Modified coracoclavicular stabilization technique using a bidirectional loop system versus clavicular hook plate for acute unstable acromioclavicular joint dislocation : Retrospective cohort study

Abstract

Background : Dislocation of Acromioclavicular (AC) joint is not uncommon and mostly involve younger, male individuals. There are patients that do not respond well to conservative management and may require surgical treatment. There are two principles of operative technique. One is transarticular fixation of AC joint and the other is coracoclavicular (CC) fixation. Both two techniques may or may not include ligamentous repaired. However, both techniques have many complication. Despite the vast literature available for management of this dislocation, there is no consensus regarding the gold standard treatment for this dislocation.

Objective : To assess the outcome of acute unstable AC joint dislocation when treated by modified CC stabilization technique using a bidirectional loop system compare with clavicular hook plate in intra-operative and post-operative and complications.

Material and Methods : To compare outcomes of 20 cases of modified coracoclavicular stabilization technique using a bidirectional loop system (group II) and outcomes of 20 cases of clavicular hook plate (group I) in acute unstable AC joint dislocation (Rockwood III,V) which performed from July 2017 to July 2021. Difference in surgical duration, intraoperative blood loss, total cost were compared between the two groups. Furthermore, the postoperative visual analog score, intravenous morphine use, length of hospital stay, immediate and late complication rates were compared to evaluate the curative effects of the surgical treatments.

Result : There were 20 patients in each group. There was no statistically significantly different between group in term of preoperative data. Mean estimated blood loss was higher in group I (28.5 ml) than group II (15.75ml). Mean operative time was 38.75 minutes in group I less than group II spent 87.50 minutes. Mean postoperative hospitalization was 3.25 days in group I more than group II was 2.3 days, mean pain score in group I was 4.75, 3.45 and group II was 2.8, 2.6 at 24 and 48 hours after surgery respectively. Use of 48 hours postoperative morphine in group I was 9.95 ml and 2.35 ml in group II. No statistically significant in term of immediate postoperative complication between 2 groups. Late postoperative complication was 5 cases(25%) in group I and 0 case in group II. There was no wound complication in both groups. 

Conclusion : Modified CC stabilization technique using a bidirectional loop system was safe and feasible in AC jt. dislocation type III and V patients, it should be considered as alternative technique.