Treatment Of Acromioclavicular Dislocation And Distal Clavicular Fracture And Study Of Devices Of External Fixation

Background:Acromioclavicular dislocation and distal clavicular fracture were very common injuries.The Rockwood classification system for the injury is well accepted at Present.Treatment is various,but there is still no a consensus of opinion now on the therapy choice for different injuries.There are lots of surgical treatments of severe acromioclavicular dislocation and unstable distal clavicular fracture.But which operative method is better or the best is not fully understood,ln clinic,the doctor not only regards the disease condition of the patient and the classification system of the fracture,but also considers economic status,profession,age and subjective will of the patient.Finally doctor choose the individual treatment.Controversies mainly focus on the therapy of third-degree acromioclavicular dislocation and type-Ⅱdistal clavicular fracture.Non-operative treatment or operative treatment is disputed.Regarding there is no efficient conservative treatment in clinic at present,most doctors prefer to choose operating therapy for these great displacement injuries.We have done lots of research about these injuries, given the comprehensive therapeutic plan,in order to standardize the treatment program for these injuries.And our resrearh mainly focus on conservative treatments of these injuries and the development of external fixation device.Objectives:1.By analyzing prospectively and retrospectively the effect of different operating methods for severe acromioclavicular dislocation and unstable distal clavicular fracture in our hospital and the other centers,we determine good operative protocol.2.The main purpose of this study was to analyze the clinical effect and security for the treatment of mild moderate acromioclavicular dislocation and distal clavicular fracture of the multifunctional acromioclavicular fixing band.By trying to quantitate the pressure the fixing band needed through experiment research,we would define the indication for applying of the product and formulate the standard process for treatment.Further more,the external fixation product will be improved according to the clinical effect and provide another therapy choice besides surgery for those patients with acromioclavicular dislocation or distal clavicular fracture.Methods:1.In the operating treatment study,the retrospective and prospective study was applied.Study on 50 patients with acromioclavicular dislocation(typeⅢ-Ⅵ)and 42 patients with distal clavicular fracture(typeⅢ-Ⅵ)who have operative indication from April,2004 to October,2007 in our hospital and other centers revealed the effect of different operative methods and the reason affecting the effect.The non-randomized control trial was applied according to the classification of operative methods.We analyzed the effect of different operating methods for these two injuries respectively and the influencing factors affecting the clinical effect.The clinical effect was measured according to the JOA score,VAS score,etc.And the result was acquired through statistical comparison.2.We determined the pressure the fixing band needed through experiment research,to make sure the treatment method is efficient and safe.What is more,this experiment can provide a training method for using the external fixing band normatively.3.In the clinical study of this external fixation,the prospective study was applied.36 patients with acromioclavicular dislocation(RockwoodⅠ-Ⅲ)or distal clavicular fracture(RockwoodⅠ-Ⅲ)were adopted.All the patients were treated with the multifunctional acromioclavicular fixing band immediately after the injury was reduced manually.Patients would keep the external fixation for 2-6 weeks.And we would give patients the guidance for rehabilitation exercise during this time.All patients were followed up once a week.We could make a careful check and adjust the fixing band if necessary,to avoid the complication such as the skin sore or neurovascular damage.The external fixation was removed after 3-6 weeks.Patients should continue to keep rehabilitation exercise.The patients were followed up once a month in this stage.All the patients were followed up for 6-9 months in all.Detailed condition of patients should be recorded for every rechecking,including complications.The evaluation of treatment effect were made at 3th and 6th month, including the function of shoulder joint and upper limb,appearance of shoulder, appearance of X-ray,JOA score,pain score according to the VAS,etc.After analyzing statistically,we could obtain the data of effective power and the assessmentof the safety.Indication for applying of the product were defined according to the treatment effct for injuries.And the standard process for operating clinically were formulated.During the study,we had been trying to develop the design of the product in time according to the backing off from clinical use.4.All the date was processed and analyzed with SPSS13.0.Results:1.Research of operative treatment of acromioclavicular dislocation:Two methods were used for these patients,internal fixation with clavicular hook plate or K-wire tension band(group A,27 cases),reconstruction of coracoclavicular ligament with suture of FiberWire of Arthrex(AR-7200) after internal fixation(group B,23 cases).The evaluation of clinical effect were made at 6th month postoperative.JOA score of group A was 90.7±7.5,the excellent rate was 55.6%,and the good rate is 92.6%.JOA score of group B was 92.5±7.0,the excellent rate was 65.2%,and the good rate is 95.7%.There was no significant difference between the two groups(P＞0.05).VAS score of group A was 1.9±1.7,the excellent rate was 55.6%,and the good rate is 96.3%.VAS score of group B was 1.8±1.7,the excellent rate was 65.2 %,and the good rate is 91.3%.There was no significant difference between the two groups(P＞0.05).2.Research of operative treatment of distal clavicular fracture:Two different surgical methods were used,internal fixation with clavicular hook plate or K-wire tension band(group A,20 cases),reconstruction of coracoclavicular ligament with suture of Fiber Wire of Arthrex(AR-7200)or 5MM suture anchor(group A,22 cases).The evaluation of clinical effect were made at 6th month postoperative.JOA score of group A was 89.1±7.0,the excellent rate was 60.0%,and the good rate is 90.0%.JOA score of group B was 93.2±7.2,the excellent rate was 72.7 %,and the good rate is 91.0%.There was significant difference between the two groups(P＜0.05).The result of group B was better than group A.VAS score of group A was 2.9±2.2,the excellent rate was 45.0%,and the good rate is 85.0%.VAS score of group B was 1.5±1.3,the excellent rate was 77.3 %,and the good rate was 100%.There was significant difference between the two groups(P＜0.05).Group B was better than group A.The method using suture anchor is simpler and safer than using suture of Fiber Wire of Arthrex,and the surgical wound was smaller too.3.We determined the pressure the fixing band needed through experiment research,to make sure the treatment method is efficient and safe.We chose the 5-6cm wide tourniquet.Complications of neurovascular would not occour if the tourniquet was below 5KPa,and the subjects could maintain for more than 8h.What is more,this experiment provided a training method for using the external fixing band normatively.4.Clinical study of external fixation:All the 36 patients with conservative treatment were followed up for 6-9 months,averaged 7.2 months.Both the two groups obtained satisfactory results.For patients with acromioclavicular dislocation,JOA score at 6th was 92.6±7.0,the excellentand good rate of typeⅠwas 100%,and 100%of typeⅡ,75% of typeⅢ.And VAS score of these patients was 1.5±1.5,the excellent rate was 75%,excellent and good rate was 100%.For patients with distal clavicular fracture,JOA score at 6th was 92.4±6.4,the excellent and good rate of typeⅠwas 100%,and 80%of typeⅡ,100% of typeⅢ.And VAS score of these patients was 1.5±1.4,the excellent rate was 75%,excellent and good rate was 100%.For both the two injuries,the score of JOA and VAS at 6th month were developed significantly than that at 3th month.The complication of skin sore occurred in a acromioclavicular dislocation patient(Ⅲdegree),but not serious and it was healed quickly after treatment,and there was no neurovascular damage.Conclusions:1.For the choice of operating method for severe acromioclavicular dislocation,there was no significant difference between the two groups,the method of internal fixation only and internal fixation with coracoclavicular ligament reconstruction 2.For the choice of operating method for unstable distal clavicular fracture,the method of reconstruction of coracoclavicular ligament with suture or suture anchor is better than the method of internal fixation.Suture anchor has more advantages,such as little trauma,firm fixation and simple operation.3.It is a simple,efficient and safe conservative therapy for acromioclavicular dislocation(RockwoodⅠ-Ⅲ)and distal clavicular fracture(RockwoodⅠ-Ⅲ)with the multifunctional acromioclavicular fixing band.For typeⅤpatient who would not accept operating treatment,if reduction is well,the multifunctional acromioclavicular fixing band is available also.The clinical indication for this product was worked out by us preliminarily.