Review of Weaver and Dunn on treatment of acromioclavicular injuries, especially complete acromioclavicular separation

This classic discusses the original publication “Treatment of acromioclavicular injuries, especially complete separation” by Weaver and Dunn, which collaborated to develop a technique for joint reconstruction in 1972. Their surgical described resection 2 cm distal clavicle transfer acromial end coracoacromial ligament into medullary canal clavicle. (modified) Weaver-Dunn procedures have been regarded as one most effective techniques treat dislocation long time. However, anatomic reconstructions taken over this position since recent biomechanical studies demonstrated superior results. Although procedure has fallen out favour, it remains historical significance. For reason, review will comprise overview procedure, men behind eponym clinical implication then now. Over past few decades, indication surgery injuries (Rockwood grade III–VI) an ongoing debate. It is still not entirely clear patients benefit from do not. A subdivision III Rockwood classification was proposed (IIIA: horizontally stable; IIIB: unstable) aid decision-making.1Beitzel K Mazzocca AD Bak et al.ISAKOS upper extremity committee consensus statement on need diversification injuries.Arthroscopy. 2014; 30: 271-27810.1016/j.arthro.2013.11.005http://www.ncbi.nlm.nih.gov/pubmed/24485119Abstract Full Text PDF PubMed Scopus (123) Google Scholar At time, with type IIIB–VI may surgery. As optimal acute delayed instability, no gold standard yet established. 100 described.2Xará-Leite F Andrade R Moreira PS al.Anatomic non-anatomic improves post-operative outcomes chronic acromio-clavicular instability: systematic review.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 3779-379610.1007/s00167-019-05408-3http://www.ncbi.nlm.nih.gov/pubmed/30806755Crossref (10) The its ACJ first 1917.3Cadenat treatment dislocations fractures outer clavicle.Int Clin. 1917; 1: 145-169Google In 1972, Dunn were publish case series transfer.4Weaver JK HK Treatment separation.J Bone Joint Am. 1972; 54: 1187-119410.2106/00004623-197254060-00005http://www.ncbi.nlm.nih.gov/pubmed/4652050Crossref (401) Since that cornerstones separation. Recently, however, anatomical gained popularity among shoulder surgeons results show promise.5Mazzocca Santangelo SA Johnson ST al.A evaluation coracoclavicular reconstruction.Am J Med. 2006; 34: 236-24610.1177/0363546505281795http://www.ncbi.nlm.nih.gov/pubmed/16282577Crossref (309) Scholar, 6Thomas Litsky Jones G al.Biomechanical comparison reconstructive techniques.Am 2011; 39: 804-81010.1177/0363546510390482http://www.ncbi.nlm.nih.gov/pubmed/21257841Crossref (73) 7Beitzel Obopilwe E Chowaniec DM arthroscopic repairs suture button systems without biological augmentation.Am 2218-222510.1177/0363546511416784http://www.ncbi.nlm.nih.gov/pubmed/21841067Crossref (89) 8Li Q Hsueh P-ling Chen Y-feng Coracoclavicular reconstruction: study triple endobutton technique.Medicine. 93: e19310.1097/MD.0000000000000193http://www.ncbi.nlm.nih.gov/pubmed/25526435Crossref (18) trend slowly shifts away non-anatomical particular procedure. (Dr Dr H Dunn) in-depth expert opinions Beitzel, P Millett) subject, see online supplementary appendix 1. James Weaver9The Aspen Times Obituaries, Kilburn weaver, M.D..Available: https://www.aspentimes.com/obituaries/james-kilburn-weaver-m-d/Date: 2017Google 10Calabro personal remembrance K. weaver MD (1929-2017).Clin Orthop Relat Res. 2018; 476: 914-91610.1007/s11999.0000000000000227http://www.ncbi.nlm.nih.gov/pubmed/29538176Crossref (1) (1929–2017) born Fort Collins, Colorado. He moved Glenwood Springs, Colorado, where he spent his childhood. After graduating high school 1947, attended Harvard University, captain Ski Team. excelled both academics sports. received medical degree University Colorado Medical School Denver, followed 1-year fellowship at Edinburgh Scotland. spending several years military service Elgin Air Force base, returned assistant professor. Later, joined New Mexico Albuquerque, would serve Chief Division Orthopaedic Surgery. specialised total replacement surgery, paediatric orthopaedics sports medicine. Beyond orthopaedics, loved horses western way life; horse packing surveyors tasked mapping mountains Rockies. member numerous orthopaedic groups including American Society Medicine, Academy Surgeons, Association Surgeons Western Society, named him President. died 20 September 2017. Harold Dunn11University Utah Medicine Faculty details, HK.Available: https://medicine.utah.edu/faculty/mddetail.php?facultyID=u0031473Date: 2014Google 12Villacis DC Popkin CA Nowell JA al.Standing tall their shoulders: essential eponyms surgery.Journal Shoulder Elbow Arthroplasty. (247154921879772)10.1177/2471549218797723Crossref (1939) grew up Artesia, Mexico, cattle ranch. Riding roping early age earned calf-roping scholarship State University. completing undergraduate studies, Baylor School. married divorced twice had two children marriage. Initially being interested cardiovascular serving army participating Vietnam War time General Hospital Japan drove become surgeon. did 1 year general residency finishing 1967 met who process starting Mexico. completed 1969 faculty later Chairman, served 25 years. three areas special interest, adult hip knee, scoliosis biomechanics. His memberships include Director Board Orthopedic Association, Hip Knee Scoliosis Research Association. reconstruction, they published 1972 Journal Surgery.4Weaver targeted population dislocation, classified according Tossy Allman classification. Type consists separation disruption ligaments well ligaments, leaving grossly unstable. thought non-operative means unsuccessful because non-compliance during rehabilitation, non-effective reduction tape or bandage, complications like skin maceration, irritation pressure sores stiffness shoulder. Therefore, recommended. new approach justified many difficulties then-existing continued be encountered. Difficulties concerned migration failure metallic fixation devices, erosion bone recurrence deformity, development arthralgia subsequent surgeries remove devices. (see figure 1) oblique fashion held relative coracoid traction applied proper length selected maintain reduction. secured superiorly non-absorbable sutures restore stabilising effects torn ligaments. arm immobilised circumduction exercises are advised postoperative day. 4 weeks, active range motion allowed. 15 patients, 12 3 chronic. Good obtained 11 rates fair poor. There correlation between chronicity injury outcome after rated fair, there incomplete clavicular deformity. these symptoms pain, weakness loss motion. introduction introduced modified version technique. 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When indicated, reached regarding grafts, though literature suggests cases enhance healing ligaments.54Borbas 59Phadke Bakti Bawale al.Current concepts Clin Trauma. 480-48510.1016/j.jcot.2019.03.020http://www.ncbi.nlm.nih.gov/pubmed/31061573Abstract Overall, led somewhat redundant, Nevertheless, golden covering agreed on. Download .pdf (.13 MB) Help pdf files Supplementary data