Search Results (36)

This study investigates the total carbon dioxide (CO₂) emissions from various types of passenger vehicles in five Latin American countries: Argentina, Brazil, Ecuador, Mexico, and Paraguay. The aim was to analyze to which degree CO₂ output can be reduced in Latin America by switching from petrol cars to electric cars. The vehicles analyzed include petrol-driven cars, short-, mid-, and long-range battery electric vehicles, fuel cell electric vehicles, plug-in hybrid electric vehicles, and hybrid electric vehicles. The study examines the total CO₂ emissions including battery production, vehicle manufacturing, and their operation, considering the energy grid mix of the selected countries for the year 2023. Using experimental data and considering production conditions yields more reliable results than previous studies. The results indicate that battery cars with the shortest cruising range using batteries produced in Europe and/or America generate the lowest levels of CO₂ emissions, regardless of the energy mix. However, the emission values vary across different countries. In countries with a predominant share of renewable energy for the electricity generation, such as Paraguay, Brazil, and Ecuador, battery cars are the most effective in reducing overall CO₂ emissions. Conversely, in countries like Argentina and Mexico, where renewable energy sources constitute a smaller share of the energy mix, the use of electric vehicles yields only a minor reduction in CO₂ output, while emissions of long-range vehicles with batteries produced in Asia even exceed those of internal combustion engine vehicles. Therefore, eco-friendly electricity generation is a prerequisite for eco-friendly use of electric cars and should therefore be the goal of every country. Full article

Background/Objectives: Acromioclavicular (AC) joint injuries account for 9–12% of shoulder injuries, predominantly affecting young male athletes. While conservative treatment is established for Rockwood type I–II injuries and surgery is widely regarded as indicated for type V–VI, management of type III–IV injuries remains controversial. Biomechanical studies have shown superior results in combined reconstruction of the coracoclavicular and AC ligament complex, however clinical data is scarce. Therefore, the present study aimed to assess whether the addition of an acromioclavicular ligament reconstruction to an isolated coracoclavicular repair offers superior clinical and radiographic outcomes in the treatment of acute AC joint dislocations. Methods: A retrospective multicenter study was conducted on patients with Rockwood type III–VI AC joint injuries who underwent surgical treatment between 2019 and 2024. Patients were divided into two groups: isolated CC reconstruction (group I) and combined CC and AC ligament reconstruction (group II). Clinical outcome was assessed using patient-reported outcome measures (American Shoulder and Elbow Surgeons Score, Simple Shoulder Test, Single Assessment Numeric Evaluation, Visual Analogue Scale) and radiographic evaluations were performed regularly up to 6 months postoperatively. Results: Fifty-five patients (94.5% male, mean age 33.5 ± 10.9 years) were included in the present study. High patient satisfaction (group I: ASES 96.3 ± 7.9, SST 99.2 ± 3.3, SANE 95.3 ± 7.0; group II: ASES 95.8 ± 8.8, SST 96.8 ± 8.2, SANE 93.6 ± 12.8) was documented in both groups, but no significant differences were observed. The median coracoclavicular loosening ratio was 24.7% in the CC group and 32.6% in the CC and AC ligament reconstruction group (p = 0.830). Five complications occurred: two infections and three revision surgeries due to excessive secondary dislocations. Conclusions: Both surgical techniques demonstrated excellent clinical outcomes. In this study combined CC and AC ligament reconstruction did not yield superior clinical or radiological results compared to isolated coracoclavicular reconstruction. Our findings suggest that a routine AC ligament augmentation may not be necessary in all patients. Further randomized controlled trials are needed to validate these results. Full article

Background: Outpatient Parenteral Antimicrobial Therapy (OPAT) is a validated alternative to inpatient care for complicated infections, ensuring clinical efficacy, safety, and cost-effectiveness. However, its impact on patient-centered outcomes such as nutritional status, frailty, and cognitive well-being has rarely been studied. Methods: We conducted a multicentric retrospective observational study of patients treated with OPAT between April 2024 and July 2025 in two tertiary care hospitals. Baseline demographics, comorbidities, weight, frailty status (Rockwood Clinical Frailty Scale (CFI)), and infection-related variables were collected. Follow-up assessments evaluated body weight, frailty, and subjective cognitive status. Clinical outcomes, adverse events, and hospital readmissions were recorded. Results: Of 139 patients treated with OPAT, 119 were included in the analysis (56% male, median age 67 years). Common comorbidities were ischemic heart disease (33%), diabetes mellitus (29%), chronic pulmonary disease (22%), and solid tumors (19%). The most frequent infections were urinary tract infections (UTIs) (29%), osteomyelitis (25%), and pneumonia (17%). Multidrug-resistant (MDR) organisms were isolated in 66% of cases. Clinical recovery occurred in 82,5% of patients, while 16% required readmission in the next 30 days; no deaths were reported. Body weight (median 73 vs. 73.0 kg at baseline, p = 0.43) and frailty index (median 2.5 vs. 2.4, p = 0.16) remained stable. Cognitive status was unchanged in 85.6%, declined in 5.9%, and improved in 8.5%. Conclusions: OPAT was confirmed to be clinically robust and well tolerated, with additional potential benefits in preserving weight, frailty status, and cognitive well-being. These findings suggest that OPAT not only ensures infection control but may also protect against hospitalization-related functional decline. Prospective studies incorporating standardized geriatric and cognitive assessments are needed to confirm these preliminary findings and define OPAT’s broader role in holistic patient care. Full article

Background: Despite chemotherapy-related toxicities being more likely in older patients, no routine prediction tool has been validated for the UK population. Previous research within the TOASTIE (tolerance of anti-cancer systemic therapy in the elderly) study found a low predictive performance of the Cancer and Aging Research Group (CARG) score for severe chemotherapy-related toxicities. Building on this, the TOASTIE study dataset was used to assess the viability of developing a predictive model with baseline variables and frailty scores for severe chemotherapy-related toxicities in older patients. Methods: All patients from the TOASTIE dataset were included, with the inclusion/exclusion criteria detailed in the TOASTIE protocol. Demographic factors, self-assessment scores, Rockwood Clinical Frailty Score and researcher’s estimated risks of toxicity were assessed for their association with severe chemotherapy-related toxicities. After data partition into 70:15:15 train/validation/test, models were built on the training dataset using logistic regression (LR), LASSO and random forest (RF). Models were optimized with a validation set with LR and LASSO; cross-validation was used with RF. Model performance was assessed with balanced accuracy, NPV and AUC. Results: Of the 322 patients included, the incidence of severe toxicities was 22% (n = 71). Ten variables were statistically significant, albeit weakly associated with severe toxicities: primarily patient-reported factors, Performance Status and high baseline neutrophil count. LR models gave the best balanced accuracies of 0.6382 (AUC 0.6950, NPV 0.8696) and 0.6469 (AUC 0.6469, NPV 0.4286) with LASSO, and 0.6294 (AUC 0.6557, NPV 0.6557) with RF. Conclusions: Models lack sufficiently robust results for clinical utility. However, a high NPV in predicting no toxicity could help identify lower-risk patients who may not require dose reductions, potentially improving overall outcomes. Full article

Background: For high-grade dislocation of the acromioclavicular (AC) joint, surgical treatment is widely recommended. This study aimed to evaluate the clinical and radiological outcomes after arthroscopic-assisted stabilization of acute high-grade AC joint dislocations using a low-profile suture button (LPSB) combined with percutaneous AC cerclage fixation. A secondary objective was to quantify clavicular tunnel widening (cTW) and explore its correlation with clinical and radiological outcomes. Methods: This retrospective study included 45 patients with acute Rockwood type V injuries treated with the LPSB technique and additional AC cerclage. Clinical outcomes were the Constant Score (CS), Subjective Shoulder Value (SSV), Taft Score (TF), AC Joint Instability Score (ACJI), and VAS for pain upon palpation. Radiological assessment included coracoclavicular (CC) distance and percentage deviations compared to the contralateral side, reclassified according to Rockwood, dynamic posterior translation (DPT), cTW measurements, and assessment of ossifications and AC joint osteoarthritis. Results: After 35.3 months, significant improvements were observed in CC distance and percentage deviation. A total of 27.3% were reclassified as Rockwood type III and 2.3% as type V. Initial overreduction persisted in 18.2%. DPT was observed in 34.1% of cases. The mean CS was 89.64, the SSV was 91.1, and the VAS was 0.8. cTW occurred only below the superior button and increased significantly over time, showing a negative correlation with the SSV but no correlation with any radiological outcome parameter. No implant-related revision surgery was reported. Conclusions: Arthroscopic-assisted stabilization of acute high-grade AC joint dislocations using the LPSB technique with AC cerclage fixation provides excellent clinical outcomes and high patient satisfaction, with minimal implant-related complications and no need for revision surgery due to implant issues. Although cTW occurs, its clinical impact appears limited within this procedure. Full article

Background: Acromioclavicular joint (ACJ) injuries frequently result from trauma to the shoulder girdle and are particularly common among young, physically active individuals. These injuries account for approximately 9% of all traumatic shoulder girdle injuries and often lead to functional impairment and pain. The TightRope^® system, LARS™ band, and Bosworth screw are among over 160 currently described surgical techniques for managing ACJ dislocations. However, there is no consensus regarding the optimal surgical approach, particularly for the management of moderate Rockwood Type III ACJ dislocations. Materials and Methods: In this retrospective study, data from 246 patients who underwent surgery for ACJ dislocation between 2010 and 2018 at the Department of Orthopedics and Trauma Surgery, Medical University of Vienna, were analyzed. Patients were divided into four cohorts based on the surgical technique used: Bosworth screw, LARS (acute), LARS (chronic), and TightRope. Clinical and radiological outcomes were assessed pre- and postoperatively using the Visual Analog Scale (VAS), Constant, Disability of the Arm, Shoulder and Hand Score (DASH), Simple Shoulder Test (SST), University of California—Los Angeles Shoulder Score (UCLA), Short Form Health Survey (SF-36), and American Shoulder and Elbow Surgeons score (ASES), as well as radiographic analysis. Radiological measurements of the acromioclavicular (AC) and coracoclavicular (CC) joint spaces were taken on both the injured and uninjured shoulders to analyze and compare the reduction in joint gaps. Results: All surgical methods resulted in significant reductions in AC and CC joint gaps. The TightRope and LARS acute groups showed the greatest reductions, with minimal complication rates. Complication analysis revealed significant differences in clavicular elevation (p < 0.001) and CC-ligament ossification (p = 0.006), which were most frequent in the Bosworth group and least common in TightRope^® patients, with LARS showing intermediate values. AC joint arthrosis was uncommon in all four groups and did not differ significantly (p = 0.13). Overall, TightRope^® was associated with the most favorable complication profile. The postoperative VAS score in the TightRope group was 1.52 ± 2.06, and the Constant score was 96.83 ± 5.41, reflecting high patient satisfaction. Conclusions: All systems led to satisfactory radiological and clinical outcomes, with the LARS™ band showing particular effectiveness in chronic ACJ dislocations. While all techniques provided good results, the TightRope^® system demonstrated the most favorable overall profile in our cohort and may therefore be considered a promising contemporary option. Further studies are needed to determine the optimal treatment for moderate ACJ dislocations and to assess the cost-effectiveness of these surgical techniques. Full article

Objectives: Personalized sepsis care requires understanding how pre-existing health status can influence outcomes. The aim of this study is to evaluate its impact on in-hospital and 12-month mortality in patients with sepsis, taking into account age, comorbidities, the Charlson Comorbidity Index, frailty, anemia, and the Sequential Organ Failure Score Assessment (SOFA) in the first 24 h. Methods: An observational and retrospective study was conducted using data from the Sepsis Code program at the Hospital Universitario de La Princesa. The relationship between risk factors and mortality, as well as Intensive Care Unit (ICU) admission, was analyzed for the period 2016–2018 using bivariate and multivariate logistic regression. Results: A total of 547 patients were included. In the multivariate analysis, the risk factors independently associated with mortality were Rockwood Clinical Frailty Scale ≥ 5 (OR 2.45, p < 0.05); SOFA ≥ 4 (OR 2.13, p < 0.05); age (OR 1.98, p < 0.05); anemia (OR 1.85, p < 0.05); and specific comorbidities such as ischemic heart disease (OR 2.34, p < 0.05), severe liver disease (OR 3.62, p < 0.05), and metastatic cancer (OR 3.14, p < 0.05). Patients who were frail, had dementia, or heart failure were less likely to be admitted to the ICU. Conclusions: Frailty, comorbidities, age, and anemia are associated with outcomes in patients with sepsis and could be incorporated into mortality prediction models to guide tailored treatment strategies. Full article

Background: Acromioclavicular (AC) joint dislocations are frequent, especially kocsisamong young male athletes. While over 150 surgical techniques exist, consensus on optimal treatment—particularly for Rockwood type III injuries—remains elusive. This study evaluates the Lockdown procedure’s efficacy, safety, and patient satisfaction, a synthetic ligament technique for AC joint stabilization. Methods: A multicenter prospective study was conducted on 39 patients across three Hungarian hospitals (2018–2023). Outcomes included shoulder function, pain levels, and complication rates, with subgroup analysis of acute (≤3 weeks) versus chronic (>3 weeks) cases. A systematic review of nine studies (205 cases) was also performed to assess broader outcomes and complications. Results: Significant improvements were observed in functional scores (OSS, Constant, DASH, SST, ASES, Nottingham, Imitani) and pain reduction, especially in acute cases with no prior shoulder surgery. The mean patient age was 38.9 ± 12.68 years, with a 24.5-month average follow-up. OSS improvement between acute and chronic cases was 14.96 (95% CI: 6.45–23.47; p = 0.0017). Complications (30.8%) occurred in eleven patients, mainly minor infections; implant failure necessitated revision in 5.1%. The systematic review reported a 34.6% complication rate (predominantly minor complications, like asymptomatic subluxation −16%) and 5.4% implant removal due to failure. A meta-analysis was not feasible due to data heterogeneity. Conclusions: The Lockdown procedure significantly enhances shoulder function and reduces pain, particularly in acute dislocations. However, the procedure showed a moderate complication rate, underscoring the need for careful patient selection and postoperative management. Full article

Background: Optimal treatment for high-grade acromioclavicular (AC) joint dislocations is still not unanimous. Improving horizontal AC stability has been emphasized in recent years. Biomechanical studies and computer simulations have demonstrated that adequate horizontal stability could be restored with an additional AC fixation. We aim to prospectively investigate if AC augmentation leads to better clinical and radiological results. Methods: A total of 70 patients with a mean (± SD) age of 42 ± 11 years with acute AC joint dislocation Rockwood type IIIb and V were prospectively randomized into two equal groups. All patients underwent arthroscopically assisted stabilization using a double coracoclavicular (CC) suspensory system. Group N (No-augmentation group) had no additional fixation across the AC joint, while group T (tape-augmentation group) had additional fixation with tape. Patients were evaluated at 3, 6, and 12 months postoperatively. Primary clinical outcome measures included the Constant–Murley score and the Specific AC Score (SACS). Secondary outcome measures included the Subjective Shoulder Value (SSV), the Simple Shoulder Test (SST), the Disabilities of the Arm, Shoulder, and Hand (DASH) outcome measure, and the AC Joint Instability (ACJI) Score. Horizontal stability was radiologically measured with overlapping length (OL) and overlapping area (OA). Vertical alignment was measured with the CC distance. All radiological measurements were compared to the uninjured side and expressed in percentages as relative values. Results: There were no significant differences found between groups regarding the Constant score (p = 0.664), SACS (p = 0.518), or any other outcome measure at the one-year follow-up. Pain level (p = 0.635) and strength (p = 0.217) at the one-year mark also showed no significant differences. Clinical drawer testing for residual horizontal instability was non-significant (p = 0.061), but showed a tendency for a more stable AC joint in group T. The CC distance was smaller in group T at 6 and 12 months (p = 0.047 and p = 0.046, respectively). A two-way mixed factorial ANOVA test showed significantly lower CC differences for group T (p = 0.032); however, the gradual increase in CC distance was similar for both groups over time (p = 0.869). No significant differences were found in OL (p = 0.619) or OA (p = 0.236). Conclusions: The results of our study show that both CC stabilization with the double suspensory system alone and with additional AC fixation are effective surgical treatment options for acute AC joint dislocations, without any important clinical differences. CC distance similarly increased over one year in both groups but was better retained in the AC-augmented group, which showed a tendency toward a more stable fixation. Full article

Reservoirs and downstream rivers draining Oregon’s Cascade Range provide critical water supplies for over 1.5 million residents in dozens of communities. These waters also support planktonic and benthic cyanobacteria that produce cyanotoxins that may degrade water quality for drinking, recreation, aquatic life, and other beneficial uses. This 2016–2020 survey examined the sources and transport of four cyanotoxins—microcystins, cylindrospermopsins, anatoxins, and saxitoxins—in six river systems feeding 18 drinking water treatment plants (DWTPs) in northwestern Oregon. Benthic cyanobacteria, plankton net tows, and (or) Solid-Phase Adsorption Toxin Tracking (SPATT) samples were collected from 65 sites, including tributaries, reservoirs, main stems, and sites at or upstream from DWTPs. Concentrated extracts (320 samples) were analyzed with enzyme-linked immuno-sorbent assays (ELISA), resulting in >90% detection. Benthic cyanobacteria (n = 80) mostly Nostoc, Phormidium, Microcoleus, and Oscillatoria, yielded microcystins (76% detection), cylindrospermopsins (41%), anatoxins (45%), and saxitoxins (39%). Plankton net tow samples from tributaries and main stems (n = 94) contained saxitoxins (84%), microcystins (77%), anatoxins (25%), and cylindrospermopsins (22%), revealing their transport in seston. SPATT sampler extracts (n = 146) yielded anatoxins (81%), microcystins (66%), saxitoxins (37%), and cylindrospermopsins (32%), indicating their presence dissolved in the water. Reservoir plankton net tow samples (n = 15), most often containing Dolichospermum, yielded microcystins (87%), cylindrospermopsins (73%), and anatoxins (47%), but no saxitoxins. The high detection frequencies of cyanotoxins at sites upstream from DWTP intakes, and at sites popular for recreation, where salmon and steelhead continue to exist, highlight the need for additional study on these cyanobacteria and the factors that promote production of cyanotoxins to minimize effects on humans, aquatic ecosystems, and economies. Full article

Background/Objectives: Dislocation of the acromioclavicular joint (ACJ) is a common injury for which numerous operative fixation and reconstructive techniques have been described. This technique combines a coracoclavicular ligament (CC) repair with an acromioclavicular ligament (AC) and CC reconstruction with an additional ACJ internal brace to address both horizontal and vertical instability. Methods: The surgery is performed through a superior approach in the following sequence: (1) CC ligaments are repaired using a TightRope construct, (2) CC reconstruction is performed using a peroneus longus tendon allograft, (3) AC ligaments are repaired using an internal brace, and (4) AC reconstruction is performed with a second peroneus longus tendon allograft. The results of consecutive patients with grade IIIB, IV, and V AC joint dislocations were included. Results: Six patients with acute and six patients with chronic injuries were eligible for inclusion. The Constant–Murley Score improved significantly from 27.6 (8.0–56.5) to 61.5 (42.0–92.0) (p = 0.006 paired t-test) at 12 months of follow-up. There was one complication (frozen shoulder) from which the patient recovered spontaneously; no other complications were observed with this technique. The coracoclavicular distance (CCD) was reduced from 18.7 mm (13.0–24.0) to 10.0 mm (6.0–16.0, p < 0.001) and 10.5 mm (8.0–14.0, p = 0.002) at 12 weeks and 12 months, respectively. Conclusions: This study describes a new technique to treat acute and chronic Rockwood stage IIIB–V ACJ dislocations with promising short-term clinical and radiological results. The results suggest that the combined repair and reconstruction of the AC and CC ligaments is a safe procedure with low complication risk in experienced hands. Addressing the vertical and horizontal stability in ACJ dislocation is key to achieving optimal long-term results. Further, follow-up is required to investigate the long-term outcomes. Full article

Background/Objectives: Multiple myeloma (MM) is a plasma cell neoplasm predominantly diagnosed in older adults. However, the significance of defining patient frailty, as well as identifying the most suitable and reliable tools for its assessment, remains to be firmly established. Methods: This retrospective observational study investigated 36 patients aged 65 or older who underwent Comprehensive Geriatric Assessment (CGA). The average patient age was 76 (SD 6.22), with 33.3% being female. Patients were evaluated using the International Myeloma Working Group Frailty Index (IMWG-FI) and the 40-item Rockwood’s Frailty Index (FI) at the Oncogeriatrics clinic of the IRCCS Polyclinic San Martino Hospital, Genoa, Italy between December 2017 and August 2021. Laboratory, cancer-specific, demographic, and clinical variables were collected. Survival analysis and frailty comparison were conducted using Stata version 17.0. Results: Stepwise multivariate analysis identified the Numerical Rating Scale (NRS) (HR 1.40, 95% CI 1.09–1.78, p = 0.008) and Rockwood’s Frailty Index (FI) (HR 2.23, 95% CI 1.29–3.87, p = 0.004) as significant prognostic predictors, adjusted for sex, ISS stage, and multimorbility. Comparison between Rockwood’s FI and IMWG-FI using Spearman correlation coefficient showed no statistically significant correlation (r = 0.268, p = 0.114). Multivariate Cox model, adjusting for sex, International Staging System (ISS) stage, and Cumulative Illness Rating Scale (CIRS) comorbidity index demonstrated the superior predictive ability of Rockwood’s FI over IMWG-FI (C-index 0.775 vs. 0.749). Conclusions: The 40-item Rockwood FI emerges as a valuable tool for prognostication in old MM patients, demonstrating non-inferiority to the traditional IMWG-FI in predictive accuracy, emphasizing the importance of a comprehensive approach considering both disease-specific and patient-related factors. Full article

Background: Sarcopenia is a comorbidity associated with heart failure, which aggravates its prognosis. Objectives: To analyze the differential characteristics of polypathological patients with acute heart failure (AHF) based on the presence of low muscle strength, as well as to study whether this condition is associated with a worse prognosis. Methods: An observational study of 377 patients with a diagnosis of acute heart failure from the prospective multicentric PROFUND-IC registry was carried out. The main variable is low muscle strength, which is assessed with dynamometry or prehensile strength. Epidemiological and anthropometric characteristics, as well as associated comorbidities, were analyzed. Likewise, the etiology of the AHF episode, the number of admissions in the previous year, and the NYHA scale were also included. Finally, scores on functionality, treatment established, and mortality and readmission rates were studied. Quantitative variables are described as mean, and standard deviation, and qualitative variables are expressed as absolute numbers and percentages. A descriptive and bivariate analysis was performed according to the presence of low muscle strength (handgrip <27 kg in men and <16 kg in women), using the Welch test for quantitative measures and Chi-square for qualitative variables. In addition, Kaplan-Meier curves of readmission and mortality and a logistic regression analysis were also performed. Results: 377 patients were included (56% female, mean age 83 years). 310 (82.23%) had low muscle strength. Those with low muscle strength were older (84 vs. 78 years, p < 0.001), with more cognitive impairment (11.9% vs. 0%, p = 0.021), worse functional class (p = 0.016), lower scores in the Barthel index and Rockwood scale (p < 0.001), and higher in the PROFUND index (p < 0.001). They had higher rates of readmission and mortality without statistically significant differences. The PROFUND index is significantly associated with low muscle strength (OR 1.19, CI (1.09–1.31), p < 0.001). Conclusions: Elderly polypathological patients with acute heart failure and low muscle strength have a higher PROFUND index and a lower probability of survival per year. Full article

Objectives: This study aimed to compare 24-month radiographic follow-ups of clavicular tunnel widenings (CTWs) and coracoclavicular distances (CCDs) and examine correlations between these measurements in patients following combined coracoclavicular stabilization and acromioclavicular capsule repair in treatment of acute high-grade acromioclavicular joint injury. Methods: This retrospective study reviewed the records of patients with acute Rockwood type V acromioclavicular joint injury who underwent surgery within 3 weeks after their injury. All patients had follow-ups at 3 and 6 months and 1 and 2 years. The CTWs were measured on anteroposterior radiographs between the medial and lateral borders at the superior, middle and inferior levels of the tunnels. On anteroposterior radiographs of both clavicles, the CCDs were measured at the shortest distance between the upper border of the coracoid process and the inferior border of the clavicle and reported as the CCD ratio, which was defined as the ratio of the affected and unaffected clavicles. At the final follow-ups, clinical outcomes were assessed using American Shoulder and Elbow Surgeons (ASES) scores. Results: This study included seventeen men and six women with a mean age of 47.26 ± 10.68 years. At the final follow-ups, the mean ASES score of all patients was 95.28 ± 3.62. We found a significant correlation between the increase in the CTWs and the increase in the CCD ratios (Spearman’s rho correlation coefficient range 0.578–0.647, all p-values < 0.001). Conclusions: We found long-term postoperative widening of the clavicular tunnels, which correlated positively with a gradual postoperative decline in the acromioclavicular joint alignment reductions. Full article

Background: The arthroscopically assisted stabilization of AC joint dislocations with a suture button system is an established procedure that is widely and successfully used in everyday practice. The main advantages of this one-step method are the minimally invasive procedure and the anatomical reconstruction of the ruptured coracoclavicular ligaments with a permanent implant. With this technical note study, for the first time, the new method of navigated suture button implantation in everyday clinical practice is described with the future goal of further reducing invasiveness and increasing precision. Materials and Methods: The surgical technique is explained using precise descriptions and illustrations, photos, X-rays, and 3D reconstructions based on clinical cases. The step-by-step system setup and patient positioning, AC joint reduction and retention, 3D scan and drill tunnel planning, stab incision and Kirschner wire navigation, and cannulated drilling and implant positioning, as well as closure and documentation are described in detail. Results: The standard coracoclavicular stabilization of AC joint dislocations with the 3D C-arm navigated suture button method is described in detail. Furthermore, the feasibility of an additive horizontal acromioclavicular suture cerclage, the implantation of an additional coracoclavicular suture button system, and the single-stage cannulated screw fixation of non-displaced fractures is demonstrated. Conclusion: The navigated suture button method aims to be simple, safe, minimally invasive, and precise. Prospective clinical studies with a long follow-up should be carried out to determine the clinical and radiological outcome in comparison with current methods. Full article