Percutaneous cannulated screw coracoclavicular fixation for acute acromioclavicular dislocations

In 1941, Bosworth introduced a new method of repairing acute complete acromioclavicular dislocations in which a noncannulated coracoclavicular lag-screw was inserted by a blind technique. The author reintroduces the percutaneous coracoclavicular fixation concept. A cannulated screw was specially designed, and the technique of percutaneous insertion under fluoroscopic image control was developed. Fifty-three acromioclavicular dislocations were treated by this method. There were 40 Type III, five Type IV, and three Type V dislocations with distal clavicle fractures in conjunction with complete coracoclavicular ligament tears. Technical failures, which occurred in 17 of 53 patients (32%) included: failed percutaneous insertion in two; early screw pullout in three; late screw pullout in four; subluxation after screw removal in six; and malreduction of Type IV dislocation in two. There was no screw breakage or evidence of migration. Serous drainage occurred in two patients.