Journal of Musculoskeletal Trauma

A Clinical Study of the Trimalleolar Fractures of the Ankle: Sung Jun Kim, Il Yong Choi, Tae Kun Ahn; J Korean Soc Fract 1989;2(2):145-154. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.145

Injuries about the ankle joint resulted in not only fractures of the bone but also ruture of the ligamentous and soft tissue structures and it is important that accurate reduction and rigid internal fixation of fracture as well as repair of ruptured ligament should be performed. The author analyzed 35 cases of the trimalleolar fractures of the ankle which were admitted and treated in Department of Orthopaedic Surgery, Hanyang University Hospital from january 1984 to December 1988. The results obtained from this study were as follows; 1. Among the 35 cases, male was 25 cases(71.4%), female was 10 cases(28.6%), and average age was 37.43 years. 2. The main cause of the fracture was 18 cases of slip down(51.43%), and other causes were traffic accident(22.86%), fall from a height(17.14%), sports injury(5.71%), and other injuries(2.86%). 3. Open fractures were 2 cases(5.7%), and closed fractures 33 cases(94.3%). 4. According to the classification of Lauge-Hansen, the pronation-external rotation type was 22 cases(62.86%), and the supination-external rotation type, 13 cases(37.14%). 5. Open reduction was performed in 25 cases(71.43%), and closed reduction 10 cases(28.57%). 6. The average period of the cast immobilization after open reduction was 10.7 weeks, and 8. Fractures with a posterior marginal fragment invoving 25 percent of more of the tibial articular surface, open reduction was recommended.

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Treatment of the Trimalleolar Fracture Using Posterolateral Approach: Minimum 2-year Follow Up Results
Gwang Chul Lee, Jun-Young Lee, Sang-Ho Ha, Jae-Won You, Sang-Hong Lee, Hong-Moon Sohn, Ki-Young Nam, Kwang-Hyo Seo
Journal of the Korean Fracture Society.2011; 24(4): 328. CrossRef
Treatment of the Posterior Malleolar Fragment of Trimalleolar Fracture Using Posterolateral Approach - Preliminary Report -
Jun-Young Lee, Sang-Ho Ha, Kyung-Hwan Noh, Sang-Jun Lee
The Journal of the Korean Orthopaedic Association.2009; 44(4): 422. CrossRef
The Treatment of Posterolateral Malleolar Fractures using Percutaneous Reduction Technique
Jae-Sung Lee, Han-Jun Lee, Jae-Hyun Yoo, Hee-Chun Kim
Journal of the Korean Fracture Society.2009; 22(1): 19. CrossRef

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A Study of Classification of Ankle Fractures: Se Il Suk, Choon Ki Lee, Soo Ho Lee, Suk Kee Tae, Song Choi; J Korean Soc Fract 1989;2(2):155-163. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.155

Abstract PDF: Lauge-Hansens classification system and Webers classification system are the two most commonly used systems in ankle fractures. both are based on causative mechanism but both have some deficiencies. Authors intended to decide which is easily applicable in clinical practice and shwich provides more information about treatement, especially that of diastasis. So we analysed 143 cases of ankle fractures in Seoul National University Hospital, Kang-nam General Hospital and Namseoul Hospital from January 1983 to December 1988. The results obtained are as follows. 1. Webers type A fractures correspond not only supination-adduction but also to pronation-abduction and pronation-dorsiflexion. Type B fractures correspond most closely to supination-external rotation and possibly to pronation abduction and pronation external rotation. Type C fractures show the nearest equivalence to pronation-external rotation and occasionally correspond to supination-external roation or pronation-abduction. 2. Diastasis was noted in 16 cases(28%) of type B and in 18 cases(74%) of type C and this lower incidence was seemed to be due to neglect of diastasis at physical examination or during operation. 3. It seemed to be more reasonable to fix the diastasis with tibiofibular fixation screw especially in type C. 4. Webers simpler classification system, which can explain the hidden ligamentous injury such as diastasis, was more easily applicable in daily use than Lauge-Hansen classification.

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Analsis of the Distal Tibial Physeal and Epiphyseal Injury: In Ho Choi, Choon Ki Lee, Duk Yong Lee, Se Il Suk, Song Choi, Yong Hoon Kim, Suk Kee Tae, Seong Il Kim; J Korean Soc Fract 1989;2(2):164-173. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.164

Abstract PDF: We have reviewed 21 cases of physeal and epiphyseal fracture of the distal tibia including one case of juvenile Tillaux fracture and four cases of triplane fracture. The patterns of fracture were correlated with the mechanism of injury using the modified Lauge-Hansen method and sysemic classification of the triplane frature was proposed. Treatment included closed reduction and cast(9 cases), closed reduction and percutaneous pin fixation(4 cases), and open reduction(8 cases). Two of the nine patients treated by means of closed reduction and cast had ankle joint incongruity or progressive varus deformity requiring corrective ost eotomy. These two patients had either Salter-Harris Type III ro Type IV fracture after supination-inversion injury. In one patient, who had 100 per cent displacement of the distal tibial epiphysis and degloving injury of the ankle, premature physeal arrest developed after open reduction and internal fixaion for Salter-Harris Type Tyre I fracture. If there are triagular metaphseal ledge along with the juvenile Tillaux fracture-like vertical epiphyseal fracture line on the antero-posterior view and Salter-Harris Type II or Type IV frature on the lateral view, a certain type of triplane fracture is strongly suggested. Plain radiographs, however, could not accurately demontrate the detailed configuration of the triplane fracture, instead computerized axial tomography was very helpful us to analyse the true dimensions of the triplane fracture. We agree that displace Salter-Harri Type III or Type IV and transitional fractures with a fracture gap of more than two millimeters in the weight-bearing portion of the epiphysis regure open reduction.

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Compression Arthrodesis of Ankle Joint using Autocompression Angle Plate: Eun Sun Moon, Eun Kyoo Song, Yong Gi Choi; J Korean Soc Fract 1989;2(2):174-178. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.174

Abstract PDF: We performed the compression arthrodesis in ankle joint of 4 cases, using autocompression angle plate. In all cases, we made successful union within 3 months, without any specific complications. This method gives several advantages, such as short period of external support, good cosmetic effect, early union and early rehabilitation.

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Fracture of the Neck of the Talus: Ik Dong Kim, Poong Taek Kim, Byung Chul Park, Young Wook Choi, Young Gu Lyu, Sung Ho Kim; J Korean Soc Fract 1989;2(2):179-188. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.179

Abstract PDF: We Clinically analysed 10 cases of fractures of the neck of the talus which had been treated at the Department of Orthopedic Surgery, Kyungbook Nantional University Hospital from 1984 to 1988 and the following results were obtained. 1. Of the 10 cases, Hawkiins type I was 2 cases, type II, 4 cases and type III, 4 cases. 2. Avascular necrosis was developed in 7 cases. 1 of type I, 3 of type II and 3 of type III. 3. In all 6 cases with comminution at subtalar and medial aspect of talus, avascular necrosis was developed. 4. Hawkins sign was evident in the plane roentgenogram from 5th weeks to 12th weeks(mean at 8th weeks) and we could diagnose the avascular necrosis of talar body at 9.3th weeks. 5. Bone scan was not a helpful diagnostic tool for the confirmation of the avascular necrosis of the talar body. 6. Absolute non-weight bearing is mandatory until solid union is obtained and partial weight bearing with PTB brace is advisable after emergence of the sign of revasculariztion on the plane roetgenogram. 7. Of the 10 cases of the fracture of the neck of the talus, satisfactory results were obtained in 7 cases and of the 7 cases with avascular necrosis, relatively good results were in 5 cases.

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Clinical Observation for the Treatment of Talus Fracture: Yung Khee Chung, Baek Yong Song, Yong Whan Woo; J Korean Soc Fract 1989;2(2):189-193. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.189

Abstract PDF: Major fractures and dislocations of the talus are uncommon, but the management of this fracture and of the complications is difficult. The results of treatment of this fracture as a whole are generally poor. This is mostly due to frequent complications such as avascular necrosis of the talus. The authors analyzed the 13 cases of the talus fracture and evaluated the results. We obtained the following results; 1. In final results, 3 cases were excellent, 4, cases were good, 3 cases were fair and 2 cases were poor. 2. Avascular necorsis of the talar body occurred in 4 cases of all fractures. 3. Other complications were arthrofibrosis, subtalar arthritis, infection and drsal exostosis of the talar neck.

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Avascular Necrosis After the Fracture of the Neck of the Talus: Chang Ju Lee, Won Ho Cho, Ho Guen Chang, Byung Il Min; J Korean Soc Fract 1989;2(2):194-201. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.194

Abstract PDF: Avascular necrosis was a frequent complication of the fracture of the neck of the talus. Hawkins described a subchondral radiolucency visible in the body of the talus six to eight weeks after fracture. This sign has proved to be a useful objective prognostic sign; the presence of this sign would not undergo avscular necrosis. In eleven patients, serial roetgenograms were examined for this phenomenon. The results were as follows: 1. Six fractures that had the Hawkins sign did not undergo avascular necrosis. 2. Also, we experienced two cases of partial Hawkins sign which developed the partial avascular necrosis.

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Ankle Dislocation Without Associated Fractures: Report of 2 cases: Kyu Hyun Yang, Jun Sub Jahng, Koon Soon Kang, Myoung Hoon Han; J Korean Soc Fract 1989;2(2):202-205. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.202

Abstract PDF: Tibio-talar dislocation that is not associated with fracture is a rare injury. In 1939, Wilson et al. reviewed fourteen cases and described two cases of their own. Since then, there have been few reports of limited experiences. The authors experienced two cases of posteromedial dislocation without fracture among 32 cases of ankle dislocation which were treated at department of Orthopedic Surgery, Yonsei Univeristy College of Medicine from April 1983 to May 1989.

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3 Cases of Open Comminuted Fracture of the Ankle with the Loss of the Lateral Malleolus: Hui Wan Park, Jun Sub Jahng, Koon Soon Kang, Yong Ho Kang; J Korean Soc Fract 1989;2(2):206-210. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.206

Abstract PDF: The importance of fixation of the medial malleolus was stressed in the treatment of ankle joint fractures in the early 60s; later more attention was paid to the effects of the treatment of the lateral malleolus. Fibular integrity is essential in stabilizing of the ankle joint. Loss of lateral malleolus may result in separation of inferior tibiofibular joint, ankle instability and talus displacement. Eventually this leads to traumatic arthritis. The authors experienced 3 cases of loss of lateral malleolus which were treated at Yongdong Severance hospital, Yonsei University College of Medicine. The results were obtained as follows; total loss of lateral malleolus leads to adductioin instability of talus and slightly lateral talar shift, and partial loss of lateral malleolus leads to no lateral talar shift. But the results are obtained for short term and long term follow up is needed.

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A Clinical Study of tibial Pilon Fractures: Key Yong Kim, Duck Yun Cho, Jai Gon Seo, Sung Bum Yang, Kyu Jung Cho; J Korean Soc Fract 1989;2(2):211-218. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.211

Abstract PDF: The tibial pilon fracture is one of the most difficult fracuture to treat because of severe metaphyseal bone defect, comminution of the articular surface, disruption of ankle mortise and accompanying soft tissues injury resulting from axial compression and rotational forces. The recent concept of management of tibial pilon fracture is to open and provide anatomical reduction with stable internal fixation, early joint motion and considerably delayed weight bearing. We reviewed 16 cases of tibial pilon fracture experienced from June 1985 to December 1 988 and the result were as follows; Tibial pilon fracture comprises 8.7% of all ankle fractures(183 cases) during the period and prevalent in male. According to the classification by Ruedi and Allgoewer, 2 cases of typeI, 9 cases of type II and 5 cases of type III. 3 cses treated conservatively and 13 cases operatively. Better results were obtaiined in latter group, and in typeI and type II than III. The important factors influencing the clinical result were the type of fracture and accuracy of reduction including maintainace of fibular length.

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The Treatment of Type III Open Tibia Fractures with Ender Nails: Preliminary Report: Sang Ho Ha, Sang Hong Lee, Dong Min Shin, Jin Seok Park; J Korean Soc Fract 1989;2(2):219-228. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.219

Abstract PDF: Type III open tibial fracture is difficult to treat beacause of frequent complications, and recently external fixation have been used successfully. Intramedullary nailing with flexible nails is now routinely performed in Type I and II open tibial fractures. Thirteen cases of Type III open tibial fractures teated with Ender nails from January 1 983 to December 1988 were identified and retrospectively reviewed. The results were as follows; 1. The patients were predominantly more common in male and the average age was 41 years, and most common cause was traffic accident. 2. According to the Gustilo and Andersons classification, Type III-A was 7 cases, TypeIII-B was 5 cases, and Type III-C was 1 case. All 13 cases were combined fibular fracture. 3. All 13 cases were used two Ender nails, nailing methods were two antegrade insertioni (7 cases), two retrograde insertion (3 cases), and one antegrade & retrograde insertion (3 cases). 8 cases were operated within one day of accident, 7 cases were used other combined metals, and 5 cases were treated with Rush pinning of fibular fracture. 4. Among the secondary additional operation required after Ender nailing, bone operation were 7 cases, soft tissue operation were 5 cases, and delayed amputation were 2 cases. 5. Among II cases except amputation, controversial complications were nonunion (6 cases), chronic osteomyelitis (1 case), delayed union (1 case). 6. A retrospective evaluation of 13 cases treated Ender nailing revealed that Ender nailing was simple, effective method in some selected cases of Type III open tibia fractures.

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Treatment of Patella Fracture Using Wiring Method: Kwon Ick Ha, Sung Ho Hahn, Min Young Chung, Hyun Soo Park; J Korean Soc Fract 1989;2(2):229-233. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.229

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To determine whether any of the commomly used wiring technique are rigid enough to allow early motion in treatment of patellar fracture. Twelve cases of extensively commivuted and displaced patellar fracture were treated using wire technique (circumferential combined tension band wiring) at N.P.H. from April 1987 to April 1989. This method has advatages of simple and rigid fixation and results were satisfactory.

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Results of Tension Band Wiring and Additional Circumferential Wiring in Treatment of Comminuted Patella Fracture
Young Min Lee, Kook Jin Chung, Ji Hyo Hwang, Hong Kyun Kim, Yong Hyun Yoon
Journal of the Korean Fracture Society.2014; 27(3): 206. CrossRef

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Change of Patellar Length after Internal Fixation of the Patellar Fracture: Min Jong Lee, Sang Soo Kim, Kyung Youl Jhon; J Korean Soc Fract 1989;2(2):234-245. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.234

Abstract PDF: As fracture of the patella may casue loss of continuity of the extensor mechanism and incongruity of the patellofemoral joint, the aim of treatment is to restore function and strength of the knee and to minimize posttraumatic osteoathritis by closed or open methods. To know which method is adequate to fixation of the patellar fractures, the authors reviewed 35 cases of the patellar fractures, which were treated with K-wire fixation, circumferential wiring, modified tension band wiring or combined circumferential wiring with modified tension band wiring, with radiological change of patellar length after exercise, and obtained the following results: 1. Postoperative lengthening of the patea occurred in 17 out of 35 cases(49%) and the range was 1.3 to 8.0mm, mean 3.1mm 2. Patellar lenthening occurred in cases with K-wire fixation or cirumferential wiring more than modified thension band or combined circumferential wiring with modified tension band fixation. 3. Modified tension band added to circumferential wiring may be obtained more rigid fixation in comminuted fracture, especially.

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A Clinical Analysis of Supracondylar and Intercondylar Fracture of the Femur: Chang Mu Yu, Jong Oh Kim, Dong Woo Chang, Taik Seon Kim, Jai Ik Shim; J Korean Soc Fract 1989;2(2):246-254. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.246

Abstract PDF: The treatment of supracondylar and intercondylar fracture of femur has been controversial due to its anatomical characteristics and potential complications. We analyzed 27 cases of supracondylar and intercondylar fracture of femur in the Department of Orthopaedic Surgery in Korea Veterans Hospital from Jan. 1983 to Sep. 1988. The results were as follows. 1. The prevalent age distribution were 3rd, 5th and 8th decades(63.2%). 2 The most common cause of injury was traffic accident(48.2%). 3. Fifteen out of nineteen cases treated by anatomical reduction with figid internal fixation achieved satisfactory results(78.9%). 4. Four out of eight cases treated by conservative method achieved satisfactory results(50.0%). 5. The main complications were infection(22.2%), posttraumatic arthritis(2.2%) and malunion(11.1%). 6. The result of treatment depend largely on anatomical reduction, rigid internal fixation and early joint motion.

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Bilateral Femoral Fractures in Adults: Roh Kwon Jae; J Korean Soc Fract 1989;2(2):255-262. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.255

Abstract PDF

Recently, the incidence of multiple trauma combined with cerebral injury and multiple long bone fractures has been increased associatied with the high rate of automobile and the industrial accident. When the femur was fractured, it is difficult to reduce accurately and immoblize due to the displacement, because this bone is responsible for the weight bearing and surrounded by the strong muscle groups. Especially, bilateral fracture of femur which was usually produced by high energy trauma was combined with the other injuries. So the treatment & rehabilitation were difficult and recovery period was prolonged. 11 cases with both femoral fractures which were treated at Department of Orthopaedic Surgery, Ewha Womans University Hospital from January, 1984 to December, 1988 were clinically analyzed and the results were as follows. 1. The prevalent age ranged from 20 to 29 years. 2. Among 11 cases, 7 cases were male nad 4 cases were female. 3. The cause of injury was mainly the dash board injury due to the traffic accident. Of 11 cases, 10 were combined with injuried of another sites. 4. The union time was varied from 12 weeks to 18 weeks and average time was 15 weeks. 5. The complication were limitation of motion of knee joint in 5 cases, nonunion in 2 cases, delayed union, angulation and metalic migration in case, each other. 6. Protected parial wt. bearing was performed between 12 weeks and 20 weeks and non protected full wt. bearing was performed between 6 months and 26 months after operation.

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Femoral Shaft Fracture of a Middle-aged Male Adult during Playing Baseball
Ho-Seung Jeon, Young-Kyun Woo, Seok-Ha Hwang, Seung-Pyo Seo, Ho-Won Jeong, Sung-Tae Lim
The Korean Journal of Sports Medicine.2017; 35(1): 57. CrossRef

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Pervention of the Cortical Breakage by Using the Lowman Clamp During the Flexible Intramedullary Nailing in the cases fo the Trochanteric Fractures: Moo Kyung Ko, Kyung Jo Woo, In jung Chare, Hong Kun Lee; J Korean Soc Fract 1989;2(2):263-268. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.263

Abstract PDF: Flexible intramedullary nailing has offered the many advantages in the treatment of the trochanteric fractures. But there has been many complications such as the knee joint pain, the deformity of external rotation of the femur, insufficient fixation of the fracture, peroneal nerve palsy, cortical breakage of insertion site of nailing and linear fracture of the femur. Of these complications, the cortical breakage and linear fractures of the femur was prevented by suing the Lownam clamp on the proximal site of insertion hole during the nailing. The authors have treated 31 cases of the trochanteric fractures with this method from March 1985 to December 1988 and the results are as follows: 1. There was neither cortical breakage nor linear fracture at the site of insertion hole in all cases of 31. 2. wide operation field was obtained with Lowman clamp by traction of muscles near by. 3. The handle of Lowman clamp can be used as indicator to determine the grade of anteversion. 4. It is confirmed that intramedullary nailing with Lowman clamp is simpler than conventional method and is highly recommended.

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Delayed Femoral Neck Fracture in Interlocking Intramedullary Nailed Femur: A case report: Sung Man Rowe, Eun Sun Moon, Eun Kyoo Song, Sung Taek Jung; J Korean Soc Fract 1989;2(2):269-273. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.269

Abstract PDF: We report an uncommon complication following interlocking intramedullary nailing of the femur: delayed femoral neck fracture after 5 months of unevenful postoperative course. He was a 47-year-old laborer with good quality of bone, nevertheless he sustained femoral neck fracture after minor fall on the ground. We thought that loss of bone elasticity caused by interlocked nail in the whole femoral shaft including intertrochanteric portion made stress concentration on the femoral neck to develop a fracture with minor magnitude of traumatic force.

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Treatment of Nonunion Using Electrical Stimulation Only: Se Il Suk, Moon Sang Chung, Sang Hoon Lee, Phil Hyun Chung, Moon Sung Han, Yong Min Kim; J Korean Soc Fract 1989;2(2):274-280. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.274

Abstract PDF: Negative electric charge is known to induce osteoblastic activity in bone. Therefore, electrical stimulation can be used clinically to promote more active new bone formation in the fracture site. Among many methods in the treatment of fracture nonunion, electrical stimulation can be emplyed as one of the useful methods, which is less of noninvasive and rather simple. We experienced 10 cases of fracture nonunion managed with EST without surgery in the Department of Orthtopedic Surgery of Seoul National University Hospital from September 1980 to March 1987. Of these, 6 cases were managed with semiinvasive direct current method and resulted in union of all cases. 4 cases were managed with nonivasive capacitively coupled electric field method and resulted in union iin 3 cases but in1 case, nonunion persisted till 22 months follow-up. In the 9 cases of satisfactory results, union time varied from 2 months to 9 months with mean of 4 months. No remarkable complication was found in these cases. In conclusion, electrial sitmulation therapy is thought to be one of the useful and hopeful methods in the treatment of fracture nonunion cases in which surgery is not absolutely indicated.

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Free Fibular Graft to the Segmental Dedect of Long Bone: Yung Khee Chung, Jung Han Yoo, Yong Han Woo; J Korean Soc Fract 1989;2(2):281-287. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.281

Abstract PDF: Since the documentation of bone graft techniques by Walther in 1820, it has been used widely for the treatment of nonunion, and bone defect due to osteomyelitis, neoplasm, or trauma, and ofr arthrodesis. But many problems are still remained in the treatment of the extensive bone defect. Therefore, varous techniques have evolved to conventional autogenous graft, fresh allograft bone trandsplantation, or free vascularized bone graft. According to Dell P.C. et al, the vascularized grafts were transiently stronger than the conventional nonvascularized ones at six weeks postoperatively because of the differences in the repari mechanisms but thereafter there were no appreciable differences. Therefore, except an inadequate soft tissue bed such as in a chronically infected nonunion, a congenital pseudarthosis, and a previously irradiated or heavily scrred soft tissue bed, we expect good result with conventional nonvascularized fibular graft when there is a segmental bone defect less than 12cm, and/or inadequate fascilities for the microvascular surgery. The four patients with the segmental defect of long bone were treated with conventional nonvascularized fibular graft at Kang Nam Sacred Heart Hospital between July 1980 and October 1988, and are reported with reviews of literatures.

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Treatment of Distal Clavicular Fracture with Ruptured Coracoclavicular Ligament by Weaver and Dunn Method: In Heon Park, Kee Byoung Lee, Myung Ryool Park, Jin Young Lee, Kyun Ho Chang; J Korean Soc Fract 1989;2(2):288-291. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.288

Abstract PDF: We reported two patients with fracture of distal clavicle combined with rupture of the coracoclavicular ligament which was treated by Weaver and Dunn method recently. The following results were obtained: 1. The over all recovery were graded good. 2. The Weaver and Dunn nethod is recommendabel for several reasons such as relatively easy surgical procedure, elimination of secondary procedure and degenerative change of the acromioclavicular joint, cosmetic acceptability and early functional recovery.

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