Clinical Orthopaedics and Related Research

, Volume 466, Issue 3, pp 646–651 | Cite as

Complications After Open Distal Clavicle Excision

  • Efstathis Chronopoulos
  • Harpreet S. Gill
  • Michael T. Freehill
  • Steve A. Petersen
  • Edward G. McFarland
Symposium: New Approaches to Shoulder Surgery
First Online:
Received:
Accepted:

Abstract

Isolated distal clavicle excision performed as an open procedure has been considered safe and, in the literature, has been considered the standard for comparison with arthroscopic distal clavicle excisions. However, we noticed isolated open distal clavicle excision was associated with a number of complications. We therefore raised two questions about the complication rate in a cohort of our patients who had undergone this procedure: (1) What was the complication rate and how did it compare to that in the existing literature on this subject? and (2) Were the complications in our cohort similar to those previously reported? We studied 42 patients who underwent an isolated distal clavicle excision between 1992 and 2003. There were 27 complications (64%), which was substantially higher than rates previously reported. Complications in our cohort not previously reported included continued acromioclavicular joint tenderness and scar hypertrophy. Our study suggests complications after open distal clavicle excisions may be more frequent than and may differ from previously reported rates and types.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Keywords

High Complication Rate Hypertrophic Scar Local Tenderness Distal Clavicle Diagnostic Arthroscopy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References

  1. 1.
    Auge WK II, Fischer RA. Arthroscopic distal clavicle resection for isolated atraumatic osteolysis in weight lifters. Am J Sports Med. 1998;26:189–192.PubMedGoogle Scholar
  2. 2.
    Berg EE, Ciullo JV. The SLAP lesion: a cause of failure after distal clavicle resection. Arthroscopy. 1997;13:85–89.PubMedGoogle Scholar
  3. 3.
    Blazar PE, Iannotti JP, Williams GR. Anteroposterior instability of the distal clavicle after distal clavicle resection. Clin Orthop Relat Res. 1998;348:114–120.PubMedCrossRefGoogle Scholar
  4. 4.
    Cahill BR. Osteolysis of the distal part of the clavicle in male athletes. J Bone Joint Surg Am. 1982;64:1053–1058.PubMedGoogle Scholar
  5. 5.
    Cahill BR. Atraumatic osteolysis of the distal clavicle. A review. Sports Med. 1992;13:214–222.PubMedCrossRefGoogle Scholar
  6. 6.
    Chronopoulos E, Kim TK, Park HB, Ashenbrenner D, McFarland EG. Diagnostic value of physical tests for isolated chronic acromioclavicular lesions. Am J Sports Med. 2004;32:655–661.PubMedCrossRefGoogle Scholar
  7. 7.
    Cook FF, Tibone JE. The Mumford procedure in athletes. An objective analysis of function. Am J Sports Med. 1988;16:97–100.PubMedCrossRefGoogle Scholar
  8. 8.
    Eskola A, Santavirta S, Viljakka HT, Wirta J, Partio TE, Hoikka V. The results of operative resection of the lateral end of the clavicle. J Bone Joint Surg Am. 1996;78:584–587.PubMedGoogle Scholar
  9. 9.
    Eskola A, Vainionpaa S, Korkala S, Santavirta S, Gronblad M, Rokkanen P. Four-year outcome of operative treatment of acute acromioclavicular dislocation. J Orthop Trauma. 1991;5:9–13.PubMedCrossRefGoogle Scholar
  10. 10.
    Flatow EL, Cordasco FA, Bigliani LU. Arthroscopic resection of the outer end of the clavicle from a superior approach: a critical, quantitative, radiographic assessment of bone removal. Arthroscopy. 1992;8:55–64.PubMedCrossRefGoogle Scholar
  11. 11.
    Flatow EL, Duralde XA, Nicholson GP, Pollock RG, Bigliani LU. Arthroscopic resection of the distal clavicle with a superior approach. J Shoulder Elbow Surg. 1995;4:41–50.PubMedCrossRefGoogle Scholar
  12. 12.
    Gartsman GM. Arthroscopic resection of the acromioclavicular joint. Am J Sports Med. 1993;21:71–77.PubMedCrossRefGoogle Scholar
  13. 13.
    Grimes DW, Garner RW. The degeneration of the acromioclavicular joint. Orthop Rev. 1980;9:41–44.Google Scholar
  14. 14.
    Gürbüz H, Unalan H, Sarisaltik H, Sekhavat H, Candan L. The role of acromioclavicular arthritis in impingement syndromes. Yonsei Med J. 1998;39:97–102.PubMedGoogle Scholar
  15. 15.
    Gurd FB. The treatment of complete dislocation of the outer end of the clavicle. An hitherto undescribed operation. Ann Surg. 1941;113:1094–1098.PubMedGoogle Scholar
  16. 16.
    Jacob AK, Sallay PI. Therapeutic efficacy of corticosteroid injections in the acromioclavicular joint. Biomed Sci Instrum. 1997;34:380–385.PubMedGoogle Scholar
  17. 17.
    Kay SP, Dragoo JL, Lee R. Long-term results of arthroscopic resection of the distal clavicle with concomitant subacromial decompression. Arthroscopy. 2003;19:805–809.PubMedCrossRefGoogle Scholar
  18. 18.
    Kay SP, Ellman H, Harris E. Arthroscopic distal clavicle excision. Technique and early results. Clin Orthop Relat Res. 1994;301:181–184.PubMedGoogle Scholar
  19. 19.
    Kim TK, McFarland EG. Internal impingement of the shoulder in flexion. Clin Orthop Relat Res. 2004;421:112–119.PubMedCrossRefGoogle Scholar
  20. 20.
    Lesko PD. Variation of the arthroscopic Mumford procedure for resecting the distal clavicle. J South Orthop Assoc. 2001;10:194–200.PubMedGoogle Scholar
  21. 21.
    Martin SD, Baumgarten TE, Andrews JR. Arthroscopic resection of the distal aspect of the clavicle with concomitant subacromial decompression. J Bone Joint Surg Am. 2001;83:328–335.PubMedCrossRefGoogle Scholar
  22. 22.
    McFarland EG, Neira CA, Gutierrez MI, Cosgarea AJ, Magee M. Clinical significance of the arthroscopic drive-through sign in shoulder surgery. Arthroscopy. 2001;17:38–43.PubMedCrossRefGoogle Scholar
  23. 23.
    Mumford EB. Acromioclavicular dislocation: a new operative treatment. J Bone Joint Surg Am. 1941;23:799–802.Google Scholar
  24. 24.
    Neer CS II. Fractures of the distal third of the clavicle. Clin Orthop Relat Res. 1968;58:43–50.PubMedGoogle Scholar
  25. 25.
    Neer CS II. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. 1972;54:41–50.PubMedGoogle Scholar
  26. 26.
    Novak PJ, Bach BR Jr, Romeo AA, Hager CA. Surgical resection of the distal clavicle. J Shoulder Elbow Surg. 1995;4:35–40.PubMedCrossRefGoogle Scholar
  27. 27.
    O’Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26:610–613.PubMedGoogle Scholar
  28. 28.
    Petchell JF, Sonnabend DH, Hughes JS. Distal clavicular excision: a detailed functional assessment. Aust N Z J Surg. 1995;65:262–266.PubMedCrossRefGoogle Scholar
  29. 29.
    Petersson CJ. Resection of the lateral end of the clavicle. A 3- to 30-year follow-up. Acta Orthop Scand. 1983;54:904–907.PubMedGoogle Scholar
  30. 30.
    Sage FP, Salvatore JE. Injuries of the acromioclavicular joint: a study of results in 96 patients. South Med J. 1963;56:486–495.PubMedGoogle Scholar
  31. 31.
    Slawski DP, Cahill BR. Atraumatic osteolysis of the distal clavicle. Results of open surgical excision. Am J Sports Med. 1994;22:267–271.PubMedCrossRefGoogle Scholar
  32. 32.
    Snyder SJ, Banas MP, Karzel RP. The arthroscopic Mumford procedure: an analysis of results. Arthroscopy. 1995;11:157–164.PubMedCrossRefGoogle Scholar
  33. 33.
    Taylor GM, Tooke M. Degeneration of the acromio-clavicular joint as a cause of shoulder pain. J Bone Joint Surg Br. 1977;59:507.Google Scholar
  34. 34.
    Tolin BS, Snyder SJ. Our technique for the arthroscopic Mumford procedure. Orthop Clin North Am. 1993;24:143–151.PubMedGoogle Scholar
  35. 35.
    Wagner CJ. Partial claviculectomy. Am J Surg. 1953;85:259–265.PubMedCrossRefGoogle Scholar
  36. 36.
    Worcester JN Jr, Green DP. Osteoarthritis of the acromioclavicular joint. Clin Orthop Relat Res. 1968;58:69–73.PubMedCrossRefGoogle Scholar
  37. 37.
    Zawadsky M, Marra G, Wiater JM, Levine WN, Pollock RG, Flatow EL, Bigliani LU. Osteolysis of the distal clavicle: long-term results of arthroscopic resection. Arthroscopy. 2000;16:600–606.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Efstathis Chronopoulos
    • 1
  • Harpreet S. Gill
    • 1
  • Michael T. Freehill
    • 1
  • Steve A. Petersen
    • 1
  • Edward G. McFarland
    • 1
    • 2
  1. 1.Division of Shoulder Surgery, Department of Orthopaedic SurgeryThe Johns Hopkins UniversityBaltimoreUSA
  2. 2.Department of Orthopaedic SurgeryJohns Hopkins Bayview Medical CenterBaltimoreUSA

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