RESUMEN
BACKGROUND: Numerous techniques have been used to treat acromioclavicular (AC) joint dislocation, with anatomic reconstruction of the coracoclavicular (CC) ligaments becoming a popular method of fixation. Anatomic CC ligament reconstruction is commonly performed with cortical fixation buttons (CFBs) or tendon grafts (TGs). PURPOSE: To report and compare short-term complications associated with AC joint stabilization procedures using CFBs or TGs. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We conducted a retrospective review of the operative treatment of AC joint injuries between April 2007 and January 2013 at 2 institutions. Thirty-eight patients who had undergone a procedure for AC joint instability were evaluated. In these 38 patients with a mean age of 36.2 years, 18 shoulders underwent fixation using the CFB technique and 20 shoulders underwent reconstruction using the TG technique. RESULTS: The overall complication rate was 42.1% (16/38). There were 11 complications in the 18 patients in the CFB group (61.1%), including 7 construct failures resulting in a loss of reduction. The most common mode of failure was suture breakage (n = 3), followed by button migration (n = 2) and coracoid fracture (n = 2). There were 5 complications in the TG group (25%), including 3 cases of asymptomatic subluxation, 1 symptomatic suture granuloma, and 1 superficial infection. There were no instances of construct failure seen in TG fixations. CFB fixation was found to have a statistically significant increase in complications (P = .0243) and construct failure (P = .002) compared with TG fixation. CONCLUSION: CFB fixation was associated with a higher rate of failure and higher rate of early complications when compared with TG fixation.
RESUMEN
BACKGROUND: The posterior approach to the ankle and hindfoot can be used for fixation of fractures, fusions, or osteotomies and is especially useful in patients with poor soft tissue anteriorly, medially, or laterally. However, a high rate of wound complications has been reported with standard posterolateral and posteromedial approaches. Because of local wound problems with the standard approaches, we have used a midline posterior approach and a longitudinal midline splitting of the Achilles tendon. This approach provides excellent exposure while minimizing wound healing complications. This approach provides dissection between angiosomes, which should optimize preservation of the blood supply to the skin flaps. METHODS: We retrospectively evaluated wound healing in 33 consecutive patients who had surgery using the modified midline posterior approach. The mean age of the patients was 48 (range 16 to 83) years. The mean followup was 24 (range 12 to 73) months. Surgical procedures included ankle and pantalar arthrodeses (primary and revision), talectomies with tibiocalcaneal arthrodesis, repairs of fracture nonunions, reconstruction of a chronic Achilles rupture, and hardware removal with multiple debridements of chronic osteomyelitis. RESULTS: There were no instances of skin flap necrosis. One patient with diabetic neuropathic arthropathy developed a small superficial wound eschar that healed with dressing changes alone. Four patients developed deep infections; two of these had a history of deep infection and the other two had significant comorbidities. CONCLUSIONS: The modified midline posterior approach to the distal tibia, ankle, and hindfoot has a low primary wound complication rate without sacrificing exposure. This approach can be used for any procedure requiring posterior access to the distal tibia, ankle joint, or subtalar joint.