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Archives of Orthopaedic and Trauma Surgery

, Volume 132, Issue 1, pp 33–39 | Cite as

Hook plate fixation for acromioclavicular joint separations restores coracoclavicular distance more accurately than PDS augmentation, however presents with a high rate of acromial osteolysis

  • Anica EschlerEmail author
  • Georg Gradl
  • Philip Gierer
  • Thomas Mittlmeier
  • Markus Beck
Orthopaedic Surgery

Abstract

Introduction

Hook plate fixation of acromioclavicular (AC) joint separations carries the disadvantage of compulsory implant removal, occasional implant fatigue and secondary loss of reduction. This study compares the clinical and radiological outcome of a new polyaxial angular stable hook plate (HP) with absorbable polydioxansulfate (PDS) sling.

Materials and methods

Between 2002 and 2009, out of a consecutive series of 81 patients with symptomatic Rockwood type V lesions 52 patients received clinical and radiographic follow-up (HP: n = 27; PDS: n = 25). HP patients were prospectively analyzed and retrospectively compared with the PDS group. Radiological follow-up included comparative coraco- and acromioclavicular distance (CCD/ACD) measurements as percentage of the uninjured shoulder. For clinical follow-up a standardized functional shoulder assessment with Constant Score, DASH Score, Taft Score and a self-report questionnaire including the visual analog scale (VAS) was carried out.

Results

Direct postoperative radiographs showed an overcorrection of CCD in the HP group (−4.4% of the uninjured side) and failure of anatomic correction in the PDS group (+11.0%). After implant removal, CCD increased in the HP group extensively to 16.7% (overall loss of reduction: 21.1%) and 23.9% in the PDS group. Redisplacement (100% increase of CCD) occurred in five cases (HP: 2, PDS: 3) and partial loss of reduction in four cases of each group. Comparing functional results no differences could be seen between both the groups (Constant-Score HP: 91.2 points, PDS: 94.6 points; Taft-Score HP: 9.4 points, PDS: 10.0 points). The DASH-Score revealed better results for PDS group (3.4 points, HP: 8.0 points). Signs of acromial osteolysis appeared in five cases (18.5%) in HP group. There was no case of implant failure. The X-rays of six patients (HP: 4, PDS: 2) showed AC-joint-osteoarthritis.

Conclusion

Hook plate fixation employing a polyaxial angular stable plate finally restores the coracoclavicular distance more accurately than augmentation with a PDS sling. Although in HP group no implant failure occurred, major disadvantages are initial overcorrection and acromial osteolysis. Both have no influence on final functional results.

Keywords

AC-joint Acromioclavicular dislocation Coracoclavicular distance Hook plate PDS augmentation Acromial osteolysis Overcorrection Rockwood Tossy 

Notes

Acknowledgments

We would like to thank H. Krentz of the Department of Medical Informatics and Biometry of the University of Rostock for statistical support and the whole surgical and radiological staff of the University of Rostock for their support during the performance of this study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Anica Eschler
    • 1
    Email author
  • Georg Gradl
    • 1
  • Philip Gierer
    • 1
  • Thomas Mittlmeier
    • 1
  • Markus Beck
    • 1
  1. 1.Department of Trauma and Reconstructive SurgeryUniversity of RostockRostockGermany

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