アルコール依存症患者の鎖骨遠位端骨折にフックプレートを使用した際の問題点

概要

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Acromioclavicular hook plate (AC hook plate) is one of the treatment options for distal clavicle fracture. We experienced two cases of displacement of the plate one month after the operation. Both of them were alcoholic, which may be a high risk factor. Case 1 was a 55-year-old female. Her chief complaint was left shoulder pain. She suffered the distal clavicle fracture by a fall on her shoulder when she was drunk. The fracture was fixed with the AC hook plate one week after the first admission. X-ray at 28 days after surgery showed the hook of the plate displaced over the acromion. Fracture was finally fixed by tension band wiring, and we observed that the hook separated the acromion.Case 2 was a 34-year-old male. His chief complaint was left shoulder pain. He suffered distal clavicle fracture by a direct falling impact of a heavy object, and was operated on 8 days after the first admission. He also showed the hook displaced over the acromion after a fall two days after the operation. Later we learned he was an alcoholic. The fracture was also re-operated on using tension band wiring. We found the acromion was separated by the hook.We usually use AC hook plate for distal clavicle fracture, and only these two cases resulted in failure. They are young enough for secure fixation, but the operative findings demonstrated the acromion was separated by the hook. In these cases, cause of failure may be alcoholism and a consecutive decrease in bone strength.