Static Balance in Participants with Temporomandibular Joint Disc Displacement without Reduction Versus Healthy Participants: A Cross-Sectional Study.

BACKGROUND There is no consensus on the association between body posture and temporomandibular disorders (TMDs). This study aimed to assess differences in static balance between healthy participants and patients with temporomandibular joint disc displacement without reduction. MATERIAL AND METHODS Sixteen patients with temporomandibular joint disc displacement without reduction and 14 healthy participants were included. Static balance tests were performed in the rest and "cotton rolls" (participants biting 2 cotton rolls with their upper and lower teeth) mandibular positions. The mean body's center of gravity (COG) sway velocity was tested in each mandibular position on a firm surface with and without eyes open and on a foam surface with and without eyes open. RESULTS The COG sway velocity did not differ between the TMD and healthy groups regarding mandibular position or testing condition (P>0.05). However, in the control group, the COG sway velocity in the mandibular rest position was significantly higher than that in the "cotton rolls" mandibular position when standing on a foam surface with the eyes closed (P=0.024). In the TMD group, there was no difference in the COG sway velocity between the 2 mandible positions under any condition (P>0.05). CONCLUSIONS This study provides new evidence for static balance alterations in patients with temporomandibular joint disc displacement without reduction. Further studies are needed to investigate postural control changes in patients with arthrogenous TMDs. This study was registered in the Chinese Clinical Trial Registry (no. ChiCTR1800018369).

Simple traumatic elbow dislocations; benefit from early functional rehabilitation: A systematic review with meta-analysis including PRISMA criteria.

INTRODUCTION: Elbow dislocation is the second most frequent joint dislocation after shoulder dislocation. They have a high relevance because they can result in subsequent damage and limitations in range of motion. The treatment options are controversially discussed.The purpose of this systematic review and meta-analysis was to review the literature and analyze the evidence of early functional rehabilitation. METHODS: A systematic literature search was performed via Ovid Medline, whereby 1645 publications were identified and evaluated in a stepwise approach. Of these publications 29 met the inclusion criteria of the authors and described simple elbow dislocations in 5765 patients.Data from the studies and subgroups included were initially categorized descriptively in conservative and surgical primary therapies, in immobilizing (immobilization lasting 2 weeks or longer) and free-functional follow-up treatments, and those data were then extracted from each subgroup in absolutes. We then pooled these numbers into descriptive statistics to ensure their comparability. We determined the success rates from the numbers of excellent and good results of the specific used outcome scores. RESULTS: The effect estimate of the conservative therapy's success rate was 84% and for surgical treatment 80% (P < .0001). The difference between the immobilizing treatment (78% success rate) and early-function therapy (83% success rate) was significant (P = .002).In a subgroup analysis the success rate of conservative and immobilizing therapy was 79%, of conservative and early-functional therapy 91%, of surgical and immobilizing groups' was 77% and of the surgical and early-functional therapies was 93%. The difference among the 4 treatment options was significant (P < .0001), as were differences between the 2 conservative groups (P < .0001) and between the 2 surgical groups (P = .044). DISCUSSION: Conservative therapy is the dominant therapy. Regardless of the primary therapy chosen in simple elbow dislocations: early functional follow-up care seems to be superior to immobilizing therapy with a duration more than 2 weeks.

An Update on Simple Elbow Dislocations: A Protocol for Early Return to Sport in High School Wrestlers.

ABSTRACT: The principles and management of simple elbow dislocations have evolved over time. In the past, a conservative approach of immobilization and slow rehabilitation were used. More modern treatments emphasize an understanding of the soft tissues about the elbow joint and prescribe an aggressive approach to regaining motion. Elbow stiffness is a common effect of the injury. We outline our treatment principles in a series of high school wrestlers with simple elbow dislocation. The ultimate goal is to return to sport in a safe but early timeframe. We recommend a brief period of immobilization with close follow-up and no motion restrictions after immobilization is removed. This review and case series emphasize the importance of aggressive but safe return to sport in high school wrestlers with an elbow dislocation.

Rehabilitation Posture Does Not Affect the Outcome of Arthroscopically Treated Acromioclavicular Dislocation.

PURPOSE: To assess the effect of the patient's posture (erect or supine) during rehabilitation sessions on pain, function, and the coracoclavicular (CC) distance after arthroscopic treatment of acromioclavicular joint dislocation. METHODS: Sixty patients with acute type III or V acromioclavicular dislocation injuries were randomly allocated into 2 groups according to their posture during the rehabilitation phase: supine rehabilitation group (SRG) or erect rehabilitation group (ERG). Arthroscopic stabilization with a suspensory fixation device was used in all patients. The visual analog scale (VAS) score was assessed on the first postoperative day and at 1, 3, and 6 months postoperatively. The Constant-Murley score (CMS) was recorded preoperatively and at 3, 6, 12, and 24 months postoperatively. The CC distance was assessed preoperatively; on the first postoperative day; and at 6, 12, and 24 months postoperatively. RESULTS: No significant differences were found between the 2 groups in terms of the VAS score, CMS, and CC distance changes. A significant improvement over the follow-up phase was identified in the VAS score and CMS in both groups. The CC distance in both groups was significantly reduced from preoperatively (29.34 mm in the ERG and 28.65 mm in the SRG) to the first postoperative day (10.44 mm and 10.11 mm, respectively). However, a statistically significant re-widening of the CC distance (P < .001) occurred within the first 6 months after surgery (13.55 mm in the ERG and 13.50 mm in the SRG) and at 12 months (15.51 mm and 15.80 mm, respectively). CONCLUSIONS: The patient's posture during early postoperative rehabilitation does not affect the CC distance changes. LEVEL OF EVIDENCE: Level I, randomized prospective comparative study.

The serious full-length forearm injury - a case report and literature review.

BACKGROUND: Among upper limb injuries, carpal bone fractures and dislocation, Essex-Lopresti injury, and the terrible triad injury of the elbow are serious and relatively rare injuries. These injuries require surgical intervention. The surgical method is difficult, and the treatment effect is poor. These injuries have not been described in the same limb in the literature. CASE PRESENTATION: A 21-year-old male patient fell from a height in our institution and sustained multiple injuries, including carpal bone fracture-dislocation, Essex-Lopresti injury, and the terrible triad injury of the elbow of his right upper limb. After 2 surgeries and rehabilitation, he returned to work. We reviewed available reviews and related literature on serious upper-limb damage. CONCLUSIONS: Full-length forearm injury is very rarely encountered, and the management of such fractures is difficult. Radial head replacement with a metal prosthesis, reconstructed the IOM with Tightrope, and fixed the DRUJ with a K-wire pin is appropriate treatment.

A RGBD-Based Interactive System for Gaming-Driven Rehabilitation of Upper Limbs.

Current physiotherapy services may not be effective or suitable for certain patients due to lack of motivation, poor adherence to exercises, insufficient supervision and feedback or, in the worst case, refusal to continue with the rehabilitation plan. This paper introduces a novel approach for rehabilitation of upper limbs through KineActiv, a platform based on Microsoft Kinect v2 and developed in Unity Engine. KineActiv proposes exergames to encourage patients to perform rehabilitation exercises prescribed by a specialist, controls the patient's performance, and corrects execution errors on the fly. KineActiv comprises a web platform where the physiotherapist can review session results, monitor patient health, and adjust rehabilitation routines. We recruited 10 patients for assessing the system usability as well as the system performance. Results show that KineActiv is a usable, enjoyable and reliable system, that does not cause any negative feelings.

Return to work after acromioclavicular joint stabilization: a retrospective case control study.

BACKGROUND: Considering the epidemiology of acromioclavicular (AC) dislocation related to young and active patients, the impact on working capacity is highly relevant. The purpose of this study was to determine the capacity of work and time to return to work (RTW) after AC joint stabilization. We hypothesized that manual working patients show more restrictions returning to work. METHODS: In this retrospective case series, pre- and posttraumatic working capacity of 54 patients (FU-rate 80.1%, FU time 23, range 18-45 month) stabilized in single TightRope technique was analyzed. Clinical outcome (DASH, Constant-Murley score) and complications were evaluated in addition. RESULTS: Fifty one of 54 patients (94.5%) were returned to work at final follow-up. The median time to return was 13 (5-143) weeks. Manual working patients showed lower RTW-rates (91.2% vs. 100%; p = .151), longer RTW-time (15.5 vs. 6 weeks; p = .008), and more often persistent shoulder symptoms at work (55.9% vs. 5%; p < .001). CONCLUSION: After stabilization of AC joint dislocation, the majority of patients returned to work, needing substantial time to return. Manual working patients required more time and often suffer under persistent symptoms at work.

Outcomes of midfoot and hindfoot fractures in multitrauma patients.

INTRODUCTION: Multitrauma patients suffering hindfoot fractures, including calcaneal and talar fractures, often result in poor outcomes. However, less is known about the outcomes following midfoot fracture in the mutitrauma population. This study aims to describe the epidemiology of midfoot fractures in multitrauma patients and to compare the outcomes of midfoot and hindfoot fractures in this population. METHODS: Data about multitrauma patients (Injury Severity Score >12) sustaining a unilateral midfoot or hindfoot fracture were obtained from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) and from retrospective review of medical records at a major trauma centre. Further outcome data were obtained via a survey using the American Academy of Orthopedic Surgeons Foot and Ankle Score (AAOS FAS) and the 12-item Short Form Health Survey (SF-12). RESULTS: 122 multitrauma patients were included; 81 with hindfoot fractures and 41 with midfoot fractures. The median ISS (IQR) was 22 (17-29) and 27 (17-24) for the hindfoot and midfoot groups, respectively (p = 0.23). Hindfoot and midfoot fractures were commonly associated with intracranial injuries (80.3%), spine injuries (60.7%), ipsilateral lower extremity injuries (24.6%) and pelvic injuries (16.4%). The mean (SD) time to follow up was 4.5 (±2.7) years. There were no differences in mean SF-12 physical (37.97 vs 35.22, p = 0.33) or mental (46.90 vs 46.67, p = 0.94) component summary scores between the groups. There were no differences in mean AAOS FAS standard scores (69.3 vs 69.1, p = 0.97) or shoe comfort scores (median 40 vs 40 p = 0.18) between the groups. CONCLUSION: Functional outcomes in multitrauma patients with midfoot or hindfoot fractures were comparable. These findings suggest that midfoot fractures should be treated with the same degree of due diligence as hindfoot fractures in the multitrauma patient.

Successful medical management and rehabilitation of exercise-induced dorsal scapular luxation in an ultramarathon endurance sled dog with magnetic resonance imaging diagnosis of grade II serratus ventralis strain.

Dorsal displacement of the scapula in dogs is rare and often traumatic. This report describes dorsal luxation of the scapula in a sled dog. This case is unique given the injury was sport-related. Magnetic resonance imaging helped direct therapy and monitor healing; and medical management with rehabilitation resulted in full recovery and return to sport. One year after injury, the dog completed both a 482 km and a 1600 km endurance race, placing among the leading teams in the 1600-km race.

Traitement médical réussi d'une luxation scapulaire dorsale aiguë secondaire à la pratique du sport d'endurance chez un chien de traîneau et diagnostic par IRM d'une lésion du m. dentelé ventral. Le déplacement dorsal de la scapula est rare chez le chien et souvent d'origine traumatique. Ce rapport décrit une luxation scapulaire dorsale aiguë chez un chien de traîneau à l'effort. L'intérêt de ce cas tient à sa cause, associé à la pratique de l'activité sportive; à l'analyse des changements en IRM soutenant une thérapie ciblée consistant en un support médical ainsi que d'un programme de rééducation physique, résultant en un rétablissement complet. Un an après cette blessure, le chien termina des courses d'endurance de 482 km et de 1600 km, se classant lors de cette dernière parmi les meilleures équipes de la course.(Traduit par les auteurs).

Luxatio erecta humeri with humeral greater tuberosity fracture and axillary nerve injury.

Luxatio erecta humeri is the rarest type of glenohumeral dislocation, which has been reported to be associated with humeral fracture, rotator cuff tear and neurovascular injury. To our knowledge, a single-sided acute inferior glenohumeral dislocation associated with humeral greater tuberosity fracture and axillary nerve injury has not yet been reported. Here, we reported a traumatic first-time inferior shoulder dislocation from a construction worker who got hyperflexion of the left shoulder when fell and grasped the railing causing. The patient underwent traction counter-traction closed reduction followed by proper immobilization, and rehabilitation therapy. At thirteen months follow-up, the patient had returned to the workload that required high stress on shoulder joint with an excellent outcome.

Return to sport after acute acromioclavicular stabilization: a randomized control of double-suture-button system versus clavicular hook plate compared to uninjured shoulder sport athletes.

PURPOSE: Traumatic high-grade acromioclavicular joint (ACJ) separations can be surgically stabilized by numerous anatomic and non-anatomic procedures. The return to sport (Maffe et al. in Am J Sports Med 23:93-98, 1995] and remaining sport-associated impairments after acute ACJ stabilization has not yet been investigated. METHODS: 73 consecutive athletes with acute high-grade ACJ separation were prospectively assigned into two groups (64.4% randomized, 35.6% intention-to-treat): open clavicular hook plate (cHP) implantation (GI) or arthroscopically assisted double double-suture-button (dDSB) implantation (GII). Patients were analyzed using shoulder sport-specific measurement tools for sport ability (ASOSS), sport activity (SSAS), and numerical analog scales: NASpain during sport, NASshoulder function in sport, and NASre-achievement of sport level. Four points of examination were established: preoperative evaluation (FU0) and first postoperative follow-up (FU1) at 6 months; FU2 at 12 months; and FU3 at 24 months after surgery. The control group (GIII) consisted of 140 healthy athletes without anamnesis of prior macro-injury or surgery. RESULTS: After surgical stabilization, 29 of 35 athletes in GI (82.9%; 38.6 ± 9.9 years) and 32 of 38 in GII (82.9%; 38.6 ± 9.9 years) were followed up for 24 months (FU3) (loss 17.8%). All operated athletes showed significantly increased scores compared to FU0 (p < 0.05). Compared to GI, GII showed significantly superior outcome data for sporting ability as well as for NASre-achievement of sport level (p < 0.05). While GII re-achieved GIII-comparable SSAS and ASOSS levels, GI remained at a significantly inferior level. Athletes after ACJ injury of Rockwood grade IV/V and overhead athletes benefited significantly from the dDSB procedure. CONCLUSION: The dDSB procedure enabled significantly superior sport-specific outcomes compared to the cHP procedure. Athletes after dDSB surgeries re-achieved the sporting ability and the sport activity levels of healthy athletes, whereas athletes after cHP implantation remained at significantly inferior levels. The more extensive dDSB procedure and the more restrictive rehabilitation are recommended for treatment of acute high-grade ACJ separations of functionally high-demanding athletes. LEVEL OF EVIDENCE: I.

Clinical Application of Atlantoaxial Pedicle Screw Placement Assisted by a Modified 3D-Printed Navigation Template.

OBJECTIVES: To investigate the primary clinical value of atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template. METHODS: We retrospectively analyzed the cases of 17 patients treated from June 2015 to September 2016 with atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template. All procedures were performed prior to surgery, including thin-slice CT scanning, medical image sampling and computerized 3D modeling of the atlantoaxial joint, optimal pedicle screw trajectory determination, and anatomical trait acquisition for the atlantoaxial pedicle, spinous process of the axis, vertebral lamina and posterior lateral mass, and design of a reverse template. During surgery, a navigation template was tightly attached to the atlantoaxial joint to assist in pedicle screw placement. Surgeons subsequently used an electric drill to remove the template through a guide channel and then placed the atlantoaxial pedicle screw. Observed indexes included the VAS score, JOA improvement rate, surgery duration, and blood loss. RESULTS: Surgery was successful in all 17 patients, with an average operation duration of 106±25 min and an average blood loss of 220±125 ml. Three days postoperatively, the VAS score decreased from 6.42±2.21 to 3.15±1.26. Six months postoperatively, the score decreased to 2.05±1.56. The postoperative JOA score increased significantly from 7.68±2.51 to 11.65±2.72 3 d after surgery and to 13.65±2.57 after 6 months. Sixty-eight pedicle screws were inserted successfully, with 34 in the atlas and 34 in the axis. According to the Kawaguchi standard, 66 screws were in grade 0 (97.06%), and 2 were in grade 1 (2.94%). The pre- and postoperative transverse and sagittal screw angles showed no significant differences. CONCLUSIONS: Atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template is worth recommending due to the improved accuracy in screw placement, improved patient safety and beneficial clinical effects.

Return to Sports and Physical Activities After Open Reduction and Internal Fixation of Lisfranc Injuries in Recreational Athletes.

BACKGROUND: The purpose of this study was to assess participation in sport and physical activity following open reduction and internal fixation of a Lisfranc injury in a cohort of recreational athletes. METHODS: This study identified all adult patients aged 55 years or younger who presented with a Lisfranc injury and underwent open reduction and internal fixation (ORIF) using a Lisfranc screw combined with bridge plating technique. Sports and physical activity participation was assessed with a new sports-specific, patient-administered questionnaire. Clinical outcomes were assessed with the Foot and Ankle Outcome Score (FAOS). Thirty-three patients qualified for the study (21 men/12 women). Mean age and follow-up were 31.2 (range, 18-55) years and 2.9 (range, 1.5-5.4) years, respectively. RESULTS: Postoperatively, 31 patients (94%) were able to return to some form of sport. Twenty-two patients (66%) returned to playing sport at or above their preinjury level. Of the 11 patients who played less sport, 6 had ongoing pain, and the remaining 5 were asymptomatic but were participating less frequently because of other lifestyle reasons. In addition, of the 33 patients, 11 (33%) had some degree of ongoing pain that might limit their ability to return to sports and physical activities. There was strong correlation between overall FAOS and the Sports Questionnaire. CONCLUSION: Most patients who sustained a Lisfranc injury could return to sport and physical activity after ORIF. Patients should be counseled preoperatively that about 1 in 3 might experience continued pain at the injury site Level of Evidence: Level IV, retrospective case series.

Incarcerated Plantar Dislocation of the First Metatarsophalangeal Joint: Reduction Using Intra-articular Saline Injection.

Plantar dislocation of the first metatarsophalangeal (MTP) joint is exceedingly rare, and in prior reported cases, simple closed manipulation easily enabled reduction. We present here the first reported plantar dislocation that failed closed manipulation. We also report a technique involving injection of saline into the joint to facilitate reduction. The saline insufflation likely relieves buttonholing of the metatarsal head through the dorsal joint capsule. For first MTP joint plantar dislocations that fail reduction with manipulation, we recommend attempting injection of the joint with saline prior to subjecting the patient to open reduction. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case report.

Short-term outcomes of arthroscopic TightRope® fixation are better than hook plate fixation in acute unstable acromioclavicular joint dislocations.

AIM: The aim of this study was to compare the short-term outcomes of arthroscopic TightRope® fixation with that of hook plate fixation in patients with acute unstable acromioclavicular joint dislocations. PATIENTS AND METHODS: We conducted a prospective case-control study of twenty-six patients with an acute ACJ dislocation who underwent surgical repair with either an arthroscopic TightRope® fixation or a hook plate from 2013 to 2016. Clinical and radiological data were collected prospectively. Clinical outcomes were evaluated using the Constant Score, the University of California at Los Angeles (UCLA) Shoulder Score, Oxford Shoulder Score as well as the visual analogue scale. Radiological outcomes were assessed with the coracoclavicular distance (CCD). RESULTS: Sixteen patients underwent arthroscopic TightRope® fixation, while 10 patients underwent hook plate fixation. There were no significant differences in the preoperative variables except for the mean UCLA 4b infraspinatus score (TightRope® 2.8 vs. hook plate 3.8; p = 0.030). Duration of surgery was significantly longer in the TightRope® group. At 1 year post-operatively, the TightRope® group had a significantly better Constant Score and CCD with no complications. All patients with hook plate fixation had to undergo a second procedure for removal of implant, and 3 patients had complications. CONCLUSIONS: Arthroscopic TightRope® fixation is a good option for the treatment of acute unstable ACJ dislocations. It has better short-term clinical and radiological outcomes as well as lesser complications when compared to hook plate fixation. LEVEL OF EVIDENCE: Therapeutic, Level III.

Clinical application of atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template

OBJECTIVES: To investigate the primary clinical value of atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template. METHODS: We retrospectively analyzed the cases of 17 patients treated from June 2015 to September 2016 with atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template. All procedures were performed prior to surgery, including thin-slice CT scanning, medical image sampling and computerized 3D modeling of the atlantoaxial joint, optimal pedicle screw trajectory determination, and anatomical trait acquisition for the atlantoaxial pedicle, spinous process of the axis, vertebral lamina and posterior lateral mass, and design of a reverse template. During surgery, a navigation template was tightly attached to the atlantoaxial joint to assist in pedicle screw placement. Surgeons subsequently used an electric drill to remove the template through a guide channel and then placed the atlantoaxial pedicle screw. Observed indexes included the VAS score, JOA improvement rate, surgery duration, and blood loss. RESULTS: Surgery was successful in all 17 patients, with an average operation duration of 106±25 min and an average blood loss of 220±125 ml. Three days postoperatively, the VAS score decreased from 6.42±2.21 to 3.15±1.26. Six months postoperatively, the score decreased to 2.05±1.56. The postoperative JOA score increased significantly from 7.68±2.51 to 11.65±2.72 3 d after surgery and to 13.65±2.57 after 6 months. Sixty-eight pedicle screws were inserted successfully, with 34 in the atlas and 34 in the axis. According to the Kawaguchi standard, 66 screws were in grade 0 (97.06%), and 2 were in grade 1 (2.94%). The pre- and postoperative transverse and sagittal screw angles showed no significant differences. CONCLUSIONS: Atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template is worth recommending due to the improved accuracy in screw placement, improved patient safety and beneficial clinical effects.

Transposición del ligamento coracoacromial en el tratamiento quirúrgico de la luxación acromioclavicular aguda / Transposition of the coracoacromial ligament in the surgical treatment of acute acromioclavicular dislocation

Introducción: la luxación de la articulación acromioclavicular es frecuente en la práctica ortopédica diaria, estimándose su incidencia en aproximadamente el 10 por ciento de todas las luxaciones alrededor del hombro. Existen numerosas técnicas quirúrgicas descritas para su tratamiento con resultados variables. Objetivo: describir la evolución clínica del dolor, la movilidad del hombro y la reincorporación de los pacientes a sus actividades habituales, con el uso de la técnica de transposición del ligamento acromioclavicular. Métodos: se realizó un estudio de descriptivo de 22 pacientes con diagnóstico de luxación acromioclavicular aguda tratados quirúrgicamente mediante la técnica mencionada; se tuvo en cuenta la evolución clínica del dolor, la movilidad del hombro y la reincorporación de los pacientes a sus actividades después de la cirugía, y para ello se empleó el test funcional de Imatani. Resultados: la transposición del ligamento coracoacromial resultó ser una técnica útil y relativamente sencilla para el tratamiento quirúrgico de la luxación acromioclavicular aguda, con muy buenos resultados inmediatos, se logró considerable disminución o alivio total del dolor y recuperación completa o casi completa del rango de movilidad de la articulación del hombro, que le permite al paciente una vez rehabilitado, reincorporarse a sus actividades habituales. Conclusiones: la transposición del ligamento coracoacromial resultó útil en el tratamiento quirúrgico de la luxación acromioclavicular aguda, en cuanto al alivio del dolor, la movilidad y reincorporación a las actividades habituales(AU)

Introduction: Dislocation of the acromioclavicular joint is frequent in daily orthopedic practice, with an estimated incidence of approximately 10 percent of all dislocations around the shoulder. There are numerous surgical techniques described for its treatment with variable results. Objective: to describe the clinical evolution of pain, shoulder mobility and reincorporation of patients to their usual activities, using the technique of transposition of the acromioclavicular ligament. Methods: A descriptive study of 22 patients diagnosed with acute acromioclavicular dislocation treated surgically using the aforementioned technique was performed; the clinical evolution of pain, shoulder mobility and the reincorporation of patients to their activities after surgery were taken into account, and the functional test of Imatani was used. Results: Coracoacromial ligament transposition proved to be a useful and relatively simple technique for the surgical treatment of acute acromioclavicular dislocation, with very good immediate results, considerable reduction or total pain relief was achieved and full or near complete recovery of the range of mobility of the shoulder joint, which allows the patient once rehabilitated, to rejoin his usual activities. Conclusions: The transposition of the coracoacromial ligament was useful in the surgical treatment of acute acromioclavicular dislocation aboutpain evolution, shoulder mobility and reincorporation of patients to their usual activities(AU)

General Health Status After Nonoperative Versus Operative Treatment for Acute, Complete Acromioclavicular Joint Dislocation: Results of a Multicenter Randomized Clinical Trial.

OBJECTIVE: To assess the general health status of patients after nonoperative (Non-op) versus operative (OP) treatment for acromioclavicular (AC) joint dislocations. DESIGN: Multicenter randomized controlled clinical trial conducted in 11 Canadian trauma centers. A total of 83 patients with acute (≤28 days old), complete (Rockwood grades III, IV, or V) dislocations of the AC joint were included in this study. INTERVENTION: Participants were randomized to Non-op treatment or OP treatment with hook plate fixation. MAIN OUTCOME MEASURES: Physical and mental health were evaluated using the Short Form-36 version 2 survey at baseline, 6 weeks, 3 months, 6 months, 1 year, and 2 years. RESULTS: In the Non-op group, 33 patients had grade III injuries, 3 patients had grade IV injuries, 5 patients had grade V injuries, and the injury grade was unknown for 2 patients. In the OP group, 37 patients had grade III injuries and 3 patients had grade V injuries (no difference in Type IV and V Non-op vs. OP, P = 0.12). Fifty-eight percent of patients in the Non-op group and 63% of patients in the OP group completed the 2-year follow-up. The Non-op group had better physical health scores than the OP group at 3 months after treatment (52.13 vs. 45.75, P < 0.001). There were no significant differences between the physical health scores of the 2 groups at any other point (6 weeks, 45.81 vs. 41.21, P = 0.03; 6 months, 54.50 vs. 51.61, P = 0.02; 1 year, 55.10 vs. 53.96, P = 0.37; 2 years, 55.24 vs. 57.13, P = 0.17). Mental health scores were similar between the Non-op and OP groups at each follow-up interval (6 weeks, 49.29 vs. 51.27, P = 0.49; 3 months, 52.24 vs. 55.84, P = 0.13; 6 months, 54.89 vs. 55.05, P = 0.93; 1 year, 55.35 vs. 56.72, P = 0.35; 2 years, 56.41 vs. 55.43, P = 0.56). In both treatment groups, the preinjury physical and mental health scores were better than published population norms before declining to a level equal to or below the norm after dislocation. Physical health recovered to a level above the norm at 6 months in the Non-op group and 2 years in the OP group. Mental health recovered at 3 months in the OP group and 6 months in the Non-op group. CONCLUSIONS: Hook plate fixation does not lead to improved general health status compared with Non-op treatment. Presently, there is no definitive evidence that hook plate fixation is superior to Non-op treatment for acute complete AC joint dislocations. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.