Clavicle Fractures AC SC Case 79 year old active female fell while - - PowerPoint PPT Presentation

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Clavicle Fractures AC SC Case 79 year old active female fell while - - PowerPoint PPT Presentation

Aug 25, 2022 811 likes •1.38k views

Clavicle Fractures AC SC Case 79 year old active female fell while skiing These do well without surgery Questions: 1. Treatment: A. Operative B. Non-operative Questions 1. Operative Treatment Choices: A. Transacromial

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Clavicle Fractures

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AC SC Case 79 year old active female fell while skiing

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“These do well without surgery”

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Questions:

  • 1. Treatment:

– A. Operative – B. Non-operative

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Questions

  • 1. Operative Treatment Choices:
  • A. Transacromial Fixation
  • B. Suture anchor(s)
  • C. Plate
  • D. Plate + CC fixation
  • E. Coracoclavicular fixation
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2 weeks later

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“I thought these were supposed to do well without surgery???”

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Questions:

  • 1. Treatment:

– A. Operative – B. Non-operative

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Questions

  • 1. Operative Treatment Choices:
  • A. Transacromial Fixation
  • B. Suture anchor(s)
  • C. Plate
  • D. Plate + CC fixation
  • E. Coracoclavicular fixation
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CC Fixation

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8 weeks postop – clinically healed

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Case 1

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CASE 1

  • 20 y.o. sophomore Starting QB
  • Goes down on shoulder during 3rd game of

season in 1st quarter

  • Already has thrown for 700 yards in 1st two

games

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CASE 1

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CASE 1

On field

  • Unable to raise arm
  • Tender diffusely anterior shoulder and around

AC Joint

  • Neck with normal rom
  • NVI distally
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CASE 1

Take to Locker Room and Re-examine

  • Shoulder Pads off
  • Moderate deformity at AC joint
  • Tenderness around AC joint and anterior

shoulder

  • Now able to Raise arm and resist in all planes

with discomfort

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CASE 1

Xrays:

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CASE 1

Xrays:

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CASE 1

NEXT STEP?

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CASE 1

NEXT STEP? Done for the game? Injection? MRI?

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CASE 1

Discussion with athlete A shared decision was made and injection was chose

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CASE 1

Athlete went back out in 2nd quarter Unable to play, too painful to throw Sat out rest of game

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CASE 1

NEXT STEP?

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CASE 1

MRI

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CASE 1

NEXT STEP? Done for the year? Surgery? Rest and see if able to come back?

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Acromioclavicular Joint injuries Results from survey from NCAA Div. I ortho docs

  • Type III AC joint injuries:

Treat non-operatively 2008 67% 2016 92% Fix 2008 22% 2016 8% Fix in QB 2008 11% 2016 33%

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Case 1

  • Treated with rest and progressive motion and

strengthening

  • Improved every week
  • Came back 3 weeks later
  • Finished year and threw for 2,000 yards
  • Story done?
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Case 1

End of season exam

  • Significant deformity
  • Scapular dyskinesis
  • Cross arm adduction with elevation of clavicle
  • ver acromion
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Case 1

Not the Athlete but example of the mechanics of the AC joint

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CASE 1

NEXT STEP?

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CASE 1

Called Russ Warren & Rich Hawkins

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CASE 1

Ultimately decision was to rehab and strengthen and do surgery if did not improve

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CASE 1

Scapular mechanics remained abnormal but he felt fine was able to return to play 2 more years and became all-time leading passer for University of Colorado

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Case presentation

Complex AC joint injury

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  • 45 y.o. worker
  • MVA, multiple injuries, resolved
  • AC soreness, deformity,

dysfunction

  • Scope “AC joint repair”,

technique unknown

  • Continued symptoms, deformity-

“no change”

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  • What caused

repair failure

  • What is current

pathoanatomy, pathophysiology

  • Treatment
  • ptions

Post op 1

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Post op 2

  • Anatomic CC-

graft, sutures, 4.5 mm holes

  • AC- graft docked

to acromion, 2.4 mm holes, tension band

  • Native ant, post

AC repair, suture anchors

Kibler et al Arthroscopy April 2017

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Case 2

  • 20 year old quarterback tackled and thrown on to one of

his shoulders and sustained a significant injury

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20 yo with football injury

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Weighted views

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20 yo with football injury

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20 yo with football injury

Cross body adduction AP radiographs

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20 yo with football injury

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20 yo with football injury

19 year follow-up: Patient is now a practicing orthopedic surgeon and feels his right shoulder is “normal”

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What Would the Panel Do????

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6 months postop

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6 months postop