Name:
Modified Weaver Dunn
Description:
Modified Weaver Dunn
Thumbnail URL:
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Duration:
T00H08M09S
Embed URL:
https://stream.cadmore.media/player/66675ce2-7fb5-4883-93be-0e6e29cb64d0
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/66675ce2-7fb5-4883-93be-0e6e29cb64d0/Modified Weaver Dunn.mp4?sv=2019-02-02&sr=c&sig=SojvxvGIw4zSneg297JJNU6LlmO%2B0kniGPgMgpp%2FsIY%3D&st=2024-11-21T16%3A28%3A37Z&se=2024-11-21T18%3A33%3A37Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
The patient is a 43-year-old gentleman with chronic instability of the right AC joint. On imaging, it appears to be grade three, but clinically, AP instability can be seen making it a grade 4 dislocation.
With the patient in the beach chair position. I prefer to make an incision along the underside of the clavicle centered on the coracoid, as this is an extensile exposure for this particular procedure. Using the diathermie, an incision is made along the platysma, overlying the clavicle.
It's important to fully expose the lateral clavicle as access to the coracoid, the AC joint and the CA ligament will be required. In chronic cases, there is always a lot of scarring under the clavicle. It will also be seen that at the end of the procedure there is a lot of redundant tissue superiorily as this has been chronically stretched by the dislocation of the lateral clavicle.
Once the clavicle has been exposed and mobilized, the superior surface of the coracoid needs to be identified. Using this technique, it is not necessary to identify the inferior surface in any way. It is then relatively easy to identify the CA ligament as it comes off the coracoid laterally.
Sharp dissection is necessary to release the superior and inferior borders before the acromion is identified. Using a scalpel, the CA ligament is released from the under surface of the acromion. Using this technique, it is not necessary to take a bone block.
Once released, the adhesions can be mobilized further to give the full excursion of the ligament. A fiber wire whip stitch is then inserted along the superior border and brought up the inferior border to produce two tails.
In chronic cases there is often a lot of damage to the AC joint, and it is necessary to remove approximately 5 millimeters of the distal clavicle. This is done using a saw. The blade can then be used to chamfer the edges of the clavicle, to avoid any sharp edges which can be palpated under the skin.
A 3.8 millimetre drill hole is made in the clavicle above the coracoid. The same drill is used to make a hole through the coracoid just in front of the clavicle as a separate step.
The socket for the CA ligament is made using a 6 millimetre flip cutter. This is positioned approximately halfway from the previously made hole and the lateral clavicle. Once the drill has passed all the way through the clavicle, the blade is flipped and a socket made in the under surface of the clavicle itself. Using the nitinol passing wire,
the tight rope is passed through the clavicle.
Once through the clavicle, the button is grasped and placed in the previously drilled coracoid hole. Using the mosquito, the button is pushed in firmly until it is flush with the superior surface. May not push or the drill bit can then be used to push the button all the way through the coracoid until it flips on the other side.
Security can be confirmed by pulling on the white sutures, both on the leading button and on the superior button. The tight rope construct is then reduced but not tied down at this stage. The nitinol passing wire is then used to pull the whip stitch through the lateral clavicle hole from inferior to superior.
The AC joint is reduced completely before the tight rope is tied securely. The whip stitch sutures are then tied over a dog bone button to complete the repair.
Now the clavicle has been reduced to its anatomical position in relation to the joint, it can be seen how stretched and loose the superior capsule and superior tissues are. An essential part of the procedure is a secure repair of all of the redundant superior tissue. I prefer to do this using an interrupted fibre wire before closing the fat with a continuous absorbable suture and the skin with a continuous subcuticular suture.
Patient is then placed in a sling for four weeks to further protect the repair before full range of motion activities are resumed.
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