Title : Role of true axial X-ray in management of ACJ Injuries - QIP
Abstract:
Introduction: Acromio Clavicular (AC) joint dislocations are common injuries. Differentiating between horizontal and vertical instability is challenging, but it is possible to diagnose these conditions using axial radiographs. Accurate joint reduction is easier when surgery is performed within the first two weeks post-injury, as the ruptured ligamentous restraints can often be repaired directly. However, complete reduction becomes more difficult if several months have passed since the injury, making it challenging to identify and repair the native ligaments.
Aim: We reviewed AC joint injuries three years and assessed their imaging against the guidelines provided in the paper "The True Axial Shoulder Projection: Diagnostic Aid for Acromioclavicular Joint Dislocation," published in January 2020. Additionally, we monitored the time interval between injury and surgery against the standards outlined by Fraser-Moodie JA, Shortt NL, Robinson CM in their study "Injuries to the Acromioclavicular Joint," published in J Bone Joint Surg Br (2008).
Methods: This was a retrospective audit of ACJ injuries from December 2019 to September 2022. Data were collected using various software programs, covering 33 patients (excluding one patient due to clavicular fracture). The data included information on diagnosis, date of injury, grades, the date of the first x-ray, the date of the first axial x-ray, ACJ measurements, management details including the date of operation, and implant type. Inclusion criteria were limited to ACJ injuries, while clavicular or humeral injuries were excluded.
Results: Patient ages ranged from 20s to 60s, with 78% of cases falling between grades 2 and 4. The majority of initial x-rays were performed in the Accident & Emergency (A&E) department, with around half of the patients receiving their axial x-ray during their first x-ray session. Out of 33 patients, 32 underwent an axial x-ray, but only 6 had a true axial x-ray. Additionally, 72% of patients had a face-to-face clinic visit.
Conclusion: Concerning the time interval between the date of injury and the operation, the guidelines suggest that surgery should be performed within two weeks (as per Injuries to the Acromioclavicular Joint, J Bone Joint Surg Br 2008). However, all cases in our data set that underwent surgery had it performed between 20 to over 70 days post-injury, exceeding the recommended two-week timeframe. This delay can complicate the reduction of the AC joint.Through positive discussions with the radiology department, we successfully changed the policy to ensure that a true axial x-ray is performed for all patients presenting with an AC joint injury.
