[The Balser plate with ligament suture. A dependable method of stabilizing the acromioclavicular joint]

Between June 1990 and December 1997 116 patients with complete dislocation of the acromio-clavicular joint were treated operatively. According to the classification of Tossy and Rockwood all patients had type Tossy III or Rockwood III, IV and V of lesion. The retrospective part of the study from June 1990 to August 1994 represents 48 patients treated in 31 cases with wire-cerclage, in 14 cases with PDS-cerclage and in 3 cases with a combination of Kirschner wires and PDS. In a second group between September 1994 and 1997 68 patients were treated operatively with a special hook-plate, called Balser-plate, combined with suture of the corakoclavicular ligaments, the articular capsule and the intraarticular discuss. In the first group there was a postoperative immobilisation of the injured shoulder for 2,3 weeks necessary; in comparison to non immobilisation at the Balser-plate group. The range of motion in the Balser-plate group was free up to 90 degrees abduction. The removal of implants was performed in both groups after approximately 3 month. Postoperative complications were 8 reluxations at the acromio-clavicular joint and 10 superficial infects at the Non-Balser group and 4 superficial infects and 2 subcutaneous haematoma in the Balser group. We saw no reluxation in the Balser group. We examined 30 of 48 patients of the Non Balser group after average 50.1 month and 57 of 68 patients of the Balser group after 24.6 month. We compared the functional result, a questionnaire and the ultrasound examination of the acromio-clavicular joint with and without 10 kg weight bearing of the arm. 87.7% of the Balser patients and 67.7% of the Non-Balser-patients had free movement of the injured shoulder. Another 14.2% and 11.4% of the Balser group complained on shoulder pain with weight bearing and extreme moval in comparison to 17.4% of the Non-Balser group. At ultrasound examination comparing the injured to the non injured arm with and without 10 kg weight bearing there was a clavicula-elevation of 0.3 mm and 0.6 mm at Balser-patients and 3.0 mm and 2.5 mm at Non-Balser-patients for the injured side. In normal position the acromio-clavicular width was physiological in 50.2% of Balser patients in comparison to 36.6% of Non-Balser-patients. Under weight bearing the acromio-clavicular width increases in both groups. 63.2% of the Balser-group patients are satisfied with the result of operation, but only 43.3% of the other group (p < 0.05). Completely dissatisfied were 20% of the Non-Balser group, particularly because of the bad cosmetic result (40%).