Acromioclavicular Dislocations Type III

Abstract

Background: In contrast to acromioclavicular (AC) dislocations types I, II and Types IV, V, VI according to Rockwood, traumatologists greatly dissent about the treatment of AC dislocation type III. Before choosing an operative technique, the first question is, whether there is a surgical indication.

Material and Methods: A review of literature was done through Medline, Medscape and DynaMed.

Results: When conservative treatment was compared to surgical treatment, no clear benefit could be shown for the latter. This is partially due to small series and the fact that nonoperative treatment is generally associated with a favorable outcome. It has never been proven that operative treatment improves the final result. Operative techniques with a high rate of anatomic successes do not guarantee good final results. So, anatomic restoration does not equal a good result, but if dislocation reappears, there is a high risk of a fair or poor result. Additionally, anatomic reduction can sometimes only be obtained at the cost of considerable iatrogenic damage to the AC joint, the clavicle or the subclavicular region. Operative treatment is associated with numerous complications. And last, but certainly not least: operative treatment is not associated with a shorter time period of return to work or to sports activities nor with better muscle strength.

Conclusions: Considering the pros and cons of operative treatment, we feel one should initially treat AC dislocations type III conservatively and keep surgery for those few patients with severe, persistent complaints.