Acesso póstero-superior no tratamento cirúrgico da luxação acrômio-clavicular

Abstract

This is a new approach to the acromioclavicular joint repair, and the main characteristics is that the deltoid is not manipulated. The incision is made in Langer‘s line and 3 inches in lenght. It begins 3 inches posterior to the clavicle and them crosses clavicle, one inch medial the acromioclavicular joint. The incision is undermined so that acromioclavicular joint, the distal clavicula and the trapezius, can be vizualized. The trapezius is retracted posteriorlly and distally to vizualize the torn ends of coracoclavicular ligaments and the coracoid process. Two holes are made in the coracoid dorsum, that is the common place of conoid and trapezoid ligament attachment site, to insert anchors with Ethibond number five.A 2,0 mm drill is used to make holes 3 in the clavicle for passage of the suture .The clavicle is reduced and traction is applied to each suture to ensure that it is firm. The deltotrapezius muscles and fascia interval are carefully repaired back to the clavicle. The skin is sutured and the arm is supported in a sling for two weeks. This approach is important because the deltoid muscle is not manipuled and, with the fixation in situ, the clavicle does not tend to displace anteriorly away from the acromion, what is possible to happen when a loop is made on the coracoid. I believe that the postero-superior approach is a good way to reduce and fix the acromioclavicular joint without touch the anterior part of the shoulder; if necessary another surgery, we can use the anterior approach like Weaver- Dunn surgery.