AC lux
Alle deler > BILL > Studier > Hånd abs
Kleven T, Kvistad KA, Storrø S, Finsen V.
ACROMIO-CLAVICULAR SEPARATION TREATED WITH THE PHEMISTER OPERATION.
Int J Orthop Trauma 3: 171-73, 1993
INTRODUCTION We routinely operate complete (grade 3) acute acromio-clavicular (AC) dislocations using the Phemister procedure. Excellent results of conservative treatment have recently been reported in the literature. We wished to evaluate our own results.
MATERIAL AND METHODS During the years 1982-88 we operated 32 patients in our hospital for AC dislocation, all with Phemister's operation. We studied 20 men who had sustained the injury at an age of 26 (range: 19-60) years 50 (21-76) months postoperatively. We excluded 11 patients who lived far from our hospital and one woman. All patients were examined clinically and also completed a pro forma with visual analog scales which were converted to a point scale from 0 (worst imaginable) to 10 (best imaginable). Values over 8.5 points were arbitrarily taken to indicate an excellent result. A-P radiographs were made with and without 5 kg weights fastened to the wrists. Muscle power in extension, flexion, horizontal abduction and adduction, and external and internal rotation at 60 and 180 degrees per second was tested with a Cybex II+ isokinetic dynamometer in 13 of the patients.
RESULTS The clinical evaluation revealed a prominent lateral clavicula in seven, joint tenderness in four, and an ugly scar in three. The active and passive ranges of shoulder movement were normal in all patients. The patients' subjective evaluation was 98% excellent results for shoulder function, 78% for the cosmetic result, and 85% for the overall result of the operation. Radiographs showed 4 AC joints to be subluxated. There was, however, less than 2mm translatory movement in all joints on loading. In 14 cases there was calcification in the region of the coraco-clavicular ligament, but this did not influence shoulder joint movement. The median values for peak torque and work performed in the injured extremity were in all directions of motion within 10% of the median values on the contralateral side.
CONCLUSION In our hands the results of the Phemister operation for complete acute dislocations of the acromio-clavicular joint have been gratifying.