Axial and tangential views of the acromioclavicular joint: the introduction of new projections.
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BACKGROUND: Routine anteroposterior radiographs of the acromioclavicular (AC) joint with or without weight bearing have limitations in demonstrating the AC joint. Transarticular fixation with Kirschner wire is a treatment choice for AC dislocations. However, percutaneous fixation of the AC joint is technically demanding. The C-arm fluoroscopy can be used as routine intraoperative guidance to facilitate this procedure. The current study aims to introduce new projections, the axial and tangential views of AC joint, to help evaluate the severity of the injury and facilitate the percutaneous procedure. METHODS: Three shoulder specimens were used to find the projection directions of the axial and tangential views of the AC joint by using the digital radiography (DR) unit. The axial and tangential views were taken of 20 adult volunteers by referencing the projection directions determined in the shoulder specimens. The angles showed on the DR system and the angles between the coronal plane of the body and the vertical plane of the flat panel detector (FPD) during taking these radiographs were recorded. The C-arm fluoroscopy unit was used to take the axial and tangential views referencing the angles measured on the DR system. Routine anteroposterior radiographs of the AC joint were taken on the volunteers. The minimal distances from the distal clavicle to the acromion were measured on both tangential and anteroposterior radiographs. The data was statistically analyzed. RESULTS: The clear axial and tangential radiographs of AC joints of the volunteers were obtained using both DR and C-arm fluoroscopy units. The angles demonstrated on the DR window are (20.8 +/- 2.4) degrees for male and (18.3 +/- 2.3) degrees for female. During taking the axial views, the angles between the coronal plane of the body and vertical plane of FPD are (23.3 +/- 3.2) degrees for male and (20.1 +/- 2.4) degrees for female. During taking tangential views, the corresponding angles are (117.5 +/- 3.7) degrees for male and (113.1 +/- 3.3) degrees for female. On the tangential radiographs, the minimal distance from the distal clavicle to the acromion is (6.1 +/- 1.2) mm, wider than the same measurement on the anteroposterior radiographs (P < 0.05). Statistical analyses showed no significant differences in the above-mentioned angles and the minimal distances between the left and right AC joints (P > 0.05). There were no significant differences in the above-mentioned angles between DR and C-arm fluoroscopy units (P > 0.05). CONCLUSIONS: The axial and tangential radiographs of the AC joint can demonstrate the joint clearly and they can be easily obtained with both DR system and C-arm fluoroscopy unit in similar projection directions. (+info)
Clinical effect of acute complete acromioclavicular joint dislocation treated with micro-movable and anatomical acromioclavicular plate.
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Chondromyxoid fibroma of the clavicle extending to the adjacent joint: a case report.
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Chondromyxoid fibroma is a rare benign bone tumour usually involving bones of the lower extremity in young adults. We present a case of chondromyxoid fibroma of the left clavicle extending to the adjacent joint in a 84-year-old man. The tumour had breached the hyaline cartilage of acromioclavicular joint. The tumour was excised en bloc, and the humeral head was curetted and grafted with autogenous cancellous bone. Postoperatively, the patient had an uneventful recovery and regained excellent function of the left shoulder without any pain or stiffness. At the 18-month follow-up, there was no sign of recurrence. (+info)
Surgical treatment of Rockwood grade-V acromioclavicular joint dislocations: 50 patients followed for 15-22 years.
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Surgical treatment of chronic acromioclavicular dislocation with biologic graft vs synthetic ligament: a prospective randomized comparative study.
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Reconstruction of chronic acromioclavicular joint disruption with artificial ligament prosthesis.
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OBJECTIVE: Management of Rockwood type 3 acromioclavicular disruptions is a matter of debate. Should we adopt conservative or operative measures at first presentation? It is not clear but most of the evidences are in favour of conservative management. We present our experience in managing these patients surgically. METHODS: We present a prospective series of eight cases of chronic Rockwood type 3 acromioclavicular joint disruptions treated surgically. Anatomical reconstruction of the coracoclavicular ligament was done by artificial braided polyester ligament prosthesis. RESULTS: All the patients were able to perform daily activities from an average of the 14th postoperative day. All patients felt an improvement in pain, with decrease in average visual analogue scale from preoperative 6.5 points (range 3-9 points) to 2.0 points (range 0-5 points), Constant score from 59% to 91% and American Shoulder and Elbow Surgeons shoulder score from 65 to 93 points postoperatively. These results improved or at least remained stationary on midterm follow-up, and no deterioration was recorded at an average follow-up of 46 months. CONCLUSION: This midterm outcome analysis of the artificial ligament prosthesis is the first such follow-up study with prosthesis. Our results are encouraging and justify the further use and evaluation of this relatively new and easily reproducible technique. (+info)