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Clavicular hook plate versus dog-bone technique for acute high-grade acromioclavicular joint dislocation: a retrospective cohort study comparing clinical outcome scores, complications, and costs

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Arthroscopically assisted coracoclavicular (CC) ligament fixation techniques have been promoted as providing superior outcomes for the treatment of acute high-grade acromioclavicular joint (ACJ) dislocations. Nevertheless, there is a lack of high-level evidence for clinically relevant benefits. At our institute, orthopaedic surgeons use an arthroscopically assisted coracoclavicular ligament fixation technique (DB), while general trauma surgeons use a clavicular hook plate (cHP) technique. The aim of the study was to compare clinical outcomes, complication rates, and costs between the two groups.

Materials and methods

The hospital database was searched for patients treated for acute traumatic high-grade (Rockwood Typ ≥ III) ACJ dislocation using either a cHP or arthroscopically assisted DB technique between 2010 and 2019. Seventy-nine patients could be included (56 patients in the cHP group and 23 in the DB group). QuickDASH scores, subjective shoulder value (SSV) scores, pain scores (numerical pain rating scale 10), and complication rates were retrospectively collected through phone interviews and by screening patient charts as well as surgical reports. Costs per patient were obtained from the hospital’s accounting system.

Results

Mean follow-up was 54 ± 33.7 and 45 ± 21.7 months in the cHP and DB group, respectively. QuickDASH and SSV scores did not differ, but patients in the cHP group reported significantly lower pain scores (p = 0.033). More patients reported hypertrophic or disturbing scars (p = 0.49) and sensibility disturbances (p = 0.007) in the cHP group. Three patients suffered from a frozen shoulder in the DB group (p = 0.023).

Conclusion

Patient-reported outcomes are excellent after long-term follow-up for both techniques. There are no clinically relevant differences in clinical outcome scores based on our results and a review of the literature. Both techniques certainly have their benefits regarding secondary outcome measures.

Level of clinical evidence

Level 3, retrospective cohort study.

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Author notes

  1. Silvan Hess and Kerstin Bütler have contributed equally to this work.

Authors and Affiliations

  1. Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland

    Silvan Hess, Samuel Haupt, Christoph Sommer & Christian Michelitsch

  2. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Graubünden, Loëstrasse 99, 7000, Chur, Switzerland

    Silvan Hess, Kerstin Bütler, Samuel Haupt & Holger Grehn

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  1. Silvan Hess
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Correspondence to Silvan Hess.

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All authors declare no conflict of interest. The study did not receive any funding and was solely financed by the Department of Surgery and Department of Orthopaedic Surgery and Traumatology Kantonsspital Graubünden,

Ethical approval

The study was approved by the local ethical committee (2020-00757). All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Hess, S., Bütler, K., Haupt, S. et al. Clavicular hook plate versus dog-bone technique for acute high-grade acromioclavicular joint dislocation: a retrospective cohort study comparing clinical outcome scores, complications, and costs. Arch Orthop Trauma Surg 143, 5007–5014 (2023). https://doi.org/10.1007/s00402-023-04856-4

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