Skip to main content
SpringerLink
Log in

Akromioklavikulargelenkinstabilitäten und gelenknahe Frakturen

Instabilities and associated fractures of the acromioclavicular joint

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Hintergrund

In den vergangenen Jahren ist ein gestiegenes wissenschaftliches Interesse im Bereich der Akromioklavikulargelenkinstabilitäten (ACG-Instabilitäten) und der ACG-nahen Frakturen zu verzeichnen. Dabei besteht sowohl hinsichtlich der Einteilung des Schweregrads und der Wahl der optimalen konservativen oder operativen Versorgung als auch hinsichtlich des Therapieerfolgs und der Prognose Uneinigkeit in der Literatur.

Therapiewahl und -ergebnisse

Akute Schultereckgelenksprengungen werden auch heute vorrangig abhängig von ihrem vertikalen Versatz einer spezifischen Therapie zugeordnet. Allerdings sollte eine dynamische horizontale Instabilitätskomponente ebenso berücksichtigt werden. Auch bei lateralen Klavikulafrakturen gilt es, eine vertikale Instabilität aufgrund einer korakoklavikularen Bandruptur, die mit einem höheren Pseudarthroserisiko bei konservativer Therapie einhergeht, festzustellen. Die operative Versorgung akuter hochgradiger ACG-Instabilitäten (Typ IV–VI) und dislozierter lateraler Klavikulafrakturen war traditionell eine Domäne der offenen Chirurgie. Heute ebenfalls verfügbare arthroskopische bzw. arthroskopisch-assistierte Techniken können neben der Vermeidung einer ausgeprägten Weichteilpräparation ein geringeres Infektionsrisiko und unter kosmetischen Gesichtspunkten eine höhere Patientenakzeptanz bieten. Mittelfristige Ergebnisse dieser Techniken zeigen mit den offenen Verfahren vergleichbare Resultate. Langzeitergebnisse dieser neuen Verfahren stehen noch aus.

Abstract

Background

Increasing scientific interest in acute acromioclavicular joint (ACJ) instabilities and ACJ-associated fractures has been observed in the past few years. This may be due to the lack of data in the literature regarding specific treatment indications, unsatisfying results of open techniques, and the development of new minimally invasive surgical procedures.

Treatment selection and results

Acute ACJ instabilities are still graded according to their vertical component of instability. However, dynamic horizontal instability should also be taken into account. Even in lateral clavicle fractures, it is important to determine vertical instability due to coracoclavicular ligament injury, which is associated with higher risk of pseudarthrosis when treated conservatively. Surgical treatment of high-grade ACJ instabilities and dislocated lateral clavicle fractures has traditionally been a domain of open surgery. Today, available arthroscopic and arthroscopically-assisted techniques offer the potential of less soft-tissue preparation, a smaller risk of infection and, under cosmetic aspects, higher patient acceptance. The medium-term results of these minimally invasive techniques can compete with those of open techniques. Long-term results are still lacking.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Albrecht F, Kohaus H, Stedtfeld HW (1982) The Balser plate for acromioclavicular fixation. Chirurg 53:732–734

    CAS  PubMed  Google Scholar 

  2. Andersen JR, Willis MP, Nelson R, Mighell MA (2011) Precontoured superior locked plating of distal clavicle fractures: a new strategy. Clin Orthop Relat Res 469:3344–3350

    Article  PubMed Central  PubMed  Google Scholar 

  3. Ballmer F, Gerber C (1991) Coracoclavicular screw fixation for unstable fractures of the distal clavicle. J Bone Joint Surg Br 73:291–294

    CAS  PubMed  Google Scholar 

  4. Beitzel K, Cote MP, Apostolakos J et al (2013) Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy 29:387–397

    Article  PubMed  Google Scholar 

  5. Bloom F (1945) Wire fixation in acromioclavicular dislocation. J Bone Joint Surg 27:273–276

    Google Scholar 

  6. Bosworth B (1948) Acromioclavicular dislocation: end-results of screw suspension treatment. Ann Surg 127:98–111

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Broos P, Stoffelen D, Van de Sijpe K, Fourneau I (1997) Surgical management of complete Tossy III acromioclavicular joint dislocation with the Bosworth screw or the Wolter plate. A critical evaluation. Unfallchirurgie 23:153–160

    Article  CAS  PubMed  Google Scholar 

  8. Bunnell S (1928) Fascial graft for dislocation of the acromioclavicular joint. Surg Gynecol Obstet 46:563

    Google Scholar 

  9. Checchia S, Doneux PS, Miyazaki AN et al (2008) Treatment of distal clavicle fractures using an arthroscopic technique. J Shoulder Elbow Surg 17:395–398

    Article  PubMed  Google Scholar 

  10. Chernchujit B, Tischer T, Imhoff AB (2006) Arthroscopic reconstruction of the acromioclavicular joint disruption: surgical technique and preliminary results. Arch Orthop Trauma Surg 126:575–581

    Article  PubMed  Google Scholar 

  11. Clayer M, Slavotinek J, Krishnan J (1997) The results of coraco-clavicular slings for acromio-clavicular dislocation. Aust N Z J Surg 67:343–346

    Article  CAS  PubMed  Google Scholar 

  12. De Baets T, Truijen J, Driesen R, Pittevils T (2004) The treatment of acromioclavicular joint dislocation Tossy grade III with a clavicle hook plate. Acta Orthop Belg 70:515–519

    Google Scholar 

  13. Di Francesco A, Zoccali C, Colafarina O et al (2012) The use of hook plate in type III and V acromio-clavicular Rockwood dislocations: clinical and radiological midterm results and MRI evaluation in 42 patients. Injury 43:147–152

    Article  Google Scholar 

  14. Eberle C, Fodor P, Metzger U (1992) Hook plate (so-called Balser plate) or tension banding with the Bosworth screw in complete acromioclavicular dislocation and clavicular fracture. Z Unfallchir Versicherungsmed 85:134–139

    CAS  PubMed  Google Scholar 

  15. Ejam S, Lind T, Falkenberg B (2008) Surgical treatment of acute and chronic acromioclavicular dislocation Tossy type III and V using the hook plate. Acta Orthop Belg 74:441–445

    PubMed  Google Scholar 

  16. Elser F, Chernchujit B, Ansah P, Imhoff AB (2005) Eine neue minimal-invasive arthroskopische Technik zur Akromioklavikulargelenkrekonstruktion. Unfallchirurg 108:645–649

    Article  CAS  PubMed  Google Scholar 

  17. Faraj AA, Ketzer B (2001) The use of a hook-plate in the management of acromioclavicular injuries. Report of ten cases. Acta Orthop Belg 67:448–451

    CAS  PubMed  Google Scholar 

  18. Flinkkila T, Ristiniemi J, Lakovaara M et al (2006) Hook-plate fixation of unstable lateral clavicle fractures: a report on 63 patients. Acta Orthop 77:644–649

    Article  PubMed  Google Scholar 

  19. Gerhardt C, Kraus N, Greiner S, Scheibel M (2011) Arthroskopische Stabilisierung der akuten Schultereckgelenksprengung. Orthopade 40:61–69

    Article  CAS  PubMed  Google Scholar 

  20. Greiner S, Braunsdorf J, Perka C et al (2009) Mid to long-term results of open acromioclavicular-joint reconstruction using polydioxansulfate cerclage augmentation. Arch Orthop Trauma Surg 129:735–740

    Article  CAS  PubMed  Google Scholar 

  21. Gstettner C, Tauber M, Hitzl W, Resch H (2008) Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg 17:220–225

    Article  CAS  PubMed  Google Scholar 

  22. Henry M (1929) Acromioclavicular dislocations. Minn Med 12:431–433

    Google Scholar 

  23. Hernegger GS, Kadletz R (2006) Tight rope – the revolutionary anatomical fixation in acromioclavicular joint dislocation – case report. Tech Shoulder Elbow Surg 7:86–88

    Article  Google Scholar 

  24. Herrmann S, Schmidmaier G, Greiner S (2009) Stabilisation of vertical unstable distal clavicular fractures (Neer 2b) using locking T-plates and suture anchors. Injury 40:236–239

    Article  CAS  PubMed  Google Scholar 

  25. Kashii M, Inui H, Yamamoto K (2006) Surgical treatment of distal clavicle fractures using the clavicular hook plate. Clin Orthop Relat Res 447:159–164

    Google Scholar 

  26. Kienast B, Thietje R, Queitsch C et al (2011) Mid-term results after operative treatment of Rockwood grade III–V acromioclavicular joint dislocations with an AC-hook-plate. Eur J Med Res 16:52–56

    Article  PubMed Central  PubMed  Google Scholar 

  27. Klein SM, Badman BL, Keating CJ et al (2010) Results of surgical treatment for unstable distal clavicular fractures. J Shoulder Elbow Surg 19:1049–1055

    Article  PubMed  Google Scholar 

  28. Kona J, Bosse MJ, Staeheli JW, Rosseau RL (1990) Type II distal clavicle fractures: a retrospective review of surgical treatment. J Orthop Trauma 4:115–120

    Article  CAS  PubMed  Google Scholar 

  29. Koukakis A, Manouras A, Apostolou CD et al (2008) Results using the AO hook plate for dislocations of the acromioclavicular joint. Expert Rev Med Devices 5:567–572

    Article  PubMed  Google Scholar 

  30. Kraus N, Gerhardt C, Greiner S, Scheibel M (2012) Posttraumatische Erhebung des Acromioclavicular Joint Instability Score und Vergleich mit subjektiven und objektiven Scoringsystemen bei Schultereckgelenksinstabilitäten. Jahreskongress der Deutschen Vereinigung für Schulter- und Ellenbogenchirurgie, Berlin

  31. Lee SK, Lee JW, Song DG, Choy WS (2013) Precontoured locking plate fixation for displaced lateral clavicle fractures. Orthopedics 36:801–807

    Article  PubMed  Google Scholar 

  32. Leidel BA, Braunstein V, Kirchhoff C et al (2009) Consistency of long-term outcome of acute Rockwood grade III acromioclavicular joint separations after K-wire transfixation. J Trauma 66:1666–1671

    Article  PubMed  Google Scholar 

  33. Mall J, Jacobs CA, Philipp AW, Peter FJ (2002) Surgical treatment of the distal clavicle with polydioxanone suture tension band wiring: an alternative osteosynthesis. J Orthop Sci 7:535–537

    Article  CAS  PubMed  Google Scholar 

  34. Murray G (1940) Fixation of dislocation of the acromioclavicular joint and rupture of the coracoclavicular ligaments. Can Med Assoc J 43:270

    Google Scholar 

  35. Neer IC (1963) Fracture of the distal clavicle with detachment of the coracoclavicular ligaments in adults. J Trauma 3:99–110

    Article  PubMed  Google Scholar 

  36. Pauly S, Kraus N, Greiner S, Scheibel M (2013) Prevalence and pattern of glenohumeral injuries among acute high-grade acromioclavicular joint instabilities. J Shoulder Elbow Surg 22:760–766

    Article  PubMed  Google Scholar 

  37. Phemister D (1942) Treatment of acromioclavicular dislocation by open reduction and threaded wire fixation. J Bone Joint Surg 24:166–168

    Google Scholar 

  38. Poli A (1953) Acromioclavicular dislocation: treatment and results. Arch Ortop 6:669

    CAS  PubMed  Google Scholar 

  39. Pujol N, Philippeau JM, Richou J et al (2008) Arthroscopic treatment of distal clavicle fractures: a technical note. Knee Surg Sports Traumatol Arthrosc 16:884–886

    Article  PubMed  Google Scholar 

  40. Renger RJ, Roukema GR, Reurings JC et al (2009) The clavicle hook plate for Neer type II lateral clavicle fractures. J Orthop Trauma 23:570–574

    Article  CAS  PubMed  Google Scholar 

  41. Rieser GR, Edwards K, Gould GC et al (2013) Distal-third clavicle fracture fixation: a biomechanical evaluation of fixation. J Shoulder Elbow Surg 22:848–855

    Article  PubMed  Google Scholar 

  42. Robb AJ, Howitt S (2011) Conservative management of a type III acromioclavicular separation: a case report and 10-year follow-up. J Chiropr Med 10:261–271

    Article  PubMed Central  PubMed  Google Scholar 

  43. Robinson CM (1998) Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br 80:476–484

    Article  CAS  PubMed  Google Scholar 

  44. Rockwood C (1984) Injuries in the acromioclavicular joint: subluxations and dislocations about the shoulder. In: Rockwood C, Green DP (Hrsg) Fracture in adults. Lippincott, Philadelphia, S 860–910

  45. Rolla PR, Surace MF, Murena L (2004) Arthroscopic treatment of acute acromioclavicular joint dislocation. Arthroscopy 20:662–668

    Article  PubMed  Google Scholar 

  46. Salzmann GM, Walz L, Schoettle PB, Imhoff AB (2008) Arthroscopic anatomical reconstruction of the acromioclavicular joint. Acta Orthop Belg 74:397–400

    PubMed  Google Scholar 

  47. Scheibel M, Droschel S, Gerhardt C, Kraus N (2011) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med 39:1507–1516

    Article  PubMed  Google Scholar 

  48. Shamus JL, Shamus EC (1997) A taping technique for the treatment of acromioclavicular joint sprains: a case study. J Orthop Sports Phys Ther 25:390–394

    Article  CAS  PubMed  Google Scholar 

  49. Sim E, Schwarz N, Hocker K, Berzlanovich A (1995) Repair of complete acromioclavicular separations using the acromioclavicular-hook plate. Clin Orthop Relat Res 314:134–142

    PubMed  Google Scholar 

  50. Sundaram N, Patel DV, Porter DS (1992) Stabilization of acute acromioclavicular dislocation by a modified Bosworth technique: a long-term follow-up study. Injury 23:189–193

    Article  CAS  PubMed  Google Scholar 

  51. Tiren D, Bemmel AJ van, Swank DJ, Linden FM van der (2012) Hook plate fixation of acute displaced lateral clavicle fractures: mid-term results and a brief literature overview. J Orthop Surg Res 7:2

    Article  PubMed Central  PubMed  Google Scholar 

  52. Urist MR (1946) Complete dislocation of the acromioclavicular joint: the nature of the traumatic lesion and effective methods of treatment with an analysis of forty-one cases. J Bone Joint Surg Am 28:813–837

    CAS  PubMed  Google Scholar 

  53. Wolf EM, Fragomen AT (2010) Arthroscopic ligament reconstruction in acromioclavicular joint separation: experience & pitfalls. In: Boileau P (Hrsg) Nice shoulder course. Sauramps Médical, Nizza, S 167–175

  54. Wolf EM, Pennington WT (2001) Arthroscopic reconstruction for acromioclavicular joint dislocation. Arthroscopy 17:558–563

    Article  CAS  PubMed  Google Scholar 

  55. Wolter D, Eggers C (1984) Reposition and fixation of acromioclavicular luxation using a hooked plate. Hefte Unfallheilkd 170:80–86

    CAS  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. N. Kraus und M. Scheibel geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Campus-Mitte und Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    N. Kraus &  M. Scheibel

Authors
  1. N. Kraus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Scheibel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Scheibel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kraus, N., Scheibel, M. Akromioklavikulargelenkinstabilitäten und gelenknahe Frakturen . Trauma Berufskrankh 16, 23–30 (2014). https://doi.org/10.1007/s10039-014-2065-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10039-014-2065-7

Schlüsselwörter

Keywords

Search

Navigation