Hook Plate Removal Research Articles

Recurrence and Pain Analysis in the Treatment Outcomes of Acromioclavicular Joint Dislocation Following Hook Plate Removal

Background: The treatment of acute dislocation of the acromioclavicular joint, specifically types III to V, involves various methods, each with its own advantages and disadvantages. Objectives: This study aims to investigate the treatment outcomes of acromioclavicular joint dislocation after hook plate removal, focusing on the recurrence of dislocation and pain in the affected area. Methods: A retrospective statistical study was conducted on 40 patients (18 - 40 years old) who presented with acromioclavicular joint dislocation and received treatment at Golestan and Imam Khomeini (RA) hospitals in Ahvaz between 2013 and 2021. Among the patients, 28 were male and 12 were female, and all were treated using the hook plate method. A follow-up was conducted on all patients after an average duration of one year. Patient data were collected through radiographic analysis and completion of relevant questionnaires to assess the specific objectives of this research. Results: None of the patients treated with the hook plate method required additional surgery due to reduction loss. All patients who underwent re-surgery had their hook plates removed after an average of six months. There were no cases of plate breakage or recurrence after the operation. However, four cases (10% of all patients) reported partial dislocation. The average duration of the hook plate procedure was estimated to be 45 minutes, with an estimated blood loss of 100 cc. Furthermore, complete immobilization after the hook plate procedure lasted between three days and one week. Conclusions: The hook plate method exhibits favorable outcomes, including lower complication rates, reduced postoperative pain, minimal blood loss, shorter treatment duration, and lower surgical costs. Therefore, it is considered a preferred and economically viable treatment option.

Effect of subacromial erosion shape on rotator cuff and clinical outcomes after hook plate fixation in type 5 acromioclavicular joint dislocations: a retrospective cohort study

BackgroundSurgical fixation using hook plates is widely used in the treatment of acromioclavicular (AC) joint dislocations. The purpose of this study was to evaluate the incidence and shape of subacromial erosions after removal of the hook plate in type 5 AC joint dislocations. Further, we evaluated the effect of the shape of the subacromial erosion on the rotator cuff.MethodsWe retrospectively reviewed 30 patients who underwent hook plate fixation for type 5 AC joint dislocations at our hospital between December 2010 and December 2018. Patients with a follow-up of at least 1 year were included. Clinical outcomes were assessed using the final follow-up Constant-Murley, Korean Shoulder, and visual analog scores. To ensure that the appropriate reduction was well maintained, the coracoclavicular distances of the injured and contralateral sides were evaluated at the last follow-up. Computed tomography was performed to investigate the presence and shape of the subacromial erosion after hook plate removal at 4 months after surgery. Ultrasonography was performed to investigate the presence of rotator cuff lesions at the last follow-up. Clinical and radiological outcomes were compared between groups divided according to the presence and types of subacromial erosions.ResultsSubacromial erosion was observed in 60% of patients (18/30): 13, 2, and 3 simple groove, cave, and marginal protrusion types, respectively. Four patients showed reduction loss at the final follow-up. There were no significant differences in clinical and radiological outcomes between the groups with and without subacromial erosion. Moreover, there were no significant differences between groups according to the types of subacromial erosion. There were no rotator cuff lesions, such as partial tears, in the injured shoulders.ConclusionsHook plate fixation may induce subacromial erosions. However, the subacromial erosions caused by the hook plate did not affect the clinical outcomes of type 5 AC joint dislocations. Moreover, regardless of its shape, the subacromial erosion did not affect the clinical outcomes nor cause rotator cuff lesions after plate removal.

Ligamentous healing potential of the acromioclavicular ligament following acute anatomical reconstruction

BackgroundHorizontal instability following acute acromioclavicular joint (ACJ) reconstruction still occurs with a high prevalence. Although the human acromioclavicular ligament complex (ACLC) represents the major horizontal ACJ stabilizer, experimental studies on healing characteristics are lacking. Therefore, the purpose of this histological study was to investigate the healing potential of the ACLC following acute anatomical reconstructionMethodsIn this prospective clinical-experimental study, 28 ACLC biopsies were performed in patients with complete ACJ dislocations (Rockwood type 4 or 5) during acute hook plate stabilization (IG: implantation group; n = 14) and hook plate removal (EG: explantation group; n = 14). Histological analyses included Giemsa staining, polarized light microscopy and immunostaining against CD68, αSMA and collagen type I and type III. Histomorphological evaluation entailed cell counts, collagen expression score, ligament tissue maturity index (LTMI) and descriptive analysis of specific ligamentous structures. Statistics consisted of nonparametric Mann–Whitney U tests and a level of significance of P < .05.ResultsTotal cell counts (cells/mm2 1491 ± 296 vs. 635 ± 430; P < 0.001) and collagen III expression (3.22 ± 0.22 vs. 1.78 ± 0.41; P < 0.001) were higher in EG compared to IG. Inversely αSMA + (11 ± 9 vs. 179 ± 186; P < 0.001) and CD68 + cell counts (56 ± 20 vs. 100 ± 57; P 0.009) were significantly lower in the EG. The EG revealed a comparable reorientation of ligamentous structures. Consistently, ACLC samples of the EG (21.6 ± 2.4) displayed a high total but differently composed LTMI score (IG: 24.5 ± 1.2; P < 0.001).ConclusionsThis experimental study proved the ligamentous healing potential of the human ACLC following acute anatomical reconstruction. Histomorphologically, the ACLC reliably showed a ligamentous state of healing at a mean of about 12 weeks after surgery. However, processes of ligamentous remodeling were still evident. These experimental findings support recent clinical data showing superior horizontal ACJ stability with additional AC stabilization in the context of acute ACJ reconstruction. Though, prospective clinical and biomechanical studies are warranted to evaluate influencing factors on ACLC healing and potential impacts of acute ACLC repair on clinical outcome.Study typeControlled Laboratory Study

Comparison of Hook Plate Fixation Versus Arthroscopic Coracoclavicular Fixation Using Multiple Soft Anchor Knots for the Treatment of Acute High-Grade Acromioclavicular Joint Dislocations

To compare the clinical and radiologic outcomes of arthroscopically assisted coracoclavicular (CC) fixation using multiple soft anchor knots versus hook plate fixation in patients with acute high-grade Rockwood type III and V acromioclavicular (AC) joint dislocations. This retrospective study included 22 patients with acute Rockwood type III and V AC joint dislocations who underwent arthroscopic fixation or hook plate fixation surgery between February 2016 and March 2018. Patients were categorized into 2 groups: arthroscopically assisted CC fixation using multiple soft anchor knots group (AR, n= 12) and hook plate fixation group (HO, n= 10). We measured the CC distances (CCDs) and CCD ratio at 6 months, 1 year, and last follow-up postoperatively to compare the radiologic results between the groups. Clinical outcomes were assessed at 1 year postoperatively and at the last follow-up using the Visual Analog Scale, American Shoulder and Elbow Surgeons (ASES) scores, and Shoulder Pain and Disability Index (SPADI) scores, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Magnetic resonance imaging after hook plate removal was used to evaluate the healing ligaments and tendon-bone interface. The patients in the AR group had better ASES, SPADI, and Quick DASH scores than the patients in the HO group at 1 year postoperatively and at last follow-up. The CCD and CCD ratio were significantly better in the AR group than in the HO group at the last follow-up period (P= .007/0.029). Magnetic resonance imaging findings showed grade I in 60% of patients in the AR group and grade III in 60% of patients in the HO group. AC joint arthritic change was observed in 40% of the HO group. The CC fixation method using multiple soft anchor knots showed satisfactory results and had superior CC ligament healing ability and maintenance of CCD than hook fixation. Level III, retrospective therapeutic comparative investigation.

Hook plate with or without coracoclavicular ligament augmentation in the treatment of acute acromioclavicular separation

BackgroundAcromioclavicular (AC) separation can be treated with the use of a hook plate. Some studies have reported that coracoclavicular (CC) ligament augmentation is necessary to reduce the complications of hook plate fixation, whereas others recommend hook plate fixation alone without augmentation. The aim of this study was to compare the results and complications between these two groups.MethodsThis was an observational case-control study. Patients with acute (less than 2 weeks) Rockwood type V AC separation were treated with a hook plate at our hospital. A total of 105 cases received hook plate fixation with CC ligament augmentation (group I), and 112 cases received hook plate fixation without augmentation (group II). Constant-Murley scores were used to evaluate the function before and after implant removal, and radiographs were taken to evaluate the complications. The results and complications were compared between groups.ResultsBefore removal, the Constant-Murley score was significantly higher in group I (mean, 50.1) than in group II (mean, 42.6) (p = 0.004); however, there was no significant difference between groups at 3 and 6 months after removal. The incidence of significant acromion osteolysis was higher in group II (65/112) than in group I (25/105). Before removal, the patients with significant acromion osteolysis had worse Constant-Murley scores than those of the patients without osteolysis in both groups. The incidence of peri-implant fracture of the hook plate was higher in group II (8/112) than in group I (1/105).ConclusionThe patients without CC ligament augmentation had worse functional results before hook plate removal, a higher incidence of radiographic acromion osteolysis, and a higher incidence of peri-implant fractures than those patients with CC ligament augmentation. Therefore, CC ligament augmentation is highly recommended to improve short-term outcomes and decrease complications for Rockwood type V AC separation treated by hook plate.

Acromioclavicular joint separation treated with clavicular hook plate: a study of radiological and functional outcomes.

ACJ separation is a common shoulder injury. A variety of surgical techniques for high-grade ACJ separations have been described. A commonly used technique represents open reduction and fixation by a hook plate. Goal of the present study was to evaluate radiographic and functional outcome in patients with high-grade ACJ separations following surgical treatment with a hook plate before and after surgery as well as after hook plate removal. Patients undergoing surgery with a hook plate due to traumatic ACJ separation between 2012 and 2014 were included and examined during a follow-up control. Demographic and clinical data as well as radiographs pre- and postoperatively were evaluated. Additionally, range of motion, DASH Score and Constant-Murley Score (CMS) were analysed in a follow-up examination. Wilcoxon signed-rank test and Spearman's rank correlation were used for statistical analysis. 99 patients (88m/11w, 44y) were included in the present study. 69 (64m/5w, 49y) could be examined during long-term follow-up (38month). After hook plate removal, the CCD increased significantly (13.7 ± 0.9mm) compared to the hook plate in situ (9.9 ± 0.8mm, p = 0.000001). 68% of all patients achieved a full range of motion post-operatively. Main limitations of range of motion affected external rotation as well as ante-/retroversion. Mean DASH Score was 5.6 ± 1 points and CMS 90.0 ± 1.4 points. In contrast to a significant higher CCD after hook plate removal, nearly all patients achieved good to excellent functional results for DASH and CMS. This indicates that loss of reduction does not necessarily lead to poor functional outcome after ACJ separation surgery.

Retrospective analysis of patients with acromioclavicular joint dislocation treated with a specialized plate

The purpose of the work – to determine disadvantages of hook plates fixation in acromioclavicular joint dislocations based on a retrospective analysis of patients treated for this pathology.Materials and methods. A total of 112 patients treated for acromioclavicular joint dislocation in the SI “Institute of Traumatology and Orthopedics of the NAMS of Ukraine” between 2011 and 2018 were retrospectively analyzed. Acromioclavicular joint dislocation was fixed with a hook plate in 74 patients (66.1 %). All the patients were divided into 3 clinical groups: Group I – the hook plate was removed up to 4 months, Group II – the hook plate was removed between 4 and 6 months, Group III – the hook plate was removed after 6 months.Results. The results of the treatment were evaluated by Constant–Murley Score before the hardware removal in patients. The following indicators were obtained: in Group I, 6.7 % of patients had good results and 4 % – satisfactory and unsatisfactory results, in Group II, 43.2 % of individuals had excellent and good results and 9.5 % – satisfactory results, in Group III, 19 % had excellent and good results and 17.6 % – satisfactory and unsatisfactory treatment results. 6 months after the hardware removal, in Group I, 8.2 % of patients showed excellent and good results and 2.7 % – satisfactory results, in Group II, 52.6 % of individuals had good and excellent results, in Group III, 20.3 % of persons had excellent and good results and 16.2 % – satisfactory and unsatisfactory treatment outcomes. Failures and complications of hook plates fixation in acromioclavicular joint were observed in 36 patients, among them 18 patients were with type III dislocation and 14 patients had type V dislocation by Rockwood.Conclusions. The best results assessed by the Constant–Murley and Visual analogue scale scores were achieved in the group with the hook plate removal from the acromioclavicular joint after an interval of 4 to 6 months. When the hook plate was removed after a period of more than 6 months, complications such as irreversible changes in the acromioclavicular joint (posttraumatic osteoarthritis, bone tissue defect in the acromion etc.) were observed.

Efficacy comparison between clavicular hook plate combined with coracoclavicular ligament reconstruction and simple hook plate for acute acromioclavicular joint dislocation

Objective To compare the efficacy between hook plate combined with coracoclavicular ligament functional reconstruction by conjoined tendon transfer and single hook plate surgery in the treatment of Rockwood type III and type V acute acromioclavicular joint dislocations. Methods A prospective cohort study was conducted to analyze the clinical data of 37 patients with Rockwood type III and V acute acromioclavicular dislocations admitted to Jiangning Hospital Affiliated to Nanjing Medical University from October 2011 to April 2016. According to the random number method, the patients were divided into combined tendon and ligament reconstruction group (ligament reconstruction group, 19 patients) and clavicular hook plate group (single plate group, 18 patients). In the ligament reconstruction group, there were 14 males and five females, aged (47.0±11.4)years, and there were 10 patients with type III and nine with type V. In the simple plate group, there were 12 males and six females, aged (45.0±11.2)years, and there were 11 patients with type III and seven with type V. In the ligament reconstruction group, the acromioclavicular joint was reduced by clavicular hook plate, and the oblique ligament and the conical ligament were reconstructed by lateral half-inversion of the short head tendon of biceps brachii combined with tendon. The double-bundle functional reconstruction of coracoclavicular ligament was performed. In single plate group, hook plate was used to reduce acromioclavicular joint. The intraoperative blood loss, incision length, operation time, and visual analogue score (VAS) before operation and after 1 year follow-up were compared. Constant-Murley score and Karlsson score were used to evaluate the effect of operation. X-ray films were taken regularly to observe the reduction and maintenance of acromioclavicular joint dislocation. The complications were recorded. Results All patients were followed up for 17-24 months [(20.0±1.7)months]. There was no significant difference in intraoperative blood loss between the two groups (P>0.05). In the ligament reconstruction group and single plate group, the incision length was (13.4±0.8)cm and (6.6±0.7)cm (P 0.05); the VAS at 1 year after operation was (2.1±0.9)points and (3.8±1.4)points (P<0.05). X-ray showed good reduction of acromioclavicular joint in ligament reconstruction group, with no loss of reduction occurred after removal of hook plate. In the simple plate group, loss of reduction, resorption of distal clavicle bone and bone fusion occurred after removal of hook plate. The Constant-Murley scores in the ligament reconstruction group and the single plate group were (89.5±2.9)points and (79.6±5.0)points respectively; the excellent and good rates of Karlsson score were 89.5% (17/19) and 61.1% (11/18) (bothP<0.05), respectively. In the ligament reconstruction group, one patient complained of pain and swelling at the tendon. In the single plate group, loss of reduction occurred in three patients after removal of internal fixator; obvious subacromial osteolysis was seen in seven patients at 1 year after operation; and impingement sign was positive in nine patients at 1 year after operation. Conclusion The overall surgical effect of hook plate combined with coracoclavicular ligament functional reconstruction by conjoined tendon transfer is superior to single hook plate surgery in the treatment of type Rockwood III and Rockwood V acute acromioclavicular joint dislocations, though with longer operation time and bigger incision. Key words: Acromioclavicular joint; Dislocations; Coracoclavicular ligament

The Radiologic Comparison of Operative Treatment Using a Hook Plate versus a Distal Clavicle Locking Plate of Distal Clavicle Fracture.

BackgroundThe purpose of this study was to compare the radiologic results of patients who underwent surgery with a hook plate and a locking plate in distal clavicle fractures.MethodsSixty patients underwent surgical treatment for Neer type IIa, IIb, III, and V distal clavicle fracture. Twenty-eight patients underwent fracture fixation with a hook plate and 32 with a locking plate. Coracoclavicular distance was measured on standard anteroposterior radiographs before and after the surgery, and union was confirmed by radiograph or computed tomography taken at 6 months postoperatively. Other radiologic complications like osteolysis was also checked.ResultsBony union was confirmed in 59 patients out of 60 patients, and 1 patient in the hook plate group showed delayed union. Coracoclavicular distance was decreased more in the hook plate group after surgery (p<0.01). After 6 weeks of the hook plate removal, the coracoclavicular distance was increased a little compared to before metal removal, but there was no difference compared to the contralateral shoulder. Eleven out of 28 patients (39.3%) showed osteolysis on the acromial undersurface in the hook plate group.ConclusionsBoth the hook plate group and the locking plate group showed satisfactory radiologic results in distal clavicle fractures. Both hook plate and locking plate could be a good treatment option if it is used in proper indication in distal clavicle fracture with acromioclavicular subluxation or dislocation.

Single coracoclavicular suture fixation with Mersilene tape versus hook plate in the treatment of acute type V acromioclavicular dislocation: a retrospective analysis

BackgroundHere, we compared the clinical and radiographic outcomes between coracoclavicular (CC) fixation with Mersilene tape and hook plate for acute unstable acromioclavicular (AC) joint dislocation treatment.MethodsWe enrolled 49 patients with unstable acute AC dislocation who, between January 2010 and January 2014, underwent surgery with single CC suture fixation with Mersilene tape (M group, 25 cases) or clavicle hook plate (H group, 24 cases). In M and H groups, the average age was 43.7 (range 18–72) and 42.0 (range 17–84) years, the male to female ratio of each group was 15:20 and 19:5, and the injured side left to right ratio was 12:13 and 11:13, respectively. All patients were right-handed. We retrospectively compared the operation time, complication rate, visual analog scale (VAS), University of California at Los Angeles (UCLA) shoulder rating scale, Oxford shoulder scores, and the radiographic outcomes based on reduction loss of CC distance on postoperative follow-up.ResultsNo significant difference in patient demographics between the two groups in age (p = 0.709), gender (p = 0.217), time from injury to surgery (p = 0.863), and injured side (p = 1.000). The mean follow-up was 26.2 months (range 24–35 months). Nine cases of reduction loss (36%) and one of distal clavicle osteolysis (4%) were noted in the M group. CC distance improvement in the H group was significantly superior to that in the M group at 3 months (before hook plate removal, p < 0.001) and 12 months postoperatively (after hook plate removal, p = 0.004), while subacromial erosions were revealed in nine cases (37.5%) in the H group. No significant difference in operative time (p = 0.846), complication rate (p = 1.000), VAS (p = 0.199), mean UCLA shoulder rating scale (p = 0.353), and Oxford shoulder (p = 0.224) scores between the two groups.ConclusionsBoth hook plate and Mersilene tape fixations provided temporary stabilization of acute type V AC dislocation and yielded comparable clinical outcomes. The hook plate provided better maintenance of reduction of radiographic outcomes. CC suture fixation with Mersilene tape may serve as an alternative method of stabilization which provides acceptable outcome without the need of implant removal.

Comparison of hook plate with versus without double-tunnel coracoclavicular ligament reconstruction for repair of acute acromioclavicular joint dislocations: A prospective randomized controlled clinical trial

PurposeThis study was designed to compare the surgical outcomes of a hook plate with double-tunnel coracoclavicular (CC) ligament reconstruction by conjoined tendon transfer versus single hook plate surgery for the repair of acute type of Rockwood type III and V acromioclavicular (AC) joint dislocations. MethodsThe study cohort included 62 patients with acute (within 6 weeks after trauma) Rockwood type III and V AC joint dislocations who underwent surgery from February 2012 to September 2015. The patients were randomly allocated to the ligament reconstruction group (LR group, n = 31) or the single hook plate group (HP group, n = 31). In both groups, reduction of the AC joint by hook plate and repair of the ruptured AC ligament with absorbable Vicryl sutures were performed homoplastically. The lateral half of the short tendon of the biceps brachii muscle and the lateral half of the flexor tendon were used to reconstruct the trapezoid and conoid ligaments, respectively. Differences in surgical duration, intraoperative blood loss, incision length, and total cost were compared between the two groups. Furthermore, the preoperative and postoperative visual analogue score (VAS), postoperative American Shoulder and Elbow Surgeons (ASES) score, Constant–Murley score (CMS), Karlsson score, complication rates, and patient satisfaction at the last follow-up were compared to evaluate the curative effects of the surgical treatments. Magnetic resonance imaging (MRI) after hook plate removal was used to evaluate the reconstructed ligaments and tendon-bone interface. ResultsIn total, 25 patients in the LR group and 26 in the HP group completed the follow-up. There were no statistically significant differences in age, sex, Rockwood type, placing time, total cost, and follow-up duration between the LR and HP groups (p > 0.05). However, as compared with the HP group, the surgical duration and incision length were longer in the LR group (92.08 ± 19.25 vs. 56.54 ± 21.29 min and 13.64 ± 0.90 vs. 6.65 ± 1.01 cm, respectively, p < 0.05). In addition, there was no significant difference in preoperative VAS scores, but the postoperative VAS score was lower in LR group than in the HP group (2.52 ± 1.19 vs. 4.12 ± 1.45, respectively, p < 0.05). Moreover, patients in LR group had a remarkable higher CMS and ASES score (89.56 ± 2.80 vs. 79.31 ± 4.97 and 92.60 ± 2.79 vs. 82.35 ± 3.44, respectively, p < 0.05). The overall excellent or good result rate, as evaluated by the Karlsson score, was 92.00% (23/25) and 50.00% (13/26), respectively (p < 0.05). MRI findings revealed good condition of the reconstructed ligaments and tendon-bone interface. The incidence of complications was lower and the satisfaction rate was higher in the LR group than in the HP group (1/25 vs. 16/26 and 23/25 vs. 14/26, respectively, p < 0.05). ConclusionsThe overall surgical effect of the use of a hook plate combined with double-tunnel CC ligament reconstruction is superior to single hook plate surgery for the repair of acute Rockwood type III and V AC joint dislocations.

Arthroscopic fracture treatment of the shoulder joint

In recent years, the understanding of shoulder fractures has changed due to the progress of arthroscopy. In addition to the cosmetic result, the access morbidity, particularly the integrity of the subscapularis muscle in glenoid and scapular fractures, must be mentioned as an advantage of aminimally invasive approach. Furthermore, necessary secondary interventions, e. g. hook plate removal, can be prevented or minimized by modern implants and arthroscopic techniques.However, the available data and publications are almost exclusively limited to technical notes or small case series, so statements about faster recreation or potential reduction of infection risk cannot be made. Whether addressing concomitant injuries has an effect on the clinical and functional outcome is also unclear at the present time.

Surgical fixation of Rookwood Type III–V acromioclavicular joint dislocation with acromioclavicular: Hook plate

Context: Acromioclavicular (AC) joint dislocation is one of the common shoulder problems accounting for 9% of all shoulder injuries and occurs five times more frequently in men than in women. Aims: In the present study, we aim to assess the functional outcome of hook plate fixation for the treatment of acute Rockwood Type III–V AC joint dislocation and to know the complications associated with the implant. Settings and Design: This was a prospective study. Subjects and Methods: Twenty patients, both male and female, with a mean age of 42 years who had acute dislocation of the AC joint were included for the study. Nine patients had Type III, four patients had Type IV, and 7 patients had Type V dislocation according to Rockwood classification. Patients were followed up till 6 months and were evaluated using Constant–Murley score. Statistical Analysis used: For the statistical analysis, descriptive statistics were calculated with the objective of summarizing the set of data analyzed. Results: The mean Constant–Murley score was 82.5 at 6-month follow-up. Four patients had complications of which one had superficial infection, two had subacromial erosion, and one had osteoarthritis of AC joint. Conclusions: Radiographic outcome based on the maintenance of reduction indicates that hook plate fixation is a better treatment option and is an effective method for the treatment of AC joint dislocation. Osteoarthritis and osteolysis are two common complications, which are associated with impairment of shoulder function. Shoulder function will be improved after the removal of hook plate.

Acromioclavicular joint disruptions: A comparison of two surgical approaches 'hook' and 'rope'.

Acromioclavicular joint injuries are common shoulder girdle injuries most commonly resulting from a direct blow to the acromion with the arm adducted. Type-I or type-II acromioclavicular joint injuries can be managed with sling immobilization, early shoulder motion, and physiotherapy. The management of type-III injuries remains controversial and is individualized. Type IV and V injuries should be treated surgically. A myriad of surgical techniques for the management of acromioclavicular joint injuries have been reported. We present a comparative study of 76 patients treated with two most common modalities of treatment for AC joint disruption and that is Hook plate stabilisation (n=52) or arthroscopically assisted tight rope stabilisation (n=24). The primary objective was to establish whether hook plate stabilization was superior compared to arthroscopic tight rope fixation in reducing pain and increasing function in the short-term and long-term for patients with AC joint disruptions III-IV. We also wanted to assess how quickly patients returned to their work/job. It was a prospective study, we included all the patients operated between 2008 and 2015 for AC joint disruption by the two shoulder surgeons of our department. All patients followed a strict physiotherapy protocol and were assessed at 6 weeks, 3 months and 12 months. We used the Harm and cost criteria of assessment and the patient specific functional outcome scores. Both modalities of treatment have high patient satisfaction rate, return to work is faster in tight rope group but after a year both group of patients returned to their premorbid state. Removal of hook plate is not mandatory and lysis of acromion is rare (1% in our series). Despite the fact that both methods yielded similar results and have statistically similar number of complications, the type of postoperative complications was different between groups. The plate group had more postoperative pain and worse function but both aspects improved after plate removal. The rope group had more complex complications including deep infection and recurrence of deformity and fracture. These differences should be taken into consideration when consenting the patient regarding possible treatment.

Hook plate fixation for acute acromioclavicular dislocations without coracoclavicular ligament reconstruction: a functional outcome study in military personnel.

The aim of our study was to evaluate the shoulder function after clavicular hook plate fixation of acute acromioclavicular dislocations (Rockwood type III) in a population group consisting exclusively of high-demand military personnel. This prospective study was carried out at a tertiary care military orthopaedic centre during 2012–2013 using clavicular hook plate for management of acromioclavicular injuries without coracoclavicular ligament reconstruction in 33 patients. All patients underwent routine implant removal after 16 weeks. The functional outcome was assessed at 3, 6 and 12 months after hook plate removal and 2 years from the initial surgery using the Constant Murley and UCLA Scores. All the patients were male serving soldiers and had sustained acromioclavicular joint dislocation (Rockwood type III). Mean age of the patient group was 34.24 years (21–55 years). The mean follow-up period in this study was 23.5 months (20–26 months) after hook plate fixation and an average of 19.9 months (17–22 months) after hook plate removal. The average Constant Score at 3 months after hook plate removal was 60.3 as compared to 83.7 and 90.3 at 6 months and 1 year, respectively, and an average of 91.8 at the last follow-up that was approximately 2 years after initial surgery which was statistically significant (p value <0.05). The UCLA Score was an average of 15.27, 25.9 and 30.1 at 3, 6 months and 1 year, respectively, after removal of hook plate which improved further an average of 32.3 at the last follow-up, which was also statistically significant (p value <0.05). Clavicular hook plate fixation without coracoclavicular ligament reconstruction is a good option for acute acromioclavicular dislocations producing excellent medium-term functional results in high-demand soldiers.

Effect of the subacromial interval on the occurrence of impingement syndrome after clinical application of clavicular hook plate

Objective To analyze the effect of acromio-humeral interval on the occurrence of subacromial impingement syndrome (SIS) after the clinical application of clavicular hook plate in acromioclavicular joint dislocation (Tossy Ⅲ). Methods From July 2005 to October 2008, 63 cases of acromioclavicular joint dislocation (Tossy Ⅲ) were treated with clavicular hook plate. There were 48 males and 15 females with an average age of 33.6 years (range, 21-53 years). The relationship of the acromio-humeral interval (AHI)were analysed between the two groups by X-ray measurement. The AHI and plate-humeral interval (PHI)were measured on X-ray film to detect difference between the two groups. Results After the operation, all t he 63 cases were divided into two groups according the occurrence of SIS. There were 14 cases in the group of SIS and 49 cases in the group without SIS. The mean follow-up was 12.2 (average, 6-15) months.The average AHI of was (8.5±2.1) mm and (9.7±2.6) mm in the group of SIS and the group without SIS respectively. The difference between the two groups was statistically significant. The average PHI of the group of SIS and the group without SIS was (6.1±2.8) mm and (6.8±2.4) mm respectively. There was no difference between the two groups. After removal of the clavicular hook plate, the clinical sign disappeared in the group of SIS. According the Karlsson scoring system, the excellent and good rate of the shoulder function was 100%. Conclusion The occurrence of SIS after the clinical application of clavicular hook plate has related to the width of the subacromial interval. The syndrome could be treated by the removal of clavicular hook plate. Key words: Acromioclavicular joint; Dislocations; Shoulder impingement syndrome; Internal fixators