The results of coraco-clavicular slings for acromio-clavicular dislocation

Background: Treatment of type 3 acromio-clavicular (A-C) dislocations is controversial. There have been over 60 different surgical procedures as well as a variety of conservative measures used to treat this injury. Methods: The outcome of a coraco-clavicular (C-C) sling for grade 3-4 A-C dislocation was studied. A dissolvable sling of braided 1 polydioxanone (PDS, Ethicon) was used with or without excision of the distal end of the clavicle in six patients. The clinical and radiological outcome of the braid and acromio-clavicular joint were studied by clinical examination, plain and stress radiographs and magnetic resonance imaging (MRI). Results: All patients reported good-excellent results from 6 months after surgery. Radiological examination demonstrated some superior clavicular migration in all patients within 1 month of the procedure, although never more than that seen with a grade 2 dislocation. This migration was clinically evident only in patients with a thin build. At 1 month, the MRI demonstrated partial replacement of the braid by granulation tissue. From 6 months on, the braid was absent and fibrous tissue was noted between the coracoid and the clavicle and the acromion and clavicle. Conclusions: The coraco-clavicular sling did not maintain operative reduction of the dislocated clavicle. This did not diminish the functional result but was a cosmetic complication in patients with a thin build.