Journal of Musculoskeletal Trauma

Modified Phemister Operation for Acromioclavicular Dislocation: Jin Yung Park, Gun Nam Kim, Byung Sam Min, Moon Jib Yoo; J Korean Soc Fract 2001;14(3):456-462. Published online July 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.3.456

Abstract PDF: PURPOSE
To evaluate the clinical results after modified Phemister operation for complete dislocation of acromioclavicular joint.
MATERIALS AND METHODS
Thirty-seven cases of Fifty-three cases complete dislocation of acromioclavicular joint which were treated modified Phemister operation, follow up for at least one year, were evaluated. After operation, applied Kenny-Howard brace for six weeks and removed the inserted pins at ten to twelve weeks postoperatively. The ROM exercise was started at postoperative six weeks and meticulous ROM exercise was begun at pin removal. The clinical results were evaluated with range of movement, comparision of the coracoclavicular distance after surgery with that of follow up, and complications.
RESULTS
The range of motion were forward elevation 150 degree, external rotation 71 degree, external rotation at 90 degree abduction 77 degree, and internal rotation T8. The comparision of coracoclavicular distance after surgery(0,6mm) with that of follow up(1.0mm) showed no significant ligament laxity. The complication were subluxation in 2 cases, heterotrophic calcification in 3cases, broken K-wire in 2cases, pin site infection in 7cases and distal clavicle osteolysis in 3cases, which were healed at follow up radiographically.
CONCLUSION
To prevent of redislocation of acromioclavicular joint, we tried to insert the pin during relatively long period for sufficient healing of ruptured coracoclavicular ligament. Although immobilization period was relatively long period, clinical results were good.

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AClinical Resutlt of Modified Phemister Method for Acute Acromioclavicular Dislocation: Duk Yun Cho, Jae Hwa Kim, Kyung Chul Kim; J Korean Soc Fract 1998;11(4):947-952. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.947

Abstract PDF: There are many procedures for the treatment of acute A-C injury which have many complic ation such as limitation of shoulder motion, post traumatic arthritis and recurrence of dislocation etc. From July 1992 to June 1996 at National Medical Center, 21 patients with A-C injury had been treated by modified Phemister operation. The mean follow up time was 14.6 months. The following results are obtained. 1. There was no limitation of shoulder motion in 20 cases. 2. The comparison of coraco-clavicular distance after surgery ( 2.24 mm ) with that of fallow up ( 3.95 mm ) showed no significant difference. 3. Clinical resuls showed that good in 18 cases, fair in 2 cases, poor in 1 case. From the above result, we suggest that Modified Phemister method is simple and good procedure in the treatment of acute A-C dislocation.

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Results Following The Surgical Treatment of Acromioclavicular Joint dislocations; A Comparison of Phemister With Bosworth Operation: Jin young Park, Suk Joo Lyu, Ki Hyuk Moon, Myung Ho Kim; J Korean Soc Fract 1998;11(1):8-15. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.8

Abstract PDF: To compare the results the Bosworth with Phemister operation, we performed the Bosworth operation in 7 case and then Phemister operation in 9 case serially from 1994 to 1997 and followed them up postoperatively. The average follow-up was 19.2 months, with the longest being 32 months, and the shortest being 12 months. The extraarticular coracoclavicular fixation was done with a cancellous screw in Bosworth operation, the transarticular fixation with two or three Kirschner wires in Phemister operation and the coracoclavicular ligaments were sutured to all patient in phemister operation group. The average immobilization period 6.8 weeks(S.D.:1.0 weeks) in Bosworth operation, 6.5 weeks(S.D.:1.4 weeks) in Phemister operation. The cancellous screw or the Kirschner wires were removed in 12.6 weeks(S.D.:1.6 weeks) postoperatively in Bosworth operation, 11.8 weeks(S.D.:1.7 weeks) in Phemister operation and physiotheraphy was progressed to obtain the full range of motion. All of the patients were evaluated on a subjective(pain, night pain, medication. instability, activities of daily living), objective(range of motion) and roentgenographic(degree of displacement) basis at last follow-up. Shoulder function was assessed according to the shoulder score devised by the American Shoulder and Elbow Surgeons. The pain of Shoulder persisted remained in 1 case of Bosworth operation and in 3 cases of Phemister operation. The night pain around acromioclavicular joint was remained in 2 cases of Phemister operation. Average shoulder function index in Bosworth operation was 95 points and in Phemister operation 87 points. Average range of motion of Bosworth operation was 176degree (S.D.:9degree in forward elevation, 68degree(S.D.:11degree in external rotation, 88.6degree(S.D.:12degree in cross-rotation at 90degreeabduction, 22cm (S.D.:11cm) in cross-body adduction and T9 in internal rotation and Phemister operation 147degree(S.D. 18degree in forward elevation, 72degree S.D.:12degree in external body adduction and T8 in internal ratation. All of the patients were satisfied for results of operation. After surgery, loss of reduction was found in 3 of 7 in Bosworth operation and all of the patients were over 40 years and then conversions to Phemister operation was needed. According to short-term follow-up we prefer the transarticular Phemister method and Bosworth operation may be avoided in patients over 40 yeras old.

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Operative Treatment for Acromiclavicular Joint Dislocation: Bum Soo Kim, Sung Do Cho, Ki Bong Kim; J Korean Soc Fract 1998;11(1):1-7. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.1

Abstract PDF: Acoromioclavicular dislocation occurs frequently in young athletes and recently in automobile accident victims and laborers, and there are various kinds of operative methods for this injury. Authors performed operative treatment for 45 cases of acromioclavicular dislocation: 30 cases of modified Phemister operation and 15 cases of modified Bosworth operation from March 1992 to June 1996. Authors analysed the result of the treatment and the results obtained were as follows. 1. The clinical results evaluated by Weitzman criteria were all satisfactory in both modified Phemister method and modified Bosworth method. 2. The radiologic results were evaluated by the difference of the distance from the coracoid process to the clavicle between the normal and the injured site. And the result was more satisfactory in modified Bosworth method. 3. There were less complications in modified Bosworth method.

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