AIM: To evaluate the effects of rehabilitation training after surgical treatments on severe acromioclavicular dislocation (Post III-VI) and distal clavicle fracture (Neer II) using the clavicular hook plate. MTHODS: Thirty-five patients with acromioclavicular dislocation (Post III-VI) or distal clavicle fracture (Neer II), who underwent open reduction and internal fixation with clavicular hook plate, were selected from the Department of Orthopedics, Dongguan Hospital of Traditional Chinese Medicine between January 2001 and January 2004. All the subjects included 20 cases of acromioclavicular dislocation (11 of Post III, 7 of Post IV, 1 of Post V, and 1 of Post VI) and 15 of distal clavicle fracture (Neer II). The 35 patients were divided into systemic rehabilitation training group (n = 24) and non-training group (n = 11). The rehabilitation training consisted of three steps: 1 The first step (within two weeks postoperatively): Passive activity of shoulder joint was the main training. Affected limbs were kept in a sling with scarf bandage in one week after operation. Training on shoulder joint at the second postoperative day was composed of pendulum training; passive anteflexion and rising; passive external rotation; passive abduction, adduction and internal rotation. Training on shoulder joint at two weeks after operation included trainings on abductor muscle group, extensor muscle group of shoulder joint, rising of scapula muscle group, adduction of scapula muscle group, internal rotation of muscle group and external rotation of muscle group. 2 The second step (within 3 to 6 weeks after operation): Active activity of shoulder joint was the main training, including training of activity and muscle strength, endurance training, and training of daily activity. 3 The third step (6 months after operation): The intensity of range-of-motion exercise was strengthened, and the range of dragging and pulling shoulder joint was enlarged. The optimal sports items were swimming, ping-pong, and others, but not contractive sports. Patients in the non-training group had self-exercise according to the tolerance degree of pain. Shoulder function was assessed by the Constant score system at 6 weeks and 1 year after operation, respectively. The scale consisted of three items: pain, daily activity and range of shoulder joint motion with the total score of 100 (scoring 90 to 100 as good, 75 to 89 as fair, 60 to 74 as middle, < 60 as bad). Meanwhile, adverse events and ill effects were observed. RESULTS: All the 35 patients enter the result analysis. (1) Range of shoulder motion: Six weeks after operation, the active range of motion was 86 degrees for anteflexion, 28 degrees for posterior extension, 87 degrees for abduction, 26 degrees for adduction, 15 degrees for external rotation and 45 degrees for internal rotation in the training group. Correspondently, they were 69 degrees, 25 degrees, 61 degrees, 24 degrees, 14 degrees and 43 degrees in the non-training group, respectively. Range of anteflexion and abduction was larger in the training group than in the non-training group (p < 0.05). After one year, there was no difference in the range of motion between the two groups. (2) Constant score system: After 6 weeks, the score in the training group was 75, significantly higher than 61 in the non-training group (p < 0.05). The range of anteflexion and abduction was larger in the training group than the non-training group. After one year, there were 18 good cases and 6 fair cases in the training group, and 6 good cases, 4 fair cases and 1 middle case in the non-training group. After 6 weeks, range of anteflexion and abduction was widened in the training group as compared with the non-training group. Scores on constant score system were also higher in the training group. 3 Adverse events and ill effects: No wound infection, loosening of the internal fixation, breakage of the plate and refracture or redislocation was observed in the two groups. CONCLUSIONS: Rehabilitation intervention properly after surgical treatment on severe acromioclavicular dislocation (post III to VI).

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