfor fracture healing and bone grafting.

Descriptive characteristics of the area of origin of the deltoid muscle on the human clavicle. Is it necessary to include new terms in the Terminologia Anatomica?

The clavicular portion of the deltoid muscle (CPDM) in the human clavicle does not have a nomenclature in the Terminologia Anatomica (TA). This area is relevant in anatomy since the muscle participates in motions of glenohumeral articulation. The aim of this study was to describe the origin of the CPDM and to propose a name for the structure. Dry clavicles of 176 adults were studied, without distinction by sex. An osteometric board was used to measure the maximum length of the clavicles and a digital caliper to measure length of the CPDM’s origin, distance from the origin to the sternal end, distance from the origin to the acromial end, distance of the lateral third and middle vertical diameter. The mean of maximum of the distances and CPDM’s origin of left/right clavicle do not present significant differences. The CPDM s origin showed a high prevalence of structures as groove and roughened area (over 96% of cases). In conclusion, our definition of the CPDM shows the importance of clearly describing the observed groove and roughened area. Due to the high prevalence of the structures, the authors suggest that the terms “sulcus musculi deltoidei” and “tuberositas musculi deltoidei” be included in the TA to denominate the CPDM’s origin on the human clavicle.

EXPERIENCE IN ARTHROSCOPIC TREATMENT OF ACUTE ACROMIOCLAVICULAR JOINT INJURIES

Purpose of study: to evaluate surgical treatment results in patients with closed dislocation of the acromial end of the clavicle.Patients and methods. Eighteen patients, aged 23-54 years, with acute acromioclavicular joint injuries of IIIIV type by Rockwood were operated on during 2015 – 2018. Surgical treatment was performed at terms up to 2 weeks after injury. Reduction of the acromial end of the clavicle, arthroscopic fixation and stabilization of acromioclavicular joint by TightRope system was performed. Postoperative follow-up was cjnducted in 4 and 6 weeks, 3 months and subsequently every 6 months after surgical intervention. To evaluate the results the Constant Score and radiographs were used.Results.Follow-up period made up 1 year. Functional result, i.e. range of motion and quality of life, by Constant Score was good already on day 14 after surgery and excellent (89.6±2.9 points) at the end of treatment course (2 months after intervention). Brachial plexopathy (reduction of the thumb and 2nd finger sensitivity and muscular force in the early postoperative period) was observed in 1 case. Six months conservative treatment resulted in positive effect. In 6 months range of motion in the operated joint was equal to that in a healthy one.Conclusion.Arthroscopic treatment of acromioclavicular joint injuries by TightRope system is a highly effective and minimum invasive method but requires experience and practical skills in shoulder arthroscopy.

Investigations of cortical and cancellous clavicle bone patterns reveal an explanation for the load transmission and the higher incidence of lateral clavicle fractures in the elderly: a CT-based cadaveric study.

Clavicle fracture is known to be one of the injuries frequently occurring in the elderly. The purpose of this study was to characterise the internal structures that might correlate with the higher incidence of lateral clavicle fracture in the elderly. Twenty clavicles were collected from ten Japanese cadavers ranging from 70 to 99years (83.6 ± 7.6), scanned, and three-dimensional computed tomography (3D CT) images reconstructed. The clavicle lengths were divided into five equal segments. The four demarcation lines from the acromial end of the clavicle were defined as the observation points A, B, C, and D. The clavicles were then measured and analysed. It was shown that along the clavicles observation point A was the widest and points B and C the narrowest. Regarding the thickness, point D was the thickest among all four points, and there was no significant difference among the points A, B, and C. No male-female difference was found in either the cortical or cancellous bone ratio at all four points. Interestingly, the highest cortical bone ratio was observed at point B and the ratio was significantly decreased toward either end. The cancellous bone ratio was highest at point C and decreased toward both ends. Further observations showed that there were rays of trabeculae around point A, spreading from the superior-posterior edge or anterior edge toward each other and toward the lateral end and point B. Characteristics in the cortical and cancellous bone ratios and cancellous bone patterns might shed light on understanding the fractures in the lateral portion of the clavicle in the elderly.

Experience in arthroscopic treatment of acute acromioclavicular joint injuries

Purpose of study: to evaluate surgical treatment results in patients with closed dislocation of the acromial end of the clavicle. Patients and methods. Eighteen patients, aged 23-54 years, with acute acromioclavicular joint injuries of III-IV type by Rockwood were operated on during 2015 - 2018. Surgical treatment was performed at terms up to 2 weeks after injury. Reduction of the acromial end of the clavicle, arthroscopic fixation and stabilization of acromioclavicular joint by TightRope system was performed. Postoperative follow-up was cjnducted in 4 and 6 weeks, 3 months and subsequently every 6 months after surgical intervention. To evaluate the results the Constant Score and radiographs were used. Results. Follow-up period made up 1 year. Functional result, i.e. range of motion and quality of life, by Constant Score was good already on day 14 after surgery and excellent (89.6±2.9 points) at the end of treatment course (2 months after intervention). Brachial plexopathy (reduction of the thumb and 2nd finger sensitivity and muscular force in the early postoperative period) was observed in 1 case. Six months conservative treatment resulted in positive effect. In 6 months range of motion in the operated joint was equal to that in a healthy one. Conclusion. Arthroscopic treatment of acromioclavicular joint injuries by TightRope system is a highly effective and minimum invasive method but requires experience and practical skills in shoulder arthroscopy.

Sex assessment based on clavicular measurements in a modern Japanese population using multidetector computed tomography

Accurate sex estimation from unknown human remains is crucial as an integral and foremost step toward individual identification. The aims of this study were to assess sexual dimorphism of the clavicle and develop discriminant equations for sex estimation in a modern adult Japanese population based on clavicular measurements using three-dimensional (3D) computed tomographic (CT) images. A total of 300 cadavers (150 males, 150 females) of known age and sex that underwent postmortem CT and subsequent forensic autopsy were obtained. Four measurements were performed using 3D CT reconstructed images that extracted only bones based on the CT values, as follows: the linear distances between the medial superior margins of the left and right sternal facets to the lateral points of the left and right acromial ends, and the linear distances between the medial superior margins of the left and right sternal facets to the tips of the left and right conoid tubercles. The mean values of all measurements were significantly greater for male subjects than female subjects. Univariate discriminant function analysis (DFA) provided correct sex prediction rates of 88.3–92.2%. Stepwise DFA for the left and right clavicles yielded sex classification accuracy rates of 92.2% and 91.0%, respectively. In conclusion, clavicular measurements using 3D CT images of a contemporary Japanese population may be useful for sex estimation in forensic contexts.

Clinical profile of patients with fracture of Clavicle

It is estimated that one in every twenty fractures is a clavicle fracture. In fact 44% of all shoulder girdle fractures are clavicle fractures. The importance of proximity to vital structures in the neck and thorax necessitates the early and proper management of these fractures. About more than threefold variation in porosity and moments of inertia were found along the length of the clavicle. The greatest porosity and moments of inertia were located in the variably shaped sterna and acromial ends. The central third is denser, smaller and circular

Stature estimation in a contemporary Japanese population based on clavicular measurements using multidetector computed tomography

The aims of this study was to assess the correlation between stature and clavicular measurements in a contemporary Japanese population using three-dimensional (3D) computed tomographic (CT) images, and to establish regression equations for predicting stature. A total of 249 cadavers (131 males, 118 females) underwent postmortem CT scanning and subsequent forensic autopsy between October 2011 and May 2016 in our department. Four clavicular variables (linear distances between the superior margins of the left and right sternal facets to the anterior points of the left and right acromial ends and between the superior margins of the left and right sternal facets to the left and right conoid tubercles) were measured using 3D CT reconstructed images that extracted only bone data. The correlations between stature and each of the clavicular measurements were assessed with Pearson product–moment correlation coefficients. These clavicular measurements correlated significantly with stature in both sexes. The lowest standard error of estimation value in all, male, and female subjects was 3.62cm (r2=0.836), 3.55cm (r2=0.566), and 3.43cm (r2=0.663), respectively. In conclusion, clavicular measurements obtained from 3D CT images may be useful for stature estimation of Japanese individuals, particularly in cases where better predictors, such as long bones, are not available.

Computerized tomography based 3D modeling of the clavicle.

Previous studies have suggested clavicular morphology is highly variable, particularly in the lateral retrocurved section. Current clavicle fracture plating systems require three dimensional intra-operative contouring to achieve adequate fit and necessitate variable soft tissue dissection placing fracture perfusion and muscular attachments at risk. The aim of this study was to search for a surgically relevant superficial shape pattern. This is a retrospective CT-based analysis of 174 non-pathological clavicles in 95 adults (45 females, 50 males). Using the principle of cylindrical parameterisation generated 3-D computer models, we identified an implant preferred pathway (IPP), defined as a continuous linear region where the least possible soft tissue disruption would be necessary for plate fixation. The IPP mean form was within 3.04 mm (SD ± 1.34) on all clavicles. Clavicle length, and not shape, was found to be the biggest variable (correlation between size and form co-ordinates r = 0.99, p < 0.05), accounting for 79% of overall variability. This length variation was mainly located in the medial antecurved section. Superior convexity and recurvatum were the main shape variables, however they only contributed 8% and 5% to the overall variation, respectively. Three IPP lengths were shown to match all clavicles when aligned at the acromial end first. In contrast to previous studies, we have shown that the IPP is fairly consistent with respect to the general shape with the exception of length variation which mainly affected the medial antecurved section. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1216-1223, 2016. Future pre-contoured fracture fixation systems should provide variable length plates with a constant lateral section retrocurve and a variable medial antecurve.

Adult Neandertal clavicles from the El Sidrón site (Asturias, Spain) in the context of Homo pectoral girdle evolution

We undertook a three-dimensional geometric morphometric (3DGM) analysis on 12 new Neandertal clavicle specimens from the El Sidrón site (Spain), dated to 49,000 years ago. The 3DGM methods were applied in a comparative framework in order to improve our understanding of trait polarity in features related to Homo pectoral girdle evolution, using other Neandertals, Homo sapiens, Pan, ATD6-50 (Homo antecessor), and KNM-WT 15000 (Homo ergaster/erectus) in the reference collection. Twenty-nine homologous landmarks were measured for each clavicle. Variation and morphological similarities were assessed through principal component analysis, conducted separately for the complete clavicle and the diaphysis. On average, Neandertal clavicles had significantly larger muscular entheses, double dorsal curvature, clavicle torsion, and cranial orientation of the acromial end than non-Neandertal clavicles; the El Sidrón clavicles fit this pattern. Variation within the samples was large, with extensive overlap between Homo species; only chimpanzee specimens clearly differed from the other specimens in morphometric terms. Taken together, our morphometric analyses are consistent with the following phylogenetic sequence. The primitive condition of the clavicle is manifest in the cranial orientation of both the acromial and sternal ends. The derived condition expressed in the H. sapiens + Neandertal clade is defined by caudal rotation of both the sternal and acromial ends, but with variation in the number of acromia remaining in a certain cranial orientation. Finally, the autapomorphic Neandertal condition is defined by secondarily acquired primitive cranial re-orientation of the acromial end, which varies from individual to individual. These results suggest that the pace of phylogenetic change in the pectoral girdle does not seem to follow that of other postcranial skeletal features.

First experience of the surgical treatment of acute dislocation of clavicle acromial end

Over 100 methods of the surgical treatment of the dislocation of clavicle acromial end is known nowadays. Anatomic-biomechanic peculiarities of acromioclavicular joint and its ligamentous appa­ratus stipulate such a variety, at first, and secondly, this fact shows some disadvantages of every method. Moreover, it was defined, that complete restoration of function does not happen in 16.5–35.2 % cases. This fact shows the relevance of working out and implementa­tion of new treatment techniques. The goal: to improve the results of treatment of acromioclavicular joint injury using the restoration of coracoclavicular ligament with arthroscopic control. Methods: 5 patients (at the age from 18 to 42 years) with acute injury of ac­romioclavicular joint underwent an operation using arthroscopic equipment. The fixation of joint was carried out with «AKK rigging / АКК Такелаж» system in high-endurance nonabsorbable material. Immobilization duration in triangular bandage was equal to 2–3 weeks depending upon the severity of pain syndrome. Follow-up controls (clinical and radiographic assessment) were performed 1 and 3 months after surgery. Results: using of the method proposed for restoration of acute injures of acromioclavicular joint allowed to obtain good and excellent results in all patients after surgery. The range of motion in shoulder joint was restored in all patients completely. The proposed technique means surgery through little incisions (0.5 cm) that provide good cosmetic results. A positive feature of proposed technique is a minimal operation trauma, as far as you have not to expose a clavicle and subclavicular space for drilling it and fixator implementation. Conclusion: using of arthroscopic equipment for the restoration of acromioclavicular joint facilitates decreasing of operation trauma, terms of immobi­lization, allows predicting positive long-term results and restoring complete motion in shoulder joint.