In Locking Clavicle Hook Plate, a trans-acromial K-wire is used to secure provisional reduction. The final fixation is achieved with a figure-of-eight tension band wire combined with two K-wires preferably threaded K-wires. This fixation should not impinge upon the acromioclavicular joint so that articular disc injury can be avoided. Considering the size of the fragments, a small fragment T-plate or one-third tubular plate can be used as an alternative. A reconstruction plate 3.5 is also another valid substitute for it. Bosworth had explained the alternative technique with a screw through the plate into the base of the coracoid.
Acromioclavicular Joint Dislocation
An AC (Acromioclavicular) joint dislocation is the dislocation of the clavicle from the acromion. A complete disruption of theacromioclavicular joint (Tossy III) and if it is irreducible, is a clear indicator of operative care. However, there are many techniques for the treatment of acromioclavicular joint dislocation. Two possibilities have been explained below:
- The first one is Indirect purchase on the acromioclavicular joint with coracoclavicular fixation using screws, sutures, and wire loops. These procedures can be combined with debridement of the acromioclavicular joint and coracoclavicular ligaments repairing. The best exposure is given by saber cut incision. Transosseous sutures can be placed between the avulsed ligaments and holes in the lateral end of the clavicle. After identification of the coracoid with two temporary K-wires, a 3.2 mm drill bit is used to drill a hole through the clavicle into the coracoid. Then both cortices of the clavicle are over drilled using a 4.5 mm drill and a 6.5 mm cancellous bone screw with 16 mm thread, and a washer is inserted. The over the drilling of both cortices of the clavicle allows it to rotate without the screw loosening in the coracoid anchor. Complete the procedure by tying the sutures of the acromioclavicular reconstruction. Screw removal can be planned after 8–10 weeks after surgery.
- In the second or alternative technique, the acromioclavicular joint is exposed in the same way as for the coracoclavicular screw, and the joint is debrided. The reduction is followed and it is stabilized with a 2 mm K-wire inserted from the outer lateral side of the acromion across the joint and into the clavicle. Impaling of the cortex of the clavicle by the wire is necessary to prevent migration. In place of a K-wire, a 3.5 mm cancellous bone screw or a 4.5 mm cannulated cortex screw can be used. Then insert this screw through a gliding hole in the acromion and into the medullary canal of the clavicle. Commonly, it exits from the cortex of the clavicle because of the curve of the bone. After stabilization of the joint, a tension band of a wire or a non-absorbable suture is placed through a drill hole in the clavicle and move under the deltoid attachment to the acromion and the wire or the screw head. At this point, the patient is not allowed to use the extremity in abduction so that the breakage of the wire or screw can be prevented but the extremity can be used for other activities. The wire or screw is removed after three months and all activities can be started.