Hook plate fixation for acute acromioclavicular dislocations without coracoclavicular ligament reconstruction: a functional outcome study in military personnel

Abstract

The aim of our study was to evaluate the shoulder function after clavicular hook plate fixation of acute acromioclavicular dislocations (Rockwood type III) in a population group consisting exclusively of high-demand military personnel. This prospective study was carried out at a tertiary care military orthopaedic centre during 2012-2013 using clavicular hook plate for management of acromioclavicular injuries without coracoclavicular ligament reconstruction in 33 patients. All patients underwent routine implant removal after 16 weeks. The functional outcome was assessed at 3, 6 and 12 months after hook plate removal and 2 years from the initial surgery using the Constant Murley and UCLA Scores. All the patients were male serving soldiers and had sustained acromioclavicular joint dislocation (Rockwood type III). Mean age of the patient group was 34.24 years (21-55 years). The mean follow-up period in this study was 23.5 months (20-26 months) after hook plate fixation and an average of 19.9 months (17-22 months) after hook plate removal. The average Constant Score at 3 months after hook plate removal was 60.3 as compared to 83.7 and 90.3 at 6 months and 1 year, respectively, and an average of 91.8 at the last follow-up that was approximately 2 years after initial surgery which was statistically significant (p value <0.05). The UCLA Score was an average of 15.27, 25.9 and 30.1 at 3, 6 months and 1 year, respectively, after removal of hook plate which improved further an average of 32.3 at the last follow-up, which was also statistically significant (p value <0.05). Clavicular hook plate fixation without coracoclavicular ligament reconstruction is a good option for acute acromioclavicular dislocations producing excellent medium-term functional results in high-demand soldiers.

Keywords: Acromioclavicular dislocation; Hook plate; Military personnel.

Fig. 1

Pre-operative radiograph showing grade III acromioclavicular dislocation and an increased coracoclavicular distance

Fig. 2

Constant Score at 3, 6 months and 1 year after hook plate removal and 2 years post hook plate fixation

Fig. 3

UCLA Score at 3, 6 months and 1 year after hook plate removal and 2 years post hook plate fixation

Fig. 4

Post-operative radiograph at 12 weeks showing a congruent acromioclavicular joint and hook plate in situ

Fig. 5

Stress radiograph at 2 years post hook plate fixation: Congruent acromioclavicular articulation and normal coracoclavicular distance with mild sclerosis