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Atraumatic osteolysis of the distal clavicle
$84
J. Shoulder Elbow Surg. March/April 1996
Abstracts
Free Paper Abstracts from Stockholm 265
266
CLINICAL RESULTS OF FRACTURES OF THE CLAVICLE A PROSPECTIVE STUDY OF 147 FRACTURES. A. Nordqvist, MD, l.Redlund-Jolmell, MD, & A. van Scheele, RPT, Dept of Orthopaedics, Maim6 University Hospital, Malm6, Sweden. The aim of this study was to prospectively study the result of a clavicular fracture over a 5-year period. Special interest was focused on the importance of persisting deformation and shortening of the clavicle. Material and Methods: 147 fractures of the clavicle were primarily treated at Malta6 University Hospital in 1987.94 men and 53 women had sustained 111 mid-clavicular, 33 lateral and 3 medial fractures at a median age of 17 years. All patients were conservatively treated, generally with a sling or a figure-of-8 for on average 3 weeks and evaluated prospectively after 1 and 5 years. At 1-year follow-up 124 patients were clinically evaluated and 101 were also radiographically evaluated. At 5-year follow-up 86 patients were evaluated clinically and radiologieally. Pain and shoulder function were registered and estimated according to Constant score. Fracture healing was classified as normal union, malunion or non-union. Results: After 1 year 104 patients were asymptomatic. 20 had slight persisting pain, 5 of them also complained of slight reduction of function. No severe disability was registered.Radiographically there were 23 malunious. Non-union was seen after 7 lateral and 1 mid-clavicular fracture. 2 of these were asymptomatic. At 5-year follow-up 81 patients were satisfied while 5 had persisting moderate symptoms. The fractured clavicle was on average shorter than the contralateral shoulder. However, no significant differences in Constant score were found after fracture healing with malunion an d shortening of the clavicle. Conclusions: Fractures of the clavicle generally are benign lesions with a favourable outcome. Healing with persisting deformation and shortening of the clavicle does not influence on shoulder function and mobility. Nou-uniou is a/so compatible with a favourable outcome.
267
ATRAUMATIC OSTEOLYSISOF THE DISTAL CLAVICLE. M.Simoni Department of Orthopaedics, Santa Casa de Miseric6rdia Rio de daneiro, Brazil. Nine cases of atraumatic osteo]ysis of the distal portion of the clavicle in non-competitive male athletes were evaluated. Weight-lifting was the main physical activity of 8 patients. Pain in the acromioclavicular joint, radiologica] changes in the distal clavicle, and r e l i e f of symptoms following local injection of anesthetics led to the diagnosis. Treatment consisted in rest in the i n i t i a l phase, re]lowed by adequate rehabilitation and changes in the sport practice and was effective for 8 patients. Only one of the patients was submitted to surgical treatment with ressect~on of 1,5 cm of the distal clavicle, due to persistent pain. For all patients, return to sports activities was dependent on changes in the way of training.
SURGICAL TREATMENT OF ACROMIO-CI.AVICULARCYS1 JC LEHUEC, MD, B Z|POLI,MD, T SCtiAEVERBEKE,MD, D CHAUVEAUX,MD, A LE REBELLER,MD, CHi PELLEGRIN, UN!V.BORDEAUX, FRANCE A chronic cyst overlying the acromio-clavicalar (AC) joint is very rarer and has been only reported in 9 rases in the litterature. We report on 3 additionnal patients who were inanaged by one of us.The follow up was 12 to 48 montbs.The 3 patients bad more tllan 60 years old and had a massive rotator cuff lellr~ norlllaJ passive motion and active forward elevation between 70 to 160 degres. All t h e patients were treated by resection of tile last external centimeter of the clavicle, excision of the cyst , partial synovectomy of tile gleno-llumeral joint. The eorafo-acronlial ligament was still in phtee. The motion was improved in active forward elevation ( 90 to 170 degres/, l'ain was improved : 12,5 against 8 pre-operatively according to Cunstant score. No reccurrence 0f tile cyst was noted at tbe hist follow-up. We suggest that tile cyst is due to a syste!n of valve wllieb didn'l allow the return of synovi'JI fluid between the glenohulneral ,joint and tbe AC joint. TIle hole allowing colnm anlcation between tile two articles tllrough tile rotator cuff tear is tempornrily closed by synovlal tissue. Tile excision uf this valve wltll tile resectlol| of external end of tile clavicle is an easy snlutio, for tills problem. The procedare consisting of a large humeral-head hemiar tlloplasty , as proposed by C.A. ROCKWOOD, is reserved for higll degenerative osteoarthrosis of the glenll-llumeral j o i n t .
268
ARTHROSCOPIC ANTERIOR CAPSULAR RECONTRUCTION OF THE SHOULDER. De B e e r MA, de B e e r JF, A c k e r m a n e C. Jakaranda Hospital ~be pm:izcse of this stt~ was to evalL~te the effectiveness of arthroscopic anterior capgalar lahral recrnsTruL~uicn in anterior shculder instability, using the Stmetac a h ~ l e ck~vice. Each in,vie]Hal c ~ ged ]iga~mt shesld he ~ e d separately. It is of ~rime impsrtsnce to b a ~ the tissue at the ismretric Faint which is lateral to the hese of the ~ i d . ( ~ : Only ~atients witkl a Bankart lesion with preserved d e ~ lab~m ~ r e selected. Ms An a r t h ~ i c examinatic*] was performed in the lateral c~oitos pesition. ~ e detached struct~s w~re mibilised and ks]armed at the isometric point. Starting as inferior as possible, using an inside technique the different ligameets including the bi(L~ps anchor resttsdned. N[]ST (l~[~Kam,18~P." ~he p~tients were inmJoLlised in a sling fcr 6 we~. Early restricted active and pin,sire movsmnts were started. P ~ S~]~C~I~: Frcm January 1992 to D e o ~ 1993 87 patients were treated. All patients bad a traumstic first dislccaticn. 66% of the patiests w~re older5 than 23 years. Superior glenoid lahrun lesions were f c ~ in 19% of patients. I~: ~he m~an fo]icw-qo w~s 21 m~nths. T~elve patients redislomated (13,8%). Ten of these patients were y o ~ than 20 ~az~ of age. Patients older than 20 [~ars had a 3,5% rats of redislccation. No failtm~s of fixaticn nor reactien to the ahsgrtsble divice were fcend. O C t : Stmet~c is an e~cellent fixatien device f
J. Shoulder Elbow Surg. March/April 1996
Abstracts
Free Paper Abstracts from Stockholm 265
266
CLINICAL RESULTS OF FRACTURES OF THE CLAVICLE A PROSPECTIVE STUDY OF 147 FRACTURES. A. Nordqvist, MD, l.Redlund-Jolmell, MD, & A. van Scheele, RPT, Dept of Orthopaedics, Maim6 University Hospital, Malm6, Sweden. The aim of this study was to prospectively study the result of a clavicular fracture over a 5-year period. Special interest was focused on the importance of persisting deformation and shortening of the clavicle. Material and Methods: 147 fractures of the clavicle were primarily treated at Malta6 University Hospital in 1987.94 men and 53 women had sustained 111 mid-clavicular, 33 lateral and 3 medial fractures at a median age of 17 years. All patients were conservatively treated, generally with a sling or a figure-of-8 for on average 3 weeks and evaluated prospectively after 1 and 5 years. At 1-year follow-up 124 patients were clinically evaluated and 101 were also radiographically evaluated. At 5-year follow-up 86 patients were evaluated clinically and radiologieally. Pain and shoulder function were registered and estimated according to Constant score. Fracture healing was classified as normal union, malunion or non-union. Results: After 1 year 104 patients were asymptomatic. 20 had slight persisting pain, 5 of them also complained of slight reduction of function. No severe disability was registered.Radiographically there were 23 malunious. Non-union was seen after 7 lateral and 1 mid-clavicular fracture. 2 of these were asymptomatic. At 5-year follow-up 81 patients were satisfied while 5 had persisting moderate symptoms. The fractured clavicle was on average shorter than the contralateral shoulder. However, no significant differences in Constant score were found after fracture healing with malunion an d shortening of the clavicle. Conclusions: Fractures of the clavicle generally are benign lesions with a favourable outcome. Healing with persisting deformation and shortening of the clavicle does not influence on shoulder function and mobility. Nou-uniou is a/so compatible with a favourable outcome.
267
ATRAUMATIC OSTEOLYSISOF THE DISTAL CLAVICLE. M.Simoni Department of Orthopaedics, Santa Casa de Miseric6rdia Rio de daneiro, Brazil. Nine cases of atraumatic osteo]ysis of the distal portion of the clavicle in non-competitive male athletes were evaluated. Weight-lifting was the main physical activity of 8 patients. Pain in the acromioclavicular joint, radiologica] changes in the distal clavicle, and r e l i e f of symptoms following local injection of anesthetics led to the diagnosis. Treatment consisted in rest in the i n i t i a l phase, re]lowed by adequate rehabilitation and changes in the sport practice and was effective for 8 patients. Only one of the patients was submitted to surgical treatment with ressect~on of 1,5 cm of the distal clavicle, due to persistent pain. For all patients, return to sports activities was dependent on changes in the way of training.
SURGICAL TREATMENT OF ACROMIO-CI.AVICULARCYS1 JC LEHUEC, MD, B Z|POLI,MD, T SCtiAEVERBEKE,MD, D CHAUVEAUX,MD, A LE REBELLER,MD, CHi PELLEGRIN, UN!V.BORDEAUX, FRANCE A chronic cyst overlying the acromio-clavicalar (AC) joint is very rarer and has been only reported in 9 rases in the litterature. We report on 3 additionnal patients who were inanaged by one of us.The follow up was 12 to 48 montbs.The 3 patients bad more tllan 60 years old and had a massive rotator cuff lellr~ norlllaJ passive motion and active forward elevation between 70 to 160 degres. All t h e patients were treated by resection of tile last external centimeter of the clavicle, excision of the cyst , partial synovectomy of tile gleno-llumeral joint. The eorafo-acronlial ligament was still in phtee. The motion was improved in active forward elevation ( 90 to 170 degres/, l'ain was improved : 12,5 against 8 pre-operatively according to Cunstant score. No reccurrence 0f tile cyst was noted at tbe hist follow-up. We suggest that tile cyst is due to a syste!n of valve wllieb didn'l allow the return of synovi'JI fluid between the glenohulneral ,joint and tbe AC joint. TIle hole allowing colnm anlcation between tile two articles tllrough tile rotator cuff tear is tempornrily closed by synovlal tissue. Tile excision uf this valve wltll tile resectlol| of external end of tile clavicle is an easy snlutio, for tills problem. The procedare consisting of a large humeral-head hemiar tlloplasty , as proposed by C.A. ROCKWOOD, is reserved for higll degenerative osteoarthrosis of the glenll-llumeral j o i n t .
268
ARTHROSCOPIC ANTERIOR CAPSULAR RECONTRUCTION OF THE SHOULDER. De B e e r MA, de B e e r JF, A c k e r m a n e C. Jakaranda Hospital ~be pm:izcse of this stt~ was to evalL~te the effectiveness of arthroscopic anterior capgalar lahral recrnsTruL~uicn in anterior shculder instability, using the Stmetac a h ~ l e ck~vice. Each in,vie]Hal c ~ ged ]iga~mt shesld he ~ e d separately. It is of ~rime impsrtsnce to b a ~ the tissue at the ismretric Faint which is lateral to the hese of the ~ i d . ( ~ : Only ~atients witkl a Bankart lesion with preserved d e ~ lab~m ~ r e selected. Ms An a r t h ~ i c examinatic*] was performed in the lateral c~oitos pesition. ~ e detached struct~s w~re mibilised and ks]armed at the isometric point. Starting as inferior as possible, using an inside technique the different ligameets including the bi(L~ps anchor resttsdned. N[]ST (l~[~Kam,18~P." ~he p~tients were inmJoLlised in a sling fcr 6 we~. Early restricted active and pin,sire movsmnts were started. P ~ S~]~C~I~: Frcm January 1992 to D e o ~ 1993 87 patients were treated. All patients bad a traumstic first dislccaticn. 66% of the patiests w~re older5 than 23 years. Superior glenoid lahrun lesions were f c ~ in 19% of patients. I~: ~he m~an fo]icw-qo w~s 21 m~nths. T~elve patients redislomated (13,8%). Ten of these patients were y o ~ than 20 ~az~ of age. Patients older than 20 [~ars had a 3,5% rats of redislccation. No failtm~s of fixaticn nor reactien to the ahsgrtsble divice were fcend. O C t : Stmet~c is an e~cellent fixatien device f