Management of type III acromioclavicular joint dislocation: A Delphi consensus survey by Shoulder & Elbow Society, India (SESI)

•An anteroposterior and axillary view of the shoulder without any traction or weight in hand is sufficient in the setting of a suspected type III ACJ dislocation.•Either cross-arm adduction X-rays or clinical examination may be used to distinguish between ISAKOS IIIA and B classification of ACJ disl...

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Published inInjury Vol. 55; p. 111467
Main Authors Shah, Dr. Darshil, Sahu, Dr. Dipit, Easwaran, Dr. Raju, Kar, Dr. Abheek, Modi, Dr. Amit, Tambe, Dr. Amol, Babhulkar, Dr. Ashish, Pardiwala, Dr. Dinshaw N., Singh, Dr. Harvinder Pal, Maheshwari, Dr. J, Kumar, Dr. Kapil, Selvaraj, Dr. Karthik, Kumar, Dr. KR Prathap, Shetty, Dr. Nagraj, Kamat, Dr. Nilesh, Shah, Dr. Parag, Kocheeppan, Dr. Pradeep, Monga, Prof. Puneet, Aggarwal, Dr. Raman Kant, Chidambaram, Dr. Ram, Pathak, Dr. Shirish, Gajjar, Dr. Shreyash, Jos, Dr. Sujit, Pandey, Dr. Vivek
Format Journal Article
LanguageEnglish
Published Netherlands Elsevier Ltd 01.06.2024
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Abstract •An anteroposterior and axillary view of the shoulder without any traction or weight in hand is sufficient in the setting of a suspected type III ACJ dislocation.•Either cross-arm adduction X-rays or clinical examination may be used to distinguish between ISAKOS IIIA and B classification of ACJ dislocation to identify stable and unstable injuries.•Conservative treatment can be offered to patients who have stable injuries and who are not high-demand individuals in acute Type III ACJ dislocations.•A sling for two weeks is sufficient in conservative management of type III ACJ dislocation.•Coracoclavicular reconstruction with an autograft is an acceptable way to treat symptomatic, chronic grade III ACJ dislocation. The study aimed to report the results of the Delphi survey conducted by the Shoulder, Elbow Society India (SESI), to achieve consensus on ambiguous topics in managing type III acromioclavicular joint (ACJ) dislocations. This study was based on responses from the Shoulder Elbow Society India (SESI) panel of peer-selected twenty senior surgeons practicing shoulder orthopedics. They participated in two rounds of the survey to obtain consensus on several topics pertaining to the management of type III ACJ dislocations. Consensus was achieved when at least 70 % of the panel members selected at least a 4-point on a 5-point Likert scale. Our Delphi survey reached a consensus on seven topics of ambiguity. An anteroposterior and axillary view of the shoulder without any traction or weight in hand is sufficient in the setting of a suspected type III ACJ dislocation. Magnetic resonance imaging (MRI) is not routinely indicated in type III ACJ dislocation. Either cross-arm adduction X-rays or clinical examination may be used to distinguish between ISAKOS (International Society of Arthroscopy, Knee surgery and Orthopaedics Sports medicine) IIIA and B classification of ACJ to identify stable and unstable injuries. Conservative treatment can be offered to patients who have stable injuries and who are not high-demand individuals in acute type III ACJ dislocations. In conservative management of type III ACJ dislocation, a two-week sling suffices. Jones strapping has no clear advantage over a shoulder sling. Coracoclavicular reconstruction with an autograft is an acceptable way to treat symptomatic, chronic grade III ACJ dislocation. The survey helped achieve consensus on several controversial issues related to type III ACJ dislocations. However, there remains ambiguity on the definition of chronicity of such dislocations, the necessity of bilateral Zanca views, and the duration of conservative trial before switching to a surgical line of management.
AbstractList The study aimed to report the results of the Delphi survey conducted by the Shoulder, Elbow Society India (SESI), to achieve consensus on ambiguous topics in managing type III acromioclavicular joint (ACJ) dislocations. This study was based on responses from the Shoulder Elbow Society India (SESI) panel of peer-selected twenty senior surgeons practicing shoulder orthopedics. They participated in two rounds of the survey to obtain consensus on several topics pertaining to the management of type III ACJ dislocations. Consensus was achieved when at least 70 % of the panel members selected at least a 4-point on a 5-point Likert scale. Our Delphi survey reached a consensus on seven topics of ambiguity. An anteroposterior and axillary view of the shoulder without any traction or weight in hand is sufficient in the setting of a suspected type III ACJ dislocation. Magnetic resonance imaging (MRI) is not routinely indicated in type III ACJ dislocation. Either cross-arm adduction X-rays or clinical examination may be used to distinguish between ISAKOS (International Society of Arthroscopy, Knee surgery and Orthopaedics Sports medicine) IIIA and B classification of ACJ to identify stable and unstable injuries. Conservative treatment can be offered to patients who have stable injuries and who are not high-demand individuals in acute type III ACJ dislocations. In conservative management of type III ACJ dislocation, a two-week sling suffices. Jones strapping has no clear advantage over a shoulder sling. Coracoclavicular reconstruction with an autograft is an acceptable way to treat symptomatic, chronic grade III ACJ dislocation. The survey helped achieve consensus on several controversial issues related to type III ACJ dislocations. However, there remains ambiguity on the definition of chronicity of such dislocations, the necessity of bilateral Zanca views, and the duration of conservative trial before switching to a surgical line of management.
•An anteroposterior and axillary view of the shoulder without any traction or weight in hand is sufficient in the setting of a suspected type III ACJ dislocation.•Either cross-arm adduction X-rays or clinical examination may be used to distinguish between ISAKOS IIIA and B classification of ACJ dislocation to identify stable and unstable injuries.•Conservative treatment can be offered to patients who have stable injuries and who are not high-demand individuals in acute Type III ACJ dislocations.•A sling for two weeks is sufficient in conservative management of type III ACJ dislocation.•Coracoclavicular reconstruction with an autograft is an acceptable way to treat symptomatic, chronic grade III ACJ dislocation. The study aimed to report the results of the Delphi survey conducted by the Shoulder, Elbow Society India (SESI), to achieve consensus on ambiguous topics in managing type III acromioclavicular joint (ACJ) dislocations. This study was based on responses from the Shoulder Elbow Society India (SESI) panel of peer-selected twenty senior surgeons practicing shoulder orthopedics. They participated in two rounds of the survey to obtain consensus on several topics pertaining to the management of type III ACJ dislocations. Consensus was achieved when at least 70 % of the panel members selected at least a 4-point on a 5-point Likert scale. Our Delphi survey reached a consensus on seven topics of ambiguity. An anteroposterior and axillary view of the shoulder without any traction or weight in hand is sufficient in the setting of a suspected type III ACJ dislocation. Magnetic resonance imaging (MRI) is not routinely indicated in type III ACJ dislocation. Either cross-arm adduction X-rays or clinical examination may be used to distinguish between ISAKOS (International Society of Arthroscopy, Knee surgery and Orthopaedics Sports medicine) IIIA and B classification of ACJ to identify stable and unstable injuries. Conservative treatment can be offered to patients who have stable injuries and who are not high-demand individuals in acute type III ACJ dislocations. In conservative management of type III ACJ dislocation, a two-week sling suffices. Jones strapping has no clear advantage over a shoulder sling. Coracoclavicular reconstruction with an autograft is an acceptable way to treat symptomatic, chronic grade III ACJ dislocation. The survey helped achieve consensus on several controversial issues related to type III ACJ dislocations. However, there remains ambiguity on the definition of chronicity of such dislocations, the necessity of bilateral Zanca views, and the duration of conservative trial before switching to a surgical line of management.
The study aimed to report the results of the Delphi survey conducted by the Shoulder, Elbow Society India (SESI), to achieve consensus on ambiguous topics in managing type III acromioclavicular joint (ACJ) dislocations.PURPOSEThe study aimed to report the results of the Delphi survey conducted by the Shoulder, Elbow Society India (SESI), to achieve consensus on ambiguous topics in managing type III acromioclavicular joint (ACJ) dislocations.This study was based on responses from the Shoulder Elbow Society India (SESI) panel of peer-selected twenty senior surgeons practicing shoulder orthopedics. They participated in two rounds of the survey to obtain consensus on several topics pertaining to the management of type III ACJ dislocations. Consensus was achieved when at least 70 % of the panel members selected at least a 4-point on a 5-point Likert scale.METHODSThis study was based on responses from the Shoulder Elbow Society India (SESI) panel of peer-selected twenty senior surgeons practicing shoulder orthopedics. They participated in two rounds of the survey to obtain consensus on several topics pertaining to the management of type III ACJ dislocations. Consensus was achieved when at least 70 % of the panel members selected at least a 4-point on a 5-point Likert scale.Our Delphi survey reached a consensus on seven topics of ambiguity. An anteroposterior and axillary view of the shoulder without any traction or weight in hand is sufficient in the setting of a suspected type III ACJ dislocation. Magnetic resonance imaging (MRI) is not routinely indicated in type III ACJ dislocation. Either cross-arm adduction X-rays or clinical examination may be used to distinguish between ISAKOS (International Society of Arthroscopy, Knee surgery and Orthopaedics Sports medicine) IIIA and B classification of ACJ to identify stable and unstable injuries. Conservative treatment can be offered to patients who have stable injuries and who are not high-demand individuals in acute type III ACJ dislocations. In conservative management of type III ACJ dislocation, a two-week sling suffices. Jones strapping has no clear advantage over a shoulder sling. Coracoclavicular reconstruction with an autograft is an acceptable way to treat symptomatic, chronic grade III ACJ dislocation.RESULTSOur Delphi survey reached a consensus on seven topics of ambiguity. An anteroposterior and axillary view of the shoulder without any traction or weight in hand is sufficient in the setting of a suspected type III ACJ dislocation. Magnetic resonance imaging (MRI) is not routinely indicated in type III ACJ dislocation. Either cross-arm adduction X-rays or clinical examination may be used to distinguish between ISAKOS (International Society of Arthroscopy, Knee surgery and Orthopaedics Sports medicine) IIIA and B classification of ACJ to identify stable and unstable injuries. Conservative treatment can be offered to patients who have stable injuries and who are not high-demand individuals in acute type III ACJ dislocations. In conservative management of type III ACJ dislocation, a two-week sling suffices. Jones strapping has no clear advantage over a shoulder sling. Coracoclavicular reconstruction with an autograft is an acceptable way to treat symptomatic, chronic grade III ACJ dislocation.The survey helped achieve consensus on several controversial issues related to type III ACJ dislocations. However, there remains ambiguity on the definition of chronicity of such dislocations, the necessity of bilateral Zanca views, and the duration of conservative trial before switching to a surgical line of management.CONCLUSIONThe survey helped achieve consensus on several controversial issues related to type III ACJ dislocations. However, there remains ambiguity on the definition of chronicity of such dislocations, the necessity of bilateral Zanca views, and the duration of conservative trial before switching to a surgical line of management.
ArticleNumber 111467
Author Kocheeppan, Dr. Pradeep
Shah, Dr. Darshil
Shetty, Dr. Nagraj
Chidambaram, Dr. Ram
Modi, Dr. Amit
Kumar, Dr. KR Prathap
Kamat, Dr. Nilesh
Gajjar, Dr. Shreyash
Maheshwari, Dr. J
Tambe, Dr. Amol
Pathak, Dr. Shirish
Sahu, Dr. Dipit
Kar, Dr. Abheek
Babhulkar, Dr. Ashish
Aggarwal, Dr. Raman Kant
Singh, Dr. Harvinder Pal
Selvaraj, Dr. Karthik
Pardiwala, Dr. Dinshaw N.
Kumar, Dr. Kapil
Shah, Dr. Parag
Jos, Dr. Sujit
Easwaran, Dr. Raju
Monga, Prof. Puneet
Pandey, Dr. Vivek
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  surname: Sahu
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  organization: Sir H.N Reliance Foundation Hospital and Research Centre, Prarthana Samaj, Raja Ram Mohan Roy Rd, Girgaon, Mumbai, India
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  givenname: Dr. Raju
  orcidid: 0000-0002-3706-3553
  surname: Easwaran
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  organization: Shree Meenakshi Orthopedics & Sports Medicine Clinic, Max Super-speciality Hospital, East Shalimar Bagh, New Delhi, India
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  surname: Kar
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  organization: Apollo Multispeciality Hospital, Canal circular road, Kolkata, India
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  givenname: Dr. Amit
  surname: Modi
  fullname: Modi, Dr. Amit
  organization: University Hospitals of Leicester NHS Trust, Infirmary Square Leicester Leicestershire LE1 5WW
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  givenname: Dr. Amol
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  organization: University Hospitals of Derby & Burton NHS Foundation Trust, Uttoxeter Rd, Derby DE22 3DT, United Kingdom
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  organization: Deenanath Mangeshkar Hospital, Mhatre Bridge, Pune, India
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  givenname: Dr. Dinshaw N.
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  fullname: Pardiwala, Dr. Dinshaw N.
  organization: Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Four Bungalows, Mumbai, India
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  givenname: Dr. Harvinder Pal
  orcidid: 0000-0002-8686-2802
  surname: Singh
  fullname: Singh, Dr. Harvinder Pal
  organization: University Hospitals of Leicester NHS, Infirmary Square Leicester Leicestershire LE1 5WW, UK
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  givenname: Dr. J
  surname: Maheshwari
  fullname: Maheshwari, Dr. J
  organization: JMVM Sports Injury Centre, Sitaram Bhartia Institute, New Delhi, India
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  organization: Woodend Hospital, Aberdeen, United Kingdom
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  organization: Sunrise Hospital, Seaport - Airport Road, Kochi, Kerala, India
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  organization: Lilavati Hospital, Bandra Reclamation road, Mumbai, India
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  givenname: Dr. Nilesh
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  organization: Jehangir Hospital, Sasoon Road, Pune, India
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  givenname: Dr. Parag
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  fullname: Shah, Dr. Parag
  organization: Fracture and Orthopaedic hospital, Paldi, Ahmedabad, India
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  givenname: Dr. Pradeep
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  organization: Apollo Hospital, Bangalore, Bannerghatta road Jayanagar, Bangalore, India
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  givenname: Prof. Puneet
  surname: Monga
  fullname: Monga, Prof. Puneet
  organization: Upper limb unit, Wrightington Hospital, Wigan, United Kingdom
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  givenname: Dr. Raman Kant
  surname: Aggarwal
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  surname: Pandey
  fullname: Pandey, Dr. Vivek
  organization: Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Keywords Delphi survey
ACJ dislocation
Coracoclavicular joint reconstruction
Type 3 AC joint dislocation
Zanca view
Acromioclavicular joint dislocation
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SSID ssj0017033
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Snippet •An anteroposterior and axillary view of the shoulder without any traction or weight in hand is sufficient in the setting of a suspected type III ACJ...
The study aimed to report the results of the Delphi survey conducted by the Shoulder, Elbow Society India (SESI), to achieve consensus on ambiguous topics in...
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pubmed
elsevier
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Index Database
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StartPage 111467
SubjectTerms ACJ dislocation
Acromioclavicular Joint - injuries
Acromioclavicular Joint - surgery
Acromioclavicular joint dislocation
Consensus
Coracoclavicular joint reconstruction
Delphi survey
Delphi Technique
Humans
India
Joint Dislocations - diagnostic imaging
Joint Dislocations - surgery
Joint Dislocations - therapy
Magnetic Resonance Imaging
Radiography
Societies, Medical
Surveys and Questionnaires
Traction
Type 3 AC joint dislocation
Zanca view
Title Management of type III acromioclavicular joint dislocation: A Delphi consensus survey by Shoulder & Elbow Society, India (SESI)
URI https://dx.doi.org/10.1016/j.injury.2024.111467
https://www.ncbi.nlm.nih.gov/pubmed/39098790
https://www.proquest.com/docview/3088554580
Volume 55
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