title: Transarticular fixation by hook plate versus coracoclavicular stabilization by single multistrand titanium cable for acute Rockwood grade-V acromioclavicular joint dislocation: a case-control study.
abstract: BACKGROUND
  Hook plate (HP) is popularly used for acute and severely displaced acromioclavicular (AC) dislocations. However, subacromial impingement and acromion osteolysis induced by transarticular fixation are notorious. The current case-control study was to compare transarticular fixation by HP to coracoclavicular (CC) stabilization by single multistrand titanium cable (MSTC).
  
  
  METHODS
  Between January 2006 and August 2009, 24 patients with acute AC dislocations were surgically treated by open reduction and transarticular fixation with HP. These patients were matched to a series of 24 patients, who were managed by CC stabilization with MSTC in the same period. All AC dislocations were graded as Rockwood type V. Implant was removed 8-12 months after the primary operation in all patients, and 12 months at least were needed to assess the maintenance of AC joint. Functional results were evaluated before implant removal as well as in the last follow-up based on Constant-Murley criteria.
  
  
  RESULTS
  There were no differences of demographic data including age, dominant gender and side, injury-to-surgery interval, operation time and follow-up period. In terms of functionality, Constant score was 95.8 ± 4.1 in MSTC group, while 76.7 ± 8.0 in HP group before implant removal (P < 0.001). In detail, MSTC was superior to HP in pain, ROM and activities. Constant score was significantly improved to 86.1 ± 5.7 after hardware removal for patients in HP (P < 0.001). Degenerative change of acromioclavicular joint presented in 16 patients (66.7%) in patients treated by HP, while it was found in only 3 patients (12.5%) treated by MSTC (P < 0.001).
  
  
  CONCLUSIONS
  MSTC is superior to HP for the treatment of Rockwood type-V acromioclavicular dislocation both before and after removal of the implant. Hardware removal is of great benefits for functional improvement in patients treated by HP.
authors.affiliation: Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China. gaoyoushui@163.com.
authors.forename: You-Shui
authors.initials: YS
authors.lastname: Gao
authors.affiliation: Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China. 1827379194@qq.com.
authors.forename: Yue-Lei
authors.initials: YL
authors.lastname: Zhang
authors.affiliation: Department of Medical Statistics, Tongji University School of Medicine, Shanghai, 200092, China. azs1966@126.com.
authors.forename: Zi-Sheng
authors.initials: ZS
authors.lastname: Ai
authors.affiliation: Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China. heavycaterpillar@126.com.
authors.forename: Yu-Qiang
authors.initials: YQ
authors.lastname: Sun
authors.affiliation: Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China. changqing.zhang@yahoo.com.
authors.forename: Chang-Qing
authors.initials: CQ
authors.lastname: Zhang
authors.affiliation: Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China. zhangwei_trauma@126.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
mesh_terms: D000173:Acromioclavicular Joint / Q000293:injuries* / Q000502:physiology / Q000601:surgery*; D000203:Activities of Daily Living; D000328:Adult; D001860:Bone Plates; D001864:Bone Wires; D016022:Case-Control Studies; D020878:Device Removal; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D019637:Orthopedic Procedures / Q000295:instrumentation* / Q000379:methods*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D014025:Titanium; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014025:Titanium