抄録
The purpose of this study is to compare the outcomes of conservative treatment, a modified Bosworth's operation and a modified Dewar's operation for acromio-clavicular dislocation of grade 3according to Tossy's classification.
Forty-seven shoulders of 46 patients (43 males,3 females,22 left shoulders, and 25 right, average age 35.6 years ranging from 12 to 64 years) with a fresh acromio-clavicular dislocation were treated and investigated. We performed conservative treatment in 14 cases, Bosworth's op. in 12 and Dewar's op. in 22. The results were evaluated with the JOA shoulder rating score.
The average pain score was 86.7 points in conservative treatment,88 in Bosworth's op. and 91.7 in Dewar's op.. The functional score of every group was more than 90 points, but weakness or easy fatigue was found in 42.9% of the conservative treatment group. The average score of instability was 77.5 in Bosworth's op. and 80 in Dewar's op.. Reduction and stability of the AC joint was better in the Dewar's op. than in the 2 other groups. The re-subluxation rate was 22.7% in the Dewar's op. and 58.3% in Bosworth's op.. Osteoarthrosis of the AC joints was observed in none of the conservative group, in 3 with Bosworth's op. and in 4 of 4 with resection of the disc (100%) and 2 of the 14 without resection of the disc (14.3%) in Dewar's op..
Conservative treatment obtained good results except for residual deformity and weakness. Dewar's op. obtained good reduction, but there were more re-subluxations in the Bosworth's op.. We suposed that only primary repair of the coraco-clavicular ligament was not enough and it was necessary to augment it in order to prevent a re-subluxation and re-dislocation.
