Subacromial morphometric assessment of the clavicle hook plate
Section snippets
Materials and methods
Ethical approval to undertake this study was obtained from our institutional ethics board (Protocol #: 2007-037) and the University of Toronto (Protocol #: 22238). We evaluated 16 fresh frozen cadaveric shoulder specimens with the upper torso intact (eight male, eight female, mean age 74.8 ± 20.2 years). Specimens with external signs of shoulder surgery or disruptions to the sternoclavicular or the acromioclavicular joint were excluded. During the process of clavicle hook implantation and
Results
Sixteen shoulder specimens (eight male and eight female) were implanted with clavicle hook plates. After initial dissection, one specimen was excluded due to the presence of large osteophytes on the head of the humerus and the glenoid fossa. As a result, 15 specimens (n = 15; seven male and eight female) met all inclusion criteria and were subject to digital and statistical analyses. All seven male specimens received an 18-mm implant. Four female specimens received 15-mm implants; the remaining
Discussion
The results of our study indicate a high degree of inter-specimen variability in both the morphological dimensions of the acromion and the position of the subacromial hook, relative to specific points on the acromion. Our observation of sex differences in acromion width (male (M) = 45.3 ± 4.6 mm, female (F) = 36.7 ± 5.9 mm) and thickness (M = 6.1 mm, F = 4.4 mm) is consistent with the findings of Nicholson et al. on over 400 scapulae (M = 48.5 mm, 7.7 mm; F = 40.6 mm, 6.7 mm, respectively).34 We noted the mean
Conclusions
Our results suggest that the unique anatomy of each patient, and the lack of standard acromion dimensions, impact the location and position of the subacromial hook when a clavicle hook plate is used. The observed frequency of hook contact with surrounding subacromial structures in a static shoulder confirms that the position of the hook portion of the implant can predispose anatomic structures to the post-operative complications of subacromial impingement and bony erosion.
Conflict of interest
None of the authors, their immediate families, or any research foundation with which they are affiliated received financial payments or other benefits from any commercial entity related to the subject of this article.
Funding source
Funding of this study was provided through an unrestricted research grant from Synthes® (Canada) Ltd. Synthes® reviewed the attached article prior to its submission to this journal. However, Synthes® at no time participated in the data collection, data analysis or preparation of the article.
Acknowledgements
We would like to thank William Wood in the Division of Anatomy and John Geary, M.Sc. PT, for their technical services. We would also like to thank Synthes® (Canada) Ltd. for providing an unrestricted research grant and the clavicle hook plates used in this study.
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