Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Acromioclavicular Joint Injury
Posted: May 15 2020 #(C101461)
A

Acromioclavicular Joint Separation in 55M

HPI

A 55-year-old male presents with severe right shoulder pain and deformity following a high-speed motorcycle collision. He was initially treated with 6 weeks of conservative management with physical therapy. His pain persisted and remained severe.

PMH

Otherwise healthy

PE

His right shoulder shows a profound prominence, mobility, and tenderness over the distal clavicle. His range of motion is limited in all planes. He has reduced strength. His neurovascular status is intact.

Poll
1 of 13
1. Would you obtain additional imaging studies to guide management?
No - current radiographs are sufficient
51%
931/1815
Yes - additional radiographic views (aXR)
14%
264/1815
Yes - CT scan of the shoulder (CT)
5%
94/1815
Yes - MRI of the shoulder (MRI)
19%
351/1815
Yes - aXR + CT
1%
23/1815
Yes - aXR + MRI
4%
90/1815
Yes - aXR + CT + MRI
1%
23/1815
Outside my area of expertise - best if I don't vote
2%
39/1815
2. How would you classify this injury with the Rockwood Classification?
I would not - a classification system would not help me
1%
33/1804
Rockwood type II
2%
38/1804
Rockwood type III
39%
712/1804
Rockwood type IV
18%
337/1804
Rockwood type V
34%
627/1804
Outside my area of expertise - best if I don't vote
3%
57/1804
3. How would you manage this injury at this time?
Nonoperative (continued physical therapy)
10%
177/1747
Operative
87%
1525/1747
Outside my area of expertise - best if I don't vote
2%
45/1747
4. If you choose Operative management, what type of fixation would you perform to hold your AC reduction?
I would not choose Operative management
1%
32/1693
Fixation across AC joint (AC fixation) Alone
10%
177/1693
Fixation to the Coracoid (CC fixation) Alone
32%
545/1693
AC fixation + CC fixation
51%
866/1693
Outside my area of expertise - best if I don't vote
4%
73/1693
5. It you choose Fixation across AC joint Alone, what fixation technique would you use?
I would not choose Fixation across AC joint only
42%
675/1574
CRPP (Percutaneous K wire)
5%
94/1574
Hook plate
24%
388/1574
Heavy Suture Fixation across AC joint
10%
167/1574
Graft (auto or allo) across AC joint
11%
177/1574
Outside my area of expertise - best if I don't vote
4%
73/1574
6. If you choose Fixation to the Coracoid (+/- fixation across AC joint), what type would you use?
I would not choose Fixation to the Coracoid
4%
68/1540
Coracoclavicular Screw Fixation (Screw) (ex. Bosworth screw)
5%
89/1540
Synthetic implant (Heavy Suture, Trans-cortical device, Anchor)
30%
469/1540
Ligament reconstruction (allograft, autograft)
20%
314/1540
Screw + Ligament reconstruction
16%
247/1540
Synthetic implant + Ligament reconstruction
18%
279/1540
Outside my area of expertise - best if I don't vote
4%
74/1540
Other
0%
0/1540
7. If you choose Fixation to the Coracoid with a Synthetic implant, what fixation type would you use on the Coracoid?
I would not choose Fixation to the Coracoid with Software
10%
141/1360
Heavy Suture loop around Coracoid (e.g., suture tape, Fiberwire, Lockdown))
32%
444/1360
Trans-bicortical device (Dogbone, Cortical button, Juggernaut))
45%
617/1360
Trans-unicortical device (Suture anchor, Juggernaut)
5%
77/1360
Outside my area of expertise - best if I don't vote
5%
81/1360
8. If you choose Ligament reconstruction, what surgical approach would you use?
I would not choose Ligament reconstruction
13%
186/1363
All arthroscopic
4%
65/1363
Arthroscopic-assisted open
23%
324/1363
Open only
51%
707/1363
Outside my area of expertise - best if I don't vote
5%
81/1363
9. If you choose Ligament reconstruction, what type of graft would you use?
I would not choose Ligament reconstruction
15%
202/1323
Allograft
31%
422/1323
Autograft - palmaris longus
12%
161/1323
Autograft - semi-tendinosus
29%
394/1323
Autograft - plantaris
1%
22/1323
Autograft - other
2%
36/1323
Outside my area of expertise - best if I don't vote
6%
86/1323
10. If you choose Ligament reconstruction, what fixation techniques would you use on the Coracoid and Clavicle?
I would not choose Ligament reconstruction
12%
143/1168
Coracoid loop + Clavicle loop (figure of eight)
15%
186/1168
Coracoid loop + Clavicle bone tunnel(s)
25%
292/1168
Coracoid loop + Clavicle cortical device to graft (cortical button)
11%
133/1168
Coracoid cortical device to graft (suture anchor) + Clavicle loop
3%
40/1168
Coracoid cortical device to graft + Clavicle bone tunnel(s)
6%
78/1168
Coracoid cortical device to graft + Clavicle cortical device to graft
2%
31/1168
Coracoid bone tunnel(s) + Clavicle loop
1%
22/1168
Coracoid bone tunnel(s) + Clavicle bone tunnel(s)
6%
80/1168
Coracoid bone tunnel(s) + Clavicle cortical device to Graft
1%
22/1168
Outside my area of expertise - best if I don't vote
12%
141/1168
11. If you choose Ligament reconstruction, in addition to graft fixation on the coracoid and clavicle, would you extend fixation of the graft to the acromium?
I would not choose Ligament reconstruction
13%
152/1103
No
42%
473/1103
Yes
35%
388/1103
Outside my area of expertise - best if I don't vote
8%
90/1103
12. If you choose Ligament reconstruction, would you include a distal clavicle resection?
I would not choose Ligament reconstruction
8%
95/1134
No - never
14%
166/1134
Yes - only if pre-existing arthritis
20%
228/1134
Yes - only if irreducible
6%
77/1134
Yes - if irreducible OR pre-existing arthritis
27%
314/1134
Yes - always
16%
182/1134
Outside my area of expertise - best if I don't vote
6%
72/1134
13. If you choose Ligament reconstruction, and obtained the fixation seen below, when would you start active ROM?
I would not choose Ligament reconstruction
6%
75/1123
Immediately
3%
37/1123
3 days post-op
2%
26/1123
7 days post-op
3%
37/1123
2 weeks post-op
11%
130/1123
3 weeks post-op
10%
123/1123
4 weeks post-op
15%
177/1123
6 weeks post-op
34%
388/1123
>6 weeks post-op
6%
74/1123
Outside my area of expertise - best if I don't vote
4%
56/1123
PROCEDURE #1

Diagnostic arthroscopy of the R shoulder; Open AC/CC reconstruction with allograft; Distal clavicle resection

Intra-procedure P1
icon
OUTCOMES
Post-procedure P1
Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options