الفهرس 
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Abstract
The aim of this work was to study the results of surgical reapair of acromioclavicular joint dislocation using modified Weaver Dunn operation.
Resection of the distal end of the clavicle was suggested in 1917 by Cadenet and in 1972 was reported by Weaver and Dunn, who used the technique for both acute and chronic type III injuries. Modifications of the Weaver Dunn method were subsequently described by other authors and were felt to be especially useful for a more-active population. The coracoacromial ligament, with or without an accompanying piece of bone, may be transferred to the clavicle and can be supplemented with coracoclavicular augmentation by surgical loop.Such concepts of coracoclavicular augmentation in conjunction with the Weaver–Dunn operation have been supported by the results of experimental studies.(70,71)
Modified Weaver Dunn procedure was performed in all patients. The incision was designed based on appreciation of the relevant anatomical landmarks, anterior aspect of theacromion, lateral clavicle, and coracoids process. A strap incision was made from approximately 2-3 cm posterior to the AC joint and was extended to the tip of the coracoid process. The strap incision was advantageous not only because it was cosmetically acceptable, but also because it allowed visualization and exposure of the important anatomical areas. The procedure entails resection of distal 1.5 cm of the calvicle and making 2 drill holes in it, then coracoclavicular ligaments repair if possible followed by dissection of the coracoacromial ligament and taking its medial half preferably with a piece of bone from under surface of acromion to be implanted as graft in the resected distal end clavicle, this was followed by coracoclavicular augmentation by surgical tape or orthocord.
Modified Weaver Dunn procedure is not very common owing to its high technical difficulty than other surgical procedures used in treatment of AC dislocation. It is technically difficult to achieve a complete coracoacromial ligament release, coracoclavicular augmentation and postoperative pain inhibits the unrestricted range of motion needed to maintain motion.(69,70)
The study included twenty patients. The inclusion criteria were history of trauma whether direct or indirect,acute onset of shoulder pain, limitation of both active and passive range of motion.
There were 16 males (80%) and 4 females (20%). All patients were right handed, the right shoulder was affected in 9 patients (45%),theleft shoulder was affected in 11 patients (55%). Eight patients (40%) had diabetes mellitus and 4 patients were insulin dependent.One patient (5%) had cervical spondylosis. Thirteen were heavy workers, 3 were office workers and 4 were house wives. There were 8 patients suffering from symptoms for less than one week (acute dislocation) , 3 patients suffering from symptoms for less than 3 months and 9 patients suffering for more than 3 months (chronic dislocation). All the included patients in the study had previous unsuccessful treatment outside the hospital in the form of sling immobilization, non steroidal anti-inflammatory drugs, local steroid injection and physiotherapy.
Postoperatively, patients started shoulder stretching exercises. The patients were assessed clinically before and after surgery using the Constant and Murley shoulder score.The patients were followed up weekly for the first month post-operatively and then monthly for 5 month,all the patients completed the 6 month follow up period.
At the end of follow up, eleven patients (55%) had excellent results, seven patients (35%) had good results and two (10%) had fair results. There was a statistically significant increase in the overall Constant score with significant improvement in pain, shoulder range of motion, activity of daily living and muscle strength.The patients’ age ,sex ,side affected, previous treatment or duration of symptoms didn’t affect the final results.
One patient was 55 years old, female insulin dependent diabetic patient complained of recurrence of moderate pain at 2 months follow up ,but the pain significantly improved after taking NSAIDS, the patient was graded as good. Another patient was 27 years old had AC joint subluxation at 3 months follow up, the patient was graded as good.