title: Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion--dynamic sonographic evaluation.
abstract: BACKGROUND
  Clavicular hook plates are effective fixation devices for distal clavicle fractures and severe acromioclavicular joint dislocations. However, increasing number of studies has revealed that subacromial portion of the hook may induce acromial bony erosion, shoulder impingement, or even rotator cuff damage. By sonographic evaluation, we thus intended to determine whether the presence of hook plate may induce subacromial shoulder impingement and its relationship relative to surrounding subacromial structures.
  
  
  METHODS
  We prospectively followed 40 patients with either distal clavicle fracture or acromioclavicular joint dislocation that had surgery using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate. All patients were evaluated by monthly clinical and radiographic examinations. Static and dynamic musculoskeletal sonography examinations were performed at final follow-up before implant removal. Clinical results for pain, shoulder function, and range of motion were evaluated using Constant-Murley and Disability of Arm, Shoulder, and Hand (DASH) scores.
  
  
  RESULTS
  Clinically, 15 out of 40 patients (37.5%) presented with subacromial impingement syndrome and their functional scores were poorer than the non-impinged patients. Among them, six patients were noted to have rotator cuff lesion. Acromial erosion caused by hook pressure developed in 20 patients (50%).
  
  
  CONCLUSIONS
  We demonstrated by musculoskeletal sonography that clavicular hook plate caused subacromial shoulder impingement and rotator cuff lesion. The data also suggest an association between hardware-induced impingement and poorer functional scores. To our knowledge, the only solution is removal of the implant after bony consolidation/ligamentous healing has taken place. Thus, we advocate the removal of the implant as soon as bony union and/or ligamentous healing is achieved.
authors: Hsin-Yu
authors: HY
authors: Lin
authors: Poo-Kuang
authors: PK
authors: Wong
authors: Wei-Pin
authors: WP
authors: Ho
authors: Tai-Yuan
authors: TY
authors: Chuang
authors: Yi-Shyan
authors: YS
authors: Liao
authors: Department of Orthopaedic Surgery, Wan Fang Hospital, Taipei Medical University, No, 111, Sec, 3, Xinglong Road, Taipei 11696, Taiwan. b8701153@tmu.edu.tw.
authors: Chin-Chean
authors: CC
authors: Wong
mesh_terms: D000328:Adult; D001860:Bone Plates / Q000009:adverse effects*; D002968:Clavicle / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011446:Prospective Studies; D017006:Rotator Cuff / Q000000981:diagnostic imaging*; D000070636:Rotator Cuff Injuries; D019534:Shoulder Impingement Syndrome / Q000000981:diagnostic imaging* / Q000453:epidemiology; D016896:Treatment Outcome; D014463:Ultrasonography