The Specific AC Score (SACS): a new and validated method of assessment of isolated acromioclavicular joint pathology.

BACKGROUND: Acromioclavicular (AC) joint (ACJ) pathology is a common cause of shoulder dysfunction, and treatment recommendations vary. When the efficacy of treatment is evaluated, the ability to measure outcomes specific to the population is essential. The aim of the current research was to develop and validate a specific ACJ questionnaire. METHODS: Items for the "Specific AC Score" (SACS) were generated through the use of an expert panel, existing questionnaires, and patient feedback. Preliminary data analysis identified redundancy of items resulting in the questionnaire being refined. The final SACS was evaluated in 125 patients requiring surgical intervention of the ACJ. Internal consistency (the Cronbach α and corrected item-total correlation), content validity, criterion validity, responsiveness, and test-retest reliability (intraclass correlation coefficient) were examined and compared with the Shoulder Pain and Disability Index, Oxford Shoulder Score, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. The minimum detectable change score was calculated. RESULTS: The Cronbach α for the total scale preoperatively and postoperatively was high (preoperatively = 0.91, postoperatively = 0.93). All 3 domains (Pain, Function, Quality of Life) demonstrated acceptable internal consistency (α > 0.70), and the correlation between items in each domain was satisfactory. The responsiveness was excellent (effect size, -2.32; standard response mean, -1.85) and was higher than the other general shoulder questionnaires. There were no relevant floor or ceiling effects. Reliability was high (intraclass correlation coefficient, 0.89) and the minimum detectable change was 6.5 points. DISCUSSION: This new ACJ-specific questionnaire has been robustly developed, has good measurement properties, and has excellent responsiveness. The SACS is recommended for measuring outcomes in ACJ patients.

Case Report: Midshaft clavicle fracture with concomitant high grade (Type V) acromioclavicular joint dislocation.

Introduction: Concomitant acromioclavicular joint dislocation and midshaft clavicle fracture are rare injuries, generally resulting from high energy trauma, with limited previous experience in management. Case: A 30 year old male presented following a pushbike accident. He had suffered a head on collision with another cyclist. Radiographic examination demonstrated a displaced midshaft clavicle fracture with a Rockwood Type V acromioclavicular joint dislocation. Operative management was undertaken using a dual plating technique. At six month follow up the patient demonstrated full range of motion and had no pain. Conclusion: Appropriate radiographic evaluation and careful intraoperative assessment are required using the principles of management for acromioclavicular joint injuries, along with stabilization of the mid-clavicular fracture to reduce the risk of non-union.

Minimizing Propionibacterium acnes contamination in shoulder arthroplasty: use of a wound protector.

BACKGROUND: Propionibacterium acnes may be transmitted from the subdermal tissues to the deeper tissues during shoulder arthroplasty surgery, resulting in deep infection. The aim of this prospective, clinical study was to determine whether the use of a wound protector drape can lower the incidence of P. acnes in the wound during shoulder arthroplasty surgery. METHODS: For a consecutive series of 47 patients undergoing shoulder arthroplasty, a wound protector drape was used during surgery, to isolate the subdermal layer from the surgeons' hands, retractors and other instruments. Microbiological swabs were taken both from the subdermal layer and the exposed drape to determine the incidence of P. acnes at both sites. RESULTS: The overall incidence of P. acnes in the subdermal layer was 23%. A fivefold decrease in the incidence of P. acnes in the exposed superficial layer was demonstrated by use of the wound protector drape. CONCLUSION: Use of a wound protector drape to isolate the superficial tissue layer from the surgeons' gloves, instruments and retractors decreases the incidence of P. acnes in the surgical field. This may result in a decreased rate of transmission to the deeper tissues, and a decreased rate of P. acnes deep infection.