In the world of orthopedic surgery, the reconstruction of the acromioclavicular joint (ACJ) post-injury is a well-documented procedure aimed at restoring shoulder function and stability. However, a recent case study has brought to light a disconcerting complication that, although rare, can have severe implications for patients: osteomyelitis following ACJ reconstruction.
A Case Requiring Attention
A 31-year-old male, having endured a Rockwood 5 ACJ dislocation – a severe injury where the collarbone is displaced from the acromion – underwent an anatomical reconstruction that involved using autogenous gracilis and semitendinosus grafts, two bioscrews for the ACJ, and the coracoclavicular ligament, supported temporarily with two K-wires. Despite the routine nature of the surgery, the patient developed osteomyelitis, a bone infection that can lead to significant morbidity and increased medical costs. The case details, published in the Chinese Journal of Traumatology (Yeak R.D., Daud H., Nizlan N.M. 2019), are stirring the medical community to re-evaluate post-operative care strategies aimed at infection prevention.
The Medical Study and Its Implications
The DOI for the article detailing this rare complication is 10.1016/j.cjtee.2019.03.004, and for further understanding, one can refer to the published article in the Chinese Journal of Traumatology, 22(3), 182-185. The case has raised questions about the potential for devastating outcomes such as osteomyelitis after what’s classified as a routine ACJ reconstruction surgery.
Complications in ACJ Surgery
Complications following ACJ reconstruction surgery, like any other orthopedic procedure involving implants, are not unheard of. Infection rates vary, and superficial infections are known to occur. Clavert et al. (2015) report complication rates after arthroscopic ACJ dislocation fixation (Orthop Traumatol Surg Res, 101(suppl):S313–S316. DOI: 10.1016/j.otsr.2015.09.002), and Martetschläger et al. (2013) discuss the complications after anatomic fixation and reconstruction of the coracoclavicular ligaments (Am J Sports Med, 41:2896–2903. DOI: 10.1177/0363546513506562). These studies show varying rates of complications but do not emphasize the risk of developing osteomyelitis.
Addressing Infection Post-Surgery
The prevention and management of infections after ACJ reconstruction are paramount to a successful recovery. Neault et al. (1996) highlighted infections post nonabsorbable tape or suture repair of ACJ separations (J Shoulder Elb Surg, 5:477–478. DOI: 10.1016/S1058-2746(96)80033-2), indicating the importance of addressing this issue in postoperative care. Moreover, Provencher et al. (2009) provide insight into avoiding and managing complications of ACJ surgery, yet there remains a gap pertaining to osteomyelitis specifically.
The case report by Yeak et al. has the potential to spur changes in clinical practice, emphasizing the necessity for acute awareness and stringent infection prevention measures postoperatively.
Keywords
1. Acromioclavicular joint reconstruction complication
2. Postoperative infection in shoulder surgery
3. Osteomyelitis after ACJ surgery
4. Shoulder surgery risks and complications
5. ACJ injury and reconstructive surgery
Conclusion
Osteomyelitis following acromioclavicular joint reconstruction surgery is a rarity but carries substantial implications for the patient, including increased morbidity and health care costs. The medical community, while aware of the risks, must intensify efforts in infection prevention to mitigate such devastating outcomes. As such, the field of orthopedic surgery and particularly ACJ reconstruction must continuously evolve, with a strong emphasis on patient safety, to prevent occurrences of severe complications such as osteomyelitis.
References
1. Yeak R.D., Daud H., Nizlan N.M. (2019). Osteomyelitis post acromioclavicular joint reconstruction. Chinese Journal of Traumatology, 22(3), 182-185. DOI: 10.1016/j.cjtee.2019.03.004
2. Clavert P., Meyer A., Boyer P. (2015). Complication rates and types of failure after arthroscopic acute acromioclavicular dislocation fixation. Orthop Traumatol Surg Res, 101(suppl):S313–S316. DOI: 10.1016/j.otsr.2015.09.002
3. Martetschläger F., Horan M.P., Warth R.J. (2013). Complications after anatomic fixation and reconstruction of the coracoclavicular ligaments. Am J Sports Med, 41:2896–2903. DOI: 10.1177/0363546513506562
4. Neault M.A., Nuber G.W., Marymont J.V. (1996). Infections after surgical repair of acromioclavicular separations with nonabsorbable tape or suture. J Shoulder Elb Surg, 5:477–478. DOI: 10.1016/S1058-2746(96)80033-2
5. Provencher M.T., LeClere L.E., Romeo A.A. (2009). Springer, Avoiding and Managing Complications of Surgery of the Acromioclavicular Joint. DOI: 10.1007/978-1-4419-0383-4_5