Transcript Percutaneous K-wire fixation for AC separation type 3

MIS: Percutaneous K-wire fixation for AC separation type 3,
a preliminary report
Peeerachai Dumrongwanich,MD. Chanchit Sangkeaw,MD.
Department of Orthopaedic, Police General Hospital, Bangkok, THAILAND.
The treatment of AC joint separation Type III is still controversial between
operative and non-operative treatment. Percutaneous K-wire fixation
seemed to decrease the problem inherited with ORIF [infection, anesthetic risk, hematoma
formation, scar formation, recurrence of deformity, breakage or loosening of sutures, erosion or fracture of the distal clavicle,
postoperative pain and limitation of motion, second procedure for removal of fixation, late acromioclavicular arthritis, soft
and minimize discomfort of the conservative treatment
tissue calcification]
[skin pressure
and ulceration, recurrence of deformity, wearing the sling or brace for 8 weeks , patient cooperation, less interference with
activities of daily living, shoulder and elbow motion, soft tissue calcification, late acromioclavicular arthritis, late muscle
Twenty-one patients with adequate data were reviewed with the mean
follow-up period of 19 weeks (range, 4 – 135 weeks). Painless full range
of shoulder motion could be obtained in all patients except one, who had
limitation of abduction (150 degrees abduction). The mean Neer’s
shoulder score was 94.25 points(range, 50-100 points).
atrophy, weakness, and fatigue] .
The patient was placed in the lateral decubital position.
C-arm Fluoroscope in inferior & superior oblique view to check position
of the K-wires co-related to the model.
With percutaneous fixation early mobilization of the shoulder could be
obtained without increased morbidity from surgical exposure, and the
disadvantage of conservative treatment could also be avoided.
The patient was placed in the lateral decubital position under general
anesthesia, after the dislocated AC-joint had been closely reduced
under image-intensifier control, two K-wires (2.0mm) were inserted
into the prominent part of acromial process or scapular spine into the
distal clavicle. To prevent medial migration of the pin to the vital
organ in the neck region, the K-wires were inserted until they
penetrated the cortex of the distal clavicle and lied beneath the skin.
The purpose of the study is to evaluate the efficacy of the
percutaneous K-wire fixation in the treatment of AC-joint separation.
Ten patients had tenderness at the prominent K-wires, and the pain were
subsided after removal of K-wires. In the early part of the series pin-tract
infection occurred in two cases, in which the K-wires had not been buried
underneath the skin. One of them the K-wires were left in place until the
clinical union was achieved and the infection was resolved after implant
removal. The other one the infection was subsided after removal of Kwires and subsequent fusion of the AC-joint. In one case the K-wires
migrated medially due to excessive use of affected limb, leading to loss of
reduction. Reoperation using three K-wires fixation was performed and the
final result was not compromised. Re-separation of the AC-joint after
implant removal occurred in one case after resumption of his work as
heavy worker. It might be possible that implant removal should be delayed
for three months after surgery for heavy worker.
The assistant close reduction& Surgeon’s aiming the clavicle between
the two fingers. The K-wire was bend and cut under-neath the skin.
The pre and post-operative film showed the separation was
reduced and should be protected with a ‘night’ sling.
Conclusion: The preliminary results of the percutaneous K-wire fixation for the AC-joint Separation were
encouraged, the technique was safe and cost-effective. .
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