DUBAI 5 January 2019: 42-year-old John Dingo Demadura Rojas, a resident of Dubai was biking in a mountainous area when he had an accidental fall and injured his left clavicle.
In severe pain John was rushed to another hospital where he was advised to undergo an open surgery to restore the shoulder function. However, he approached Zulekha Hospital Sharjah for a second opinion and was keen on an alternative to the open procedure. The diagnosis revealed a grade 3 (complete) dislocation of the lateral end of the clavicle – left shoulder. It was observed that the joint between the clavicle and shoulder blade had disrupted owing to complete disruption of ligaments. This resulted in dislocation of one end of the collar bone. His shoulder movements were painfully restricted in all the planes and there was a palpable deformity over the superior aspect of the shoulder from the dislocated collar bone.
After a thorough assessment, considering John’s desire to restore his shoulder functions through a key hole surgery, Dr. Biju Pankappilly, Specialist Orthopedic Surgeon advised an arthroscopic assisted reduction of the joint with suspensory devices, along with a semitendinosus autograft augmentation for superior results. This is a biological augmentation for added stability and speeds-up the healing process.
During the arthroscopic surgery, small key holes were made around the shoulder through which an arthroscope was introduced into the shoulder joint to look for any additional intra articular pathologies inside the shoulder which are very common following a fall on the shoulder. Intraarticular injuries can be been easily missed if one resorts to an open surgery alone. The patient had a very small partial thickness rotator cuff tear which needed only debridement. Dissections had to be made around the Neuro vascular structures to aid in passing the tendon autograft through the key holes with specialised instruments – this was the most difficult part of the surgery. A small 1.5 cm incision was made over the collar bone for the purpose of drilling and a suspensory device with suture tapes and titanium buttons on both the ends were inserted to hold the acromio clavicular joint in reduced position. Semi tendinosis tendon graft taken from his leg further supported the fixation.
The patient said: “While I was worried about the incident keeping me away from my routine and sporting activities, it was an excellent experience to have had the procedure done through an arthroscopic technique. I have very little pain and I am confident I will be able to recover faster and have normal shoulder movements that will help me get back to my sporting activities in the weekends with family and friends.”
Dr. Pankappilly added: “Most people with low demands can be treated conservatively with such injuries as long as they do not mind a bony prominence from the dislocated collar bone over their shoulder and a dull ache at times. I would recommend surgery for people taking part in overhead sports, contact sports such as football or rugby, cyclists and manual labourers. Neglected injuries in this group of people may cause persistent pain and dysfunction in the shoulder and will affect their performance as they need overhead activities in their career.”
“Most surgeons perform the surgery as an open procedure. The results may be equally good but with a larger incision and dissection causing more postoperative pain to the patient and a delayed recovery time. Moreover arthroscopic surgery enables one to diagnose and treat any intraarticular pathology present. Patients who desire better cosmesis, less pain and a faster recovery will benefit more from an arthroscopic assisted procedure – this is what we did to help John.”
“The suspensory device plays a vital role in holding the reduced joint in position until the ligaments heal and the biological augmentation will make the construct much stronger speeding up the recovery. In an acute situation, one can opt not to have the tendon augmentation. However, in John’s case it was more than two weeks since his injury happened, which meant that the ligaments would have already started healing in an elongated position. This is why we decided to augment the reconstruction with a tendon graft,” he concluded.
The patient’s post operation X-ray shows excellent reduction of the dislocated acromioclavicular joint. John started his home physio sessions the day after the surgery and as time progresses he will be put on more aggressive regimes. If all goes well, John should be able to resume his biking activities in 3-4 months’ time.