Management of a Failed Infected Acromio-Clavicular Joint Fixation with Chronic Instability using Anatomical Hybrid...

Biological augmentation of anatomic acromio-clavicular joint (ACJ) reconstruction should be considered in chronic ACJ dislocations because in chronic cases, there is a lack of intrinsic healing of the ligaments. Hybrid techniques which involve combination of fibertapes or tightropes with tendon graft have demonstrated native-like biomechanical properties and are thus a suitable mode of reconstruction for chronic ACJ dislocations.

We report a case of a 39-year-old right-hand-dominant male who presented to us with failed infected ACJ fixation with a hook plate along with wound dehiscence. The patient presented with pain, deformity, exposed implant, and restricted mobility of the shoulder. The patient was managed in two stages. In the first stage, implant removal was done along with debridement, and infection was controlled with suitable antibiotics. In the second stage, the chronic ACJ dislocation was managed by Mumford's procedure and hybrid fixation technique using ACJ fixation device with Semitendinosus tendon graft augmentation. Post-operative outcomes showed no signs of infection and considerable improvement in shoulder stability and range of movements.

Anatomical ACJ reduction with suture button devices along with biological augmentation with a tendon graft is a more anatomical and definitive method of fixation of ACJ dislocations, particularly in chronic cases.