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Patel R, Khan MM, Gibson W, Banerjee R, Pardiwala A. Comparison of hook plates vs. locking plates for Neer type IIB fractures of lateral end clavicle: A systematic review. Chin J Traumatol 2025:S1008-1275(25)00008-2. [PMID: 40087117 DOI: 10.1016/j.cjtee.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/27/2024] [Accepted: 03/20/2024] [Indexed: 03/16/2025] Open
Abstract
PURPOSE Surgical management of the lateral end of clavicle fractures has been a challenge for orthopedic surgeons considering the high rate of non-union. There has been no right and wrong answer to these types of fractures and many methods discussed in the literature, but the 2 most used bony procedures are hook plate and locking plate with or without the use of supplementary soft tissue procedures. The available evidence, in this case, is scarce with questionable reliability. The idea of this systemic review is to promote evidence-based practice when choosing between the 2 implants for this fracture. This study aims to review the results by performing a systemic review of the literature comparing the results of locking plate vs. hook plate for the lateral end of clavicle fracture fixation with an emphasis on outcome and associated complications. METHODS A search of the literature was made with the keyword "clavicle" in PubMed/Ovid Medline/Embase and University of Edinburgh online library "discover Ed". A total of 4063 articles were identified including case series (with at least 3 cases) and review articles focusing on locking plate alone, comparisons of locking plate and hook plate, or hook plate alone. Articles were excluded if they were not published in English, focused on pediatric studies, or consisted only of book chapters. Studies examining tension band wiring, soft tissue procedures for fracture fixation, arthroscopic-assisted procedures, additional soft tissue procedures along with plate fixation, and fracture dislocation of the lateral end of the clavicle were also excluded. The search was then narrowed down to 21 articles after consideration of inclusion and exclusion criteria. A detailed review of the surgical methodology further excluded additional soft tissue procedures, resulting in a final selection of 15 studies. The quality of the studies was assessed using the Modified Coleman Score by the authors. RESULTS A total of 15 studies related to Neer type II fracture met the inclusion criteria. However, 2 other studies also included type V fracture as well. The mean age of patients in these studies was 32 years. The mean follow-up period was 24.3 months (ranging from 6 to 65 months). The time of radiological union was documented from 2 to 4.5 months. Constant and disabilities of arm, shoulder, and hand scores were most used as the criteria for patient outcomes. The size of the lateral fragment that can accommodate/provide bicortical fracture was documented in only 3 studies. The mean incidence of removal of hook plate was 86.9%. In contrast, the mean incidence of removal of locking plate was 27.0%. Superficial wound infection was documented in 5 studies and deep wound infection was seen in 1 study. The mean union rate for hook plate was 97.0% compared to 100% for locking plate. Complications associated with hook plate have been documented in 11 studies. The most commonly reported incidence of complication was acromial osteolysis. The quality of studies was assessed using modified Coleman score. Other than 2 studies that were considered for the study that met the "fair" standard all of them were considered "poor" based on the modified Coleman score. CONCLUSION Both hook plate and locking plate provide acceptable operative treatment options for the lateral end of clavicle fracture. However, a consideration of surgeons' experience, the likelihood of a second operation, and the size of the lateral fragment should be considered when choosing between the 2 types of implants.
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Affiliation(s)
- Ravi Patel
- Department of Trauma and Orthopaedics, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom; Department of Trauma and Orthopaedics, The Princess Royal Hospital, Apley Castle, Telford, TF1 6TF, United Kingdom; Department of Trauma and Orthopaedics, Royal Shrewsbury Hospital, Mytton Oak Rd, Shrewsbury, SY3 8XQ, United Kingdom.
| | - Muhammad Murtaza Khan
- Department of Trauma and Orthopaedics, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - William Gibson
- Department of Trauma and Orthopaedics, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - Robin Banerjee
- Department of Trauma and Orthopaedics, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - Asif Pardiwala
- Department of Trauma and Orthopaedics, Scunthorpe General Hospital, Scunthorpe, DN15 7BH, United Kingdom
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Tsai TY, Hsu SL, Hsu CH, Liao CY, Lu YD. Distal augmentation in unstable distal clavicle fractures: a retrospective cohort study of 101 cases. Arch Orthop Trauma Surg 2025; 145:111. [PMID: 39776266 DOI: 10.1007/s00402-024-05731-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 12/10/2024] [Indexed: 01/11/2025]
Abstract
INTRODUCTION The optimal management strategy for unstable distal clavicular fractures remains controversial. Recent studies on plate techniques have reported good-to-excellent outcomes with no serious complications. The questions are that: (1) Does the use of wire augmentation with locking plate in distal part (distal wire augmentation) reduce radiographic loss of reduction (RLOR) and get earlier bony union in distal clavicular fractures? (2) Which fixation methods are associated with a higher incidence of acromioclavicular (AC) joints arthritis or subluxation? We collected and analyzed clinical studies on different plate fixation methods for unstable fractures to identify the best surgical modality. METHODS This retrospective case-control study included 101 patients with Neer types IIB and V unstable distal clavicle fractures treated using plate techniques. The patients were divided into four groups according to the surgical procedure: hook plate (HP group) (n = 13), lateral locking plate alone (LP group) (n = 41), locking plate with coracoclavicular (CC) ligament suture repair (LPC group) (n = 26), and locking plate with distal wire augmentation (LPA group) without CC repair (n = 21). The clinical outcomes of shoulder function were the mean Constant score and the University of California-Los Angeles (UCLA) shoulder scale. The bony union time, loss of CC distance reduction, and AC joint condition were used to evaluate the radiographic results. One-way ANOVA, Kruskal-Wallis test, and chi-square test were performed to compare differences between groups. Multiple p-value comparison corrections were calculated using the Bonferroni method. RESULTS There were no significant differences in the mean Constant and UCLA scores among the groups after 1 year of follow-up. All fractures healed. The LPA and HP groups achieved earlier bone union (LPA 8.4 weeks, HP 8.9 weeks, LP 12.6 weeks, and LPC 13.4 weeks, P = 0.000); however, the HP group had the highest complication rate and required bone removal (LPA 4.0%, HP 23.1%, LP 0.0%, LPC 0.0%, P = 0.003). A low rate of RLOR was observed in the LPA group (LPA 9.5%, HP 23.1%, LP 22.0%, LPC 30.8%, P = 0.362). The incidence of AC joint subluxation was higher in the Neer type V group and was unrelated to surgical methods. CONCLUSIONS Hook plate and locking plate with distal wire augmentation in distal clavicle fractures result in an earlier time to bone union when compared with CC suture repair or non-CC suture repair techniques. However, HP may have the higher complication rate and require subsequent implant removal. The incorporation of distal wire augmentation appears to be beneficial in maintaining fracture reduction. In the future, larger prospective studies are needed to confirm these findings. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Tsung-Ying Tsai
- The Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan
| | - Shan-Ling Hsu
- The Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan.
| | - Chi-Hsiang Hsu
- The Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan
| | - Chin-Yi Liao
- The Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan
| | - Yu-Der Lu
- The Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan
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Eskandar M, Saed M, Yusuf S. Functional outcomes of tension band wiring versus hook plating in displaced, closed, and isolated distal clavicle fractures in adults: a comparative retrospective study. Ann Med Surg (Lond) 2024; 86:6409-6415. [PMID: 39525788 PMCID: PMC11543237 DOI: 10.1097/ms9.0000000000002475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/03/2024] [Indexed: 11/16/2024] Open
Abstract
Introduction Clavicle fractures are common among young people, generally as a consequence of car accidents, bike falls, and contact sports injuries. 15-20% of all clavicle fractures involve the lateral end of the bone. Thus, the distal clavicle fractures, in particular, have a high non-union rate ranging from 21 to 33% when treated non-operatively, underscoring the usual advice for operative treatment. While significant research has been conducted on clavicle fractures and their treatment options, no definitive guidelines or optimal approaches have been established. Hence, the aim of this study was to assess the clinical and radiological results of the two highly used surgical techniques, Tension Band Wiring (TBW) and Hook plate ones, in addition to investigating the associated functional recovery and outcomes. Methods Between August 2019 and 2022, An analytical retrospective comparative study, was done on 38 patients (20 TBW and 18 Hook plate) diagnosed with unstable fracture of the lateral third of clavicle (Neer 2), aged between 18 and 65 years old, and followed up for more than 12 months. Results TBW technique was used in 20 patients (14 males and 6 females) with mean age 39.25 years and Hook plate was used in 18 patients (14 males,4 females) with mean age of 43.11 years. The union rate was 100% in Hook plate group and 95% in TBW group. The mean time of bony union to occur was (9.55) weeks in TBW group and (8.94) weeks in Hook plate group. The mean of constant-Murley score in the last follow-up was 85.32 in the TBW group and 87.38 in the Hook plate group. superficial infection occurred in 3 cases in TBW group (15%). Four patients complained of impingement, three patients complained of acromial erosion and one patient complained of acromial osteolysis in the Hook plate group. Conclusion Both TBW and Hook plate are a good choice for the fixation of displaced distal clavicle fractures with good functional and radiological outcomes, where Hook plate have some advantages such as rigid fixation and early motion of the affected shoulder.
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Affiliation(s)
- Mohammad Eskandar
- Department of Orthopedic Surgery, Tishreen University Hospital, Lattakia, Syria
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Lee JW, Song MJ, Lee SJ, Song HS, Jung YS, Kim H. Biomechanical comparison between low profile 2.7 mm distal locking hook plate and 3.5 mm distal locking hook plate for acromioclavicular joint injury: A finite element analysis. Injury 2024; 55:111657. [PMID: 39002321 DOI: 10.1016/j.injury.2024.111657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE Although hook plate fixation is popularly used, concerns exist regarding periprosthetic fractures and the necessity to remove the plate to prevent subacromial erosion and subsequent acromion fracture, due to its non-anatomical design. We hypothesized that a low profile 2.7 mm distal locking hook plate would provide comparable stability to a properly used 3.5 mm distal locking hook plate MATERIALS AND METHODS: A 3.5 mm distal locking plate (type 1) and a low profile 2.7 mm plate (type 2) were assessed by finite element analysis. Peak von Mises stress (PVMS) was calculated on the acromion's undersurface, clavicle shaft, and hook, focusing on how these stresses varied with the number and placement of distal locking screws. RESULTS Increased distal screws in both types led to lower PVMS on the acromion's undersurface and the hook, with the lowest acromion PVMS observed in type 2 with three distal screws, and on the hook in type 1 with two distal screws. Increasing the number of distal screws similarly reduced PVMS on the clavicle shaft, with the lowest in type 1 with two distal screws. In both plate types, the most posterior distal locking screw played a crucial role in distributing stress across the acromion and the hook. CONCLUSION The low profile 2.7 mm distal locking hook plate showed comparable biomechanical results to the 3.5 mm distal locking hook plate. Increasing the number of distal locking screws showed less stress concentration on the bone and hook in both models. The most posterior distal locking screw showed an essential role in stress distribution.
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Affiliation(s)
- Jeong-Woo Lee
- Department of Biomedical Engineering, Inje University, Gimhae, Korea
| | - Min-Jun Song
- Department of Biomedical Engineering, Inje University, Gimhae, Korea
| | - Sung-Jae Lee
- Department of Biomedical Engineering, Inje University, Gimhae, Korea
| | - Hyun Seok Song
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn-Sung Jung
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyungsuk Kim
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Borbas P, Paszicsnyek A, Hofstede S, Ernstbrunner L, Wieser K. Biomechanical evaluation of fixation of the coracoclavicular stand-alone cow-hitch suture reconstruction in comparison to two established techniques for highly unstable distal clavicle fractures (Neer type V). JSES Int 2024; 8:394-399. [PMID: 38707556 PMCID: PMC11064559 DOI: 10.1016/j.jseint.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background Treatment of displaced distal clavicle fractures with bony avulsion of the coracoclavicular (CC) ligaments often warrants surgical fixation, yet a gold standard surgical technique is to be defined. The purpose of this study was to compare the biomechanical fixation strength of a new fixation technique, the CC stand-alone cow-hitch suture reconstruction, and to compare this technique with a clavicle hook plate and a lateral locking plate with CC suture reconstruction. Methods Simulated Neer type V distal clavicle fractures of the clavicle were created in 18 cadaveric shoulders, which were matched by age and gender in 3 groups: (1) clavicle hook plate (group HP), (2) lateral locking plate fixation with CC suture reconstruction (group LPCC), and (3) CC stand-alone suture reconstruction using the cow-hitch technique (group CH). After preconditioning with 25 N for 10 cycles, the specimens were cycled in the coronal plane for 500 cycles from 10N to 70N. Displacement and ultimate load to failure were documented and analyzed with the data acquisition system. Results There was a significant difference in the fracture displacement during cyclic loading between the LPCC group and the HP group (0.6 vs. 1.7 mm; P = .02) and between the CH and HP groups (0.5 vs. 1.7 mm; P = .004). Fracture displacement was not different between the LPCC and the CH groups (P = .544). The CH group and the LPCC group showed a significantly higher stiffness compared to the HP group (P < .001 and P = .003, respectively). The CH group showed a significantly higher ultimate load to failure compared with the HP group (429 vs. 172 N; P = .005) and showed a tendency toward higher ultimate load to failure when compared with the LPCC group (429 vs. 258 N; P = .071). Conclusion The CC stand-alone cow-hitch suture reconstruction and the locking plate with CC reconstruction showed higher fixation strength compared with the hook plate for simulated Neer type V distal clavicle fractures. There was a tendency of higher ultimate load to failure with the cow-hitch technique compared with the lateral locking plate with CC suture reconstruction, and given the potential advantages of less soft tissue stripping, metal-free fixation, low costs, and simple surgical technique, clinical application of the all-suture CC reconstruction using the cow-hitch for Neer type V distal clavicle fractures appears warranted.
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Affiliation(s)
- Paul Borbas
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | | | - Simon Hofstede
- Institute of Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
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Zhao XL, Liu YQ, Wang JG, Liu YC, Zhou JX, Wang BY, Zhang YJ. Distal clavicle fractures treated by anteroinferior plating with a single screw: Two case reports. World J Clin Cases 2023; 11:7502-7507. [PMID: 37969449 PMCID: PMC10643073 DOI: 10.12998/wjcc.v11.i30.7502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND For the treatment of distal clavicle fractures, each treatment method has its own advantages and disadvantages, and there is no optimal surgical solution. CASE SUMMARY Based on this, we report 2 cases of distal clavicle fractures treated utilizing an anterior inferior plate with a single screw placed in the distal, in anticipation of providing a better surgical approach to distal clavicle fracture treatment. Two patients were admitted to the hospital after trauma with a diagnosis of distal clavicle fracture, and were admitted to the hospital for internal fixation of clavicle fracture by incision and reduction, with good postoperative functional recovery. CONCLUSION With solid postoperative fixation and satisfactory prognostic functional recovery, this technique has been shown to be simple, easy to perform and effective.
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Affiliation(s)
- Xin-Lei Zhao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia Autonomous Region, China
| | - Yan-Qing Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia Autonomous Region, China
| | - Jian-Guo Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia Autonomous Region, China
| | - You-Cai Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia Autonomous Region, China
| | - Jia-Xuan Zhou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia Autonomous Region, China
| | - Bei-Yu Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia Autonomous Region, China
| | - Yi-Jun Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia Autonomous Region, China
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Pieringer A, Welter J, Fischer J, Hess F. Complications following arthroscopic-assisted coracoclavicular stabilization in patients with unstable lateral clavicle fractures. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04769-2. [PMID: 36633665 DOI: 10.1007/s00402-023-04769-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
PURPOSE Lateral clavicle fractures are unstable and prone to nonunions, which is why they are often treated surgically rather than conservatively. Despite the variety of surgical techniques found in the literature, the best method for treating this rare fracture type has not yet been determined. Our case series aimed to describe a coracoclavicular (CC) reconstruction technique and to assess complications and patient outcomes 1 year postoperatively. METHODS Nineteen patients who underwent surgery for an unstable lateral clavicle fracture (IIB, IIC, IID) with a suture button device (Dog Bone, Arthrex, Inc., Naples, FL, USA) were available for clinical and radiological follow-up. The assessments included the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) score, the Constant Score (CS), the Subjective Shoulder Value (SSV), as well as the ipsilateral and contralateral coracoclavicular distance. RESULTS The median age was 50 years (IQR 28-59), 13 (68.4%) were male and the delay to surgery was 5 days (IQR 2-9). The median clinical scores were 100 (ASES), 91 (CS), and 95 (SSV). The CC distance improved postoperatively (p = 0.003). However, nonunion occurred in 3 (15.8%) patients, 5 (26.3%) had other complications, and 5 (26.3%) needed revision surgery (4 plate removals and 1 pseudoarthrosis). The overall complication rate was 36.8%. CONCLUSION Restoring the CC ligaments alone could not reliably achieve fracture stability, with more than one-third of cases in this series experiencing major complications. Given the high revision and nonunion rates, we do not recommend this type of surgical technique.
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Affiliation(s)
| | - JoEllen Welter
- Department of Orthopedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - Janic Fischer
- Department of Orthopedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - Florian Hess
- Department of Orthopedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland.
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A systematic review and meta-analysis comparing the use of hook plates and superior plates in the treatment of displaced distal clavicle fractures. Arch Orthop Trauma Surg 2023; 143:329-352. [PMID: 34988674 DOI: 10.1007/s00402-021-04287-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/27/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Non-operative treatment of displaced distal clavicle fractures results in high non-union and yet there is no consensus on superior treatment modality. While there are a number of different techniques available for fixation, hook plate (HP) has been used most commonly. A number of modern techniques, including superior plate (SP), have shown less complications but equivocal union rate and shoulder function. The aim of this systematic review and meta-analysis is to compare the outcome of HP fixation with superior plate in surgical fixation of displaced distal clavicle fractures. PATIENTS AND METHODS A review of the online databases MEDLINE and Embase was conducted on 15 January 2021 according to PRISMA guidelines. The review was registered prospectively in the PROSPERO database. Clinical studies reporting union rate, complications and shoulder function were included. The studies were appraised using the Methodological Index for Non-Randomized Studies (MINORS) tool. RESULTS The search strategy identified 42 studies eligible for inclusion with a total of 1,261 patients. These included 17 hook-plate case series (n = 573), 18 superior plate case series, of which 6 used SP alone (n = 223) and 12 SP and simultaneous CCLR case series (n = 189), and 7 studies comparing HP and SP (n = 276). The overall complication rate was significantly higher with HP when compared to SP [(32.7% vs 12.7%; OR 6.31 (95% CI: 2.67-14.91)]. The overall union rates in the case series appeared comparable in the current SR; HP 96.4%, SP 96.9% and SP with simultaneous CCLR 97.9%. Shoulder function was most commonly assessed using CM score and the mean ranged from 83.8 to 97.2 in HP, 89 to 98 in SP group and 90.6 to 97.6 in SP with CCLR. Meta-analysis of CM score failed to show a significant difference for HP versus SP (pooled weighted mean difference was 2.67 (95% CI: - 0.09 to 5.43) with a trend to favour SP fixation. CONCLUSION The current review has demonstrated that HP, SP alone or with CCLR all offer excellent union rate and appear to provide comparative functional outcomes. However, HP is associated with significantly higher complication rates.
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Teimouri M, Ravanbod H, Farrokhzad A, Sabaghi J, Mirghaderi SP. Comparison of hook plate versus T-plate in the treatment of Neer type II distal clavicle fractures: a prospective matched comparative cohort study. J Orthop Surg Res 2022; 17:369. [PMID: 35907856 PMCID: PMC9338617 DOI: 10.1186/s13018-022-03261-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to compare the clinical and radiological outcomes of distal clavicle fracture fixation with a hook plate versus the standard non-locking T-plate for unstable Neer type II fractures. METHODS A prospective matched cohort study including two groups of hook plates and T-plates fixation was conducted in our two tertiary trauma centers. Patients with distal clavicle fractures Neer type II were assessed for union and the Constant-Murley score (CMS) at 1-, 3-, and 6-month follow-ups. Inadequate radiographic consolidation > 6 months after surgery was defined as non-union. Subscales of CMSpain, CMSactivities of daily living, CMSrange of motion (ROM), and CMSstrength were also compared between groups. According to recommendations, the implant was removed after union confirmation in the hook plate at a planned second surgery. RESULTS Sixty consecutive patients were enrolled: 30 in the T-plate group and 30 in the hook plate group. CMS showed similar functional outcomes for T-plates and hook plates at all follow-ups (Month 6: 92.0 vs. 91.7, P = 0.45). However, on the month 1 follow-up, the T-plate group scored higher than the hook plate group for ROM and pain (CMSpain = 13.0 vs. 12.3, P = 0.03; CMSROM = 35.2 vs. 33.2, P = 0.002). Despite this, Pain, ROM, and other CMS domains were comparable between groups (P > 0.05). The mean time to union was 2.5 + 1.4 months for the T-plate group and 2.3 + 1.6 months for the hook plate group (P = 0.44). There was one fixation failure in each group and one periprosthetic fracture in the hook plate group (two revisions for the hook plates and one for T-plates, P = 1.00). Non-union and other complications were not observed. CONCLUSION Both surgical approaches resulted in full recovery and good function. However, in the hook plate group ROM and pain scores were lower at 1 month. Standard non-locking T-plates are a viable alternative to hook plates with low cost and promising outcomes for treating displaced distal clavicle fractures.
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Affiliation(s)
- Mehdi Teimouri
- Department of Orthopedic Surgery, Ayatollah Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hadi Ravanbod
- Department of Orthopedic Surgery, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirhosein Farrokhzad
- Department of Orthopedic Surgery, Ayatollah Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jamal Sabaghi
- Department of Orthopedic Surgery, Ayatollah Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Peyman Mirghaderi
- Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
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Orlandi TV, Rogers NS, Burger MC, King PR, Lamberts RP. A prospective randomized controlled trial comparing plating augmented with coracoclavicular fixation and hook plate fixation of displaced distal-third clavicle fractures. J Shoulder Elbow Surg 2022; 31:906-913. [PMID: 35158065 DOI: 10.1016/j.jse.2022.01.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/29/2021] [Accepted: 01/03/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Two popular methods used to treat distal-third clavicle fractures are the traditional hook plate and the anatomically contoured locking plate. No consensus exists on whether one method is more effective than the other. Therefore, the aim of this study was to compare the efficacy of a traditional hook plate with that of an anatomically contoured locking plate augmented with coracoclavicular fixation in the treatment of distal-third clavicle fractures. METHODS Enrolled patients were randomly assigned to either the hook plate group (n = 13) or the locking plate group (n = 17). Follow-up assessments (clinical and radiologic) were performed at 6 and 12 months postoperatively. RESULTS In both groups, union was achieved in 91% of cases at 6 months and 100% at 12 months. No differences in Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley shoulder scores were noted between the hook plate and locking plate groups at 12 months. From 6 to 12 months, DASH scores improved in the hook plate group (P = .007) and Constant-Murley shoulder scores tended to improve (P = .075). Surgical time was longer in the locking plate group than in the hook plate group (P < .001). CONCLUSION Similar functional outcomes and union rates were achieved in both groups at 12 months postoperatively. However, the improvement in DASH scores in the hook plate group from 6 to 12 months suggests that patients treated with an anatomically contoured locking plate make a quicker recovery than patients treated with a hook plate.
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Affiliation(s)
- Tino-Vito Orlandi
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Nicholas S Rogers
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Marilize C Burger
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Paul R King
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Robert P Lamberts
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; Division of Biokinetics, Department of Sport Science, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
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11
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Lee SJ, Eom TW, Hyun YS. Complications and Frequency of Surgical Treatment with AO-Type Hook Plate in Shoulder Trauma: A Retrospective Study. J Clin Med 2022; 11:jcm11041026. [PMID: 35207299 PMCID: PMC8875584 DOI: 10.3390/jcm11041026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Abstract
We investigated the complications and frequency of hook plate fixation in patients with shoulder trauma. We reviewed 216 cases of hook plate fixation use at our hospital between January 2010 and May 2020. Finally, we included 76 cases of acute distal clavicle fracture (DCF) and 84 cases of acute acromioclavicular joint dislocation (ACD). We investigated all complications after hook plate use, bony union in the DCF group, and reduction loss in the ACD group. We defined painful shoulder stiffness (PSS) as aggravating resting pain with stiff shoulder, and pain on shoulder elevation (PSE) as continued shoulder pain on elevation without PSS before plate removal. PSS was managed with intra-articular steroid injections or manipulation with or without arthroscopic capsular release (ACR). PSS occurred in 36 and 33 cases of DCF and ACD, respectively. PSE occurred in 17 of 76 fractures and 13 of 84 dislocations. However, no iatrogenic rotator cuff injury was verified by magnetic resonance imaging in patients with PSS or PSE. Subacromial erosion in patients with hook plate fixation should be considered a sequela and not a complication because it is unavoidable in surgery with an AO-type hook plate. The most common complication was PSS, followed by PSE.
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12
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Baunach D, Eid K, Ricks M, Borbas P. Long-Term Clinical and Radiological Results After Hook Plate Osteosynthesis of Lateral Clavicle Fractures. J Orthop Trauma 2021; 35:378-383. [PMID: 33177428 DOI: 10.1097/bot.0000000000002007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess both clinical and radiological long-term outcomes after hook plate osteosynthesis for Neer type II lateral clavicle fractures. DESIGN Retrospective case series. SETTING Level-1 trauma center. PATIENTS/PARTICIPANTS Patients who underwent open reduction internal fixation with a hook plate for displaced fractures of the lateral third of the clavicle (Neer type II) at a single trauma hospital were identified. INTERVENTION Lateral clavicle open reduction internal fixation with a hook plate. MAIN OUTCOME MEASURES At the first of 2 long-term follow-up appointments, bilateral magnetic resonance imaging (MRI) scans and strength measurements were performed, Constant-Murley score, subjective shoulder value (SSV), and Oxford shoulder score (OSS) of both shoulders were obtained. At the second follow-up, specific acromioclavicular (AC) score, SSV, and OSS were obtained. RESULTS Twenty-one patients (mean age, 29.5 ± 9.7 years) could be included who were available for at least 1 of 2 follow-ups after 7.4 years (±2.3) and 13.9 years (±2.2). Bony union was achieved in all patients (100%) at an average of 3.4 months (±1.4). The hook plate was removed at an average of 5.5 months (±3.3) after initial surgery in all patients. No significant side-to-side differences were found in OSS, Constant-Murley score, SSV, and specific AC score and for strength testing and MRI scans. CONCLUSIONS Long-term outcome after hook plate fixation of Neer type II lateral clavicle fractures demonstrated good clinical results and shoulder strength without higher radiographic rates of AC joint osteoarthritis, subacromial impingement, or rotator cuff lesions. That may be related to a standardized early plate removal after bony fracture union. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniel Baunach
- Department of Orthopaedics and Traumatology, Cantonal Hospital Baden, Baden Switzerland ; and
| | - Karim Eid
- Department of Orthopaedics and Traumatology, Cantonal Hospital Baden, Baden Switzerland ; and
| | - Matthew Ricks
- Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom
| | - Paul Borbas
- Department of Orthopaedics and Traumatology, Cantonal Hospital Baden, Baden Switzerland ; and
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13
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Mastrantonakis K, Christogiannis C, Bakaros D, Velivasakis G, Garbi A, Daskalogiannakis E. Latarjet fracture treated with a single endobutton: A case presentation. Trauma Case Rep 2021; 31:100394. [PMID: 33490357 PMCID: PMC7811053 DOI: 10.1016/j.tcr.2020.100394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Avulsion fracture of the coracoclavicular ligament accompanied by upward displacement of the medial fragment of the clavicle represents a unique fracture pattern, first described by Latarjet and colleagues in 1975. Due to the function of the underlying articulations and the ligaments found in the area, this fracture pattern results in a combination of horizontal and vertical instability that must be taken into consideration when treating. Several surgical techniques have been proposed but none has been proven superior. CASE SUMMARY Herein, we present a Latarjet fracture of the distal clavicle treated with a single endobutton. A 45-year-old male underwent open surgical stabilization of distal clavicular fracture 15 days after trauma. After stabilization of the fracture, we applied a single endobutton, passing through the medial fragment, inferior fragment and coracoid process. The patient was observed for 14 mo postoperative, during which time he achieved union in all three fragments of the fracture and an excellent functional clinical score. CONCLUSION In Latarjet fracture treatment, augmentation of the coracoclavicular ligament is the most important parameter for a favorable result.
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Affiliation(s)
| | | | - Dimitrios Bakaros
- Department of Orthopedics, General Hospital of Rethymnon, Rethymnon 74100, Greece
| | - Georgios Velivasakis
- Department of Orthopedics, General Hospital of Rethymnon, Rethymnon 74100, Greece
| | - Anastasia Garbi
- Department of Orthopedics, General Hospital of Rethymnon, Rethymnon 74100, Greece
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Abstract
OBJECTIVES To compare the stability of NT2B clavicle fractures fixed with either a hook plating (HP), Superior Plating with Suture Augmentation (SPSA), or dual orthogonal plating (DP) with the hypothesis that DP would provide increased multiplanar stability across NT2B fractures. METHODS NT2B distal clavicle fractures were created in cadaveric specimens and fixed using (1) HP, (2) SPSA, or (3) DP. Specimens were cyclically loaded in 3 different planes of motion: (1) anteroposterior (AP), (2) superior-inferior, and (3) axial rotation while displacement was continually recorded. Afterward, a superiorly directed load was applied to the clavicle. Load to failure, stiffness, and mode of failure were recorded. RESULTS During AP loading, clavicles fixed with a DP had significantly lower mean posterior displacement compared to those fixed with SPSA at every 100-cycle interval of testing, P < 0.01. During inferior-superior loading, specimens fixed with a DP had less superior displacement than specimens fixed with an HP and SPSA, reaching significance at the 500-700 cycles of testing. There was no significant difference in axial rotation stability or load to failure between the 3 fixation techniques. CONCLUSIONS Orthogonally placed minifragment plates provide improved stability against anterior displacement with no significant difference in superior stability, axial rotational stability, stiffness, or load to failure. Further clinical studies are needed to confirm the long-term stability of dual plating and determine the risks and benefits of this novel method of distal clavicle fixation.
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15
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Kim DW, Kim DH, Kim BS, Cho CH. Current Concepts for Classification and Treatment of Distal Clavicle Fractures. Clin Orthop Surg 2020; 12:135-144. [PMID: 32489533 PMCID: PMC7237254 DOI: 10.4055/cios20010] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/19/2020] [Indexed: 12/18/2022] Open
Abstract
Distal clavicle fractures are less common than mid-shaft fractures in adults and there is no consensus on the best classification system or the ideal treatment approach considering that high nonunion rates have been reported. Although there are numerous treatment options for distal clavicle fractures, a gold standard treatment has not yet been established. Each surgical technique has its pros and cons. In this review article, we provide an overview of classification systems and treatment methods for distal clavicle fractures.
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Affiliation(s)
- Dong-Wan Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Beom-Soo Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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16
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Yoon B, Kim JY, Lee JS, Jung HS. The Radiologic Comparison of Operative Treatment Using a Hook Plate versus a Distal Clavicle Locking Plate of Distal Clavicle Fracture. Clin Shoulder Elb 2018; 21:227-233. [PMID: 33330181 PMCID: PMC7726406 DOI: 10.5397/cise.2018.21.4.227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of this study was to compare the radiologic results of patients who underwent surgery with a hook plate and a locking plate in distal clavicle fractures. Methods Sixty patients underwent surgical treatment for Neer type IIa, IIb, III, and V distal clavicle fracture. Twenty-eight patients underwent fracture fixation with a hook plate and 32 with a locking plate. Coracoclavicular distance was measured on standard anteroposterior radiographs before and after the surgery, and union was confirmed by radiograph or computed tomography taken at 6 months postoperatively. Other radiologic complications like osteolysis was also checked. Results Bony union was confirmed in 59 patients out of 60 patients, and 1 patient in the hook plate group showed delayed union. Coracoclavicular distance was decreased more in the hook plate group after surgery (p<0.01). After 6 weeks of the hook plate removal, the coracoclavicular distance was increased a little compared to before metal removal, but there was no difference compared to the contralateral shoulder. Eleven out of 28 patients (39.3%) showed osteolysis on the acromial undersurface in the hook plate group. Conclusions Both the hook plate group and the locking plate group showed satisfactory radiologic results in distal clavicle fractures. Both hook plate and locking plate could be a good treatment option if it is used in proper indication in distal clavicle fracture with acromioclavicular subluxation or dislocation.
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Affiliation(s)
- Byungil Yoon
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Yoon Kim
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae-Sung Lee
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyoung Seok Jung
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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17
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Lopiz Y, Checa P, García-Fernández C, Valle J, Vega ML, Marco F. Complications with the clavicle hook plate after fixation of Neer type II clavicle fractures. INTERNATIONAL ORTHOPAEDICS 2018; 43:1701-1708. [DOI: 10.1007/s00264-018-4108-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
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Boonard M, Sumanont S, Arirachakaran A, Sikarinkul E, Ratanapongpean P, Kanchanatawan W, Kongtharvonskul J. Fixation method for treatment of unstable distal clavicle fracture: systematic review and network meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2018; 28:1065-1078. [PMID: 29569132 DOI: 10.1007/s00590-018-2187-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/17/2018] [Indexed: 12/21/2022]
Abstract
Surgical management is recommended for unstable distal clavicle fractures. A variety of methods have been previously reported, but there is no current consensus regarding which method is most suitable. Therefore, we have conducted a systematic review and network meta-analysis to compare postoperative shoulder function and complications between different fixation methods to identify which class of fixation is best for unstable distal clavicle fractures. We searched the literature systematically using eligibility criteria of all comparative studies that compared postoperative outcomes of coracoclavicular fixation (tight rope, screw or endobutton), hook plating, plate and screws, tension band wiring and transacromial pinning fixation for unstable distal clavicle fractures from PubMed, EMBASE, and Scopus databases up to February 10, 2018. Two reviewers independently extracted data. A network meta-analysis was applied to combine direct and indirect evidence and to estimate the relative effects of the treatment options. The probability of being the best treatment was estimated using surface under the cumulative ranking curves (SUCRA). Ten comparative studies (n = 505 patients) with one RCT study (n = 42) met the inclusion criteria. Intervention included coracoclavicular fixation (n = 111 patients), hook plating (n = 300 patients), plate and screws (n = 41 patients), tension band wiring (n = 81 patients) and transacromial pinning (n = 14 patients). A network meta-analysis showed that CM scores of coracoclavicular fixation were significantly higher when compared to hook plate and tension band wiring, with pooled mean of 2.98 (95% CI 0.05-5.91) and 7.11 (95% CI 3.04-11.18). For UCLA, CC fixation and plate and screw fixation had significantly higher scores compared to hook plating fixation with a mean score 2.22 (95% CI 0.44-3.99) and 3.20 (95% CI 0.28-6.12), respectively. In terms of complications, plate and screw fixation had lower risk with RRs of 0.63 (95% CI 0.20-1.98), 0.37 (95% CI 0.19-0.72), 0.11 (95% CI 0.04-0.30) and 0.02 (95% CI 0.002-0.16) when compared to coracoclavicular fixation, hook plating, tension band wiring and transacromial pinning. The SUCRA probabilities of CC fixation were in the first rank with 96.8% for CMS, while plate and screw fixation were in the first rank with 67.7 and 93.8% for UCLA score and complications. We recommend using plate and screw and CC fixation as the first- and second-line treatment of unstable distal clavicle fractures. As the quality of studies for this meta-analysis was not high, larger and higher-quality randomized controlled trials are required to confirm these conclusions for informed clinical decision making.
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Affiliation(s)
- Manusak Boonard
- Orthopedic Department, Bangkok Hospital Udon, Udon Thani, Thailand
| | - Sermsak Sumanont
- Orthopedics Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | | | | | - Jatupon Kongtharvonskul
- Sport and Orthopedic Center, Samitivej Hospital and Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand.
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19
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Ranalletta M, Rossi LA, Barros H, Nally F, Tanoira I, Bongiovanni SL, Maignon GD. Minimally Invasive Double-Button Fixation of Displaced Lateral Clavicular Fractures in Athletes. Am J Sports Med 2017; 45:462-467. [PMID: 28146404 DOI: 10.1177/0363546516666816] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Early union and a rapid return to prior function are the priorities for young athletes with lateral clavicular fractures. Furthermore, it is essential to avoid nonunion in this subgroup of patients, as this is frequently associated with persistent pain, restriction of movement, and loss of strength and endurance of the shoulder. PURPOSE To analyze the time to return to sport, functional outcomes, and complications in a group of athletes with displaced lateral clavicular fractures treated using closed reduction and minimally invasive double-button fixation. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 21 athletes with displaced lateral clavicular fractures were treated with closed reduction and minimally invasive double-button fixation between March 2008 and October 2013. Patients completed a questionnaire focused on the time to return to sport and treatment course. Functional outcomes were assessed with the Constant score and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union, malunion, and nonunion. RESULTS Of the 21 study patients, 20 returned to sport after treatment; 100% returned to the same level. The mean time to return to play was 78 days (range, 41-120 days). Four patients (20%) returned to sport less than 6 weeks after surgery, 14 (70%) returned between 6 and 12 weeks after surgery, and 2 (10%) returned after 12 weeks. The mean Constant score was 89.1 ± 4.2 (range, 79-100), the mean QuickDASH score was 0.4 ± 2.6 (range, 0-7.1), and the mean VAS pain score was 0.4 ± 1.0 (range, 0-3) at final follow-up (mean, 41 months). The only complication was asymptomatic nonunion. Hardware removal was not necessary in any patient. CONCLUSION Closed reduction and minimally invasive double-button fixation of displaced lateral clavicular fractures in athletes was successful in terms of returning to the previous level of athletic activity regardless of the type of sport, with excellent clinical results and a low rate of complications.
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Affiliation(s)
- Maximiliano Ranalletta
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Luciano A Rossi
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Hugo Barros
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Nally
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Ignacio Tanoira
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Santiago L Bongiovanni
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Gastón D Maignon
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Dedeoğlu SS, İmren Y, Çabuk H, Çakar M, Arslan SM, Esenyel CZ. Results of minimal invasive coracoclavicular fixation by double button lift-up system in Neer type II distal clavicle fractures. J Orthop Surg (Hong Kong) 2017; 25:2309499016684722. [PMID: 28118807 DOI: 10.1177/2309499016684722] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM We aimed to evaluate clinical and functional outcomes of indirect fracture reduction performed by coracoclavicular fixation with minimal invasive double button lift-up system in Neer type IIa unstable fractures of distal clavicle. MATERIAL AND METHODS 22 patients with Neer type 2 distal clavicle fracture were enrolled in that prospective study. All patients underwent indirect reduction and osteosynthesis performed by coracoclavicular fixation with minimal invasive double button lift-up system. Postoperative follow-up was carried out clinically and radiologically with plain X-rays and utilization of Constant and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) shoulder scores. Mean follow-up time was 15 months. A standard sling was applied for 2 weeks, postoperatively. Rehabilitation program was started on postoperative day 1. RESULTS Mean age was 39 (range: 21-60), 18 of the patients were male. Right dominant extremity was affected in 14 patients. Mean duration of the surgical intervention was 40 min (range: 30-55 min). Mean union time was found to be 14 weeks (range: 7-21 weeks). Mean postoperative ASES and Constant scores were 79.9 (66.9-88.3) and 82.2 (71-100), respectively. The duration of return to normal daily activities were found to be 4.5 months. Any loss of reduction, AC joint arthrosis, and clavicular shortening were not detected in X-rays. CONCLUSION This study has demonstrated that indirect osteosynthesis performed by coracoclavicular fixation with double button lift-up system in the treatment of unstable Neer type IIa fractures of the distal clavicle had successful clinical, radiological, and functional outcomes.
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Affiliation(s)
- Süleyman Semih Dedeoğlu
- 1 Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey
| | - Yunus İmren
- 1 Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey
| | - Haluk Çabuk
- 1 Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey
| | - Murat Çakar
- 1 Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey
| | - Samet Murat Arslan
- 1 Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey
| | - Cem Zeki Esenyel
- 2 Department of Orthopaedics and Traumatology, Giresun University Hospital, İstanbul, Turkey
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Biomechanical Comparison of Superior Versus Anterior Plate Position for Fixation of Distal Clavicular Fractures: A New Model. J Orthop Trauma 2017; 31:e13-e17. [PMID: 27661732 DOI: 10.1097/bot.0000000000000707] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Although most clavicular fractures are amenable to nonoperative management, metadiaphyseal fractures are considerably more complex, with rates of suboptimal healing as high as 75% when treated nonoperatively. The poor results are ascribed to the deforming forces on the distal clavicle from the surrounding muscles and the weight of the arm. It recently has been noted that some operative fixations of these fractures are also failing when a standard superiorly placed plate is used. We hypothesized that anterior plating, when compared with superior plating, improves the strength and durability of the construct by redirecting the axis of the major deforming force across rather than in line with the screws of the construct. METHODS Six pairs of fresh-frozen human cadaveric clavicles with the scapula attached by the coracoclavicular ligaments were osteotomized just medial to the ligaments and plated with a standard 3.5-mm limited-contact dynamic compression plate. Specimens were potted and mounted on a materials testing system machine, preserving the anatomic relationship of the clavicle and scapula. They were then loaded through the coracoclavicular ligaments to mimic the weight of the arm pulling inferiorly. Each specimen was loaded with 375 N at 1 Hz for 2000 cycles. Sequential loading was then applied at 25-N intervals until failure. Statistical analysis was performed using a Wilcoxon signed-rank test. RESULTS The superiorly plated specimens failed after fewer cycles and with lower force than the anteriorly plated specimens. The median number of cycles to failure was 2082 for anterior plated specimens and 50 for superiorly plated (P = 0.028). The median load to failure was 587.5 N in the anterior group and 375 N in the superior group (P = 0.035). The median stiffness was 46.13 N/mm for anterior and 40.45 N/mm for superior (P = 0.375) plates. CONCLUSIONS Anteriorly plated distal third clavicular fractures have superior strength and durability compared with fractures plated superiorly when using a physician-contoured, 3.5-mm, limited-contact, dynamic compression plate in this cadaver model.
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Treatment of distal-third clavicular fractures (Neer type II-b) with a triple button device. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2016.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Cano-Martínez JA, Nicolás-Serrano G, Andrés-Grau J, Bento-Gerard J. Treatment of distal-third clavicular fractures (Neer type ii-b) with a triple button device. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:378-386. [PMID: 27435987 DOI: 10.1016/j.recot.2016.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/25/2016] [Accepted: 06/02/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The purpose of this study is to describe the outcomes of using a triple button device for the treatment of displaced distal-third clavicle fractures (Neer, type ii-b). MATERIAL AND METHOD A retrospective review was conducted on a series of patients between November 2011 and December 2014. Fourteen patients initially met the inclusion criteria, but 2 were excluded, leaving 12 patients (83.3% male; mean age 32.2 years) for the final analysis at a mean follow-up of 26±11.24 months (range, 12-48). Post-operative follow-up was performed at 2 weeks (two first months), and monthly thereafter, until was achieving clinically and radiological healing. The functional outcome was evaluated using the Constant score, and DASH score in the last follow-up. RESULTS The mean Constant Score was 95.5±5.2 points (range, 85-100), with a mean DASH score of 3.3±4.4 points (range, 0-12.5). The mean time to clinical healing was10.3±3.1 weeks (range, 8-16), and the mean time to radiological healing was 13.6±2.6 weeks (range, 12-20). There were no major complications. There were 5 minor complications without clinical impact: 2 coracoclavicular calcifications, 1 hypertrophic scar, 1 patient with discomfort due to the device, and 1 superficial wound infection. All patients returned their previous activity. CONCLUSION Good clinical results can be achieved with the triple button device in unstable distal fractures of the clavicle, without the need to remove the hardware.
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Affiliation(s)
- J A Cano-Martínez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Los Arcos del Mar Menor, Facultad de Medicina, Universidad de Murcia, Pozo Aledo, Murcia, España.
| | - G Nicolás-Serrano
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Los Arcos del Mar Menor, Facultad de Medicina, Universidad de Murcia, Pozo Aledo, Murcia, España
| | - J Andrés-Grau
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Los Arcos del Mar Menor, Facultad de Medicina, Universidad de Murcia, Pozo Aledo, Murcia, España
| | - J Bento-Gerard
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Los Arcos del Mar Menor, Facultad de Medicina, Universidad de Murcia, Pozo Aledo, Murcia, España
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Does Subacromial Osteolysis Affect Shoulder Function after Clavicle Hook Plating? BIOMED RESEARCH INTERNATIONAL 2016; 2016:4085305. [PMID: 27034937 PMCID: PMC4789368 DOI: 10.1155/2016/4085305] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/14/2016] [Accepted: 02/04/2016] [Indexed: 12/03/2022]
Abstract
Purpose. To evaluate whether subacromial osteolysis, one of the major complications of the clavicle hook plate procedure, affects shoulder function. Methods. We had performed a retrospective study of 72 patients diagnosed with a Neer II lateral clavicle fracture or Degree-III acromioclavicular joint dislocation in our hospital from July 2012 to December 2013. All these patients had undergone surgery with clavicle hook plate and were divided into two groups based on the occurrence of subacromial osteolysis. By using the Constant-Murley at the first follow-up visit after plates removal, we evaluated patients' shoulder function to judge if it has been affected by subacromial osteolysis. Results. We have analyzed clinical data for these 72 patients, which shows that there is no significant difference between group A (39 patients) and group B (33 patients) in age, gender, injury types or side, and shoulder function (the Constant-Murley scores are 93.38 ± 3.56 versus 94.24 ± 3.60, P > 0.05). Conclusion. The occurrence of subacromial osteolysis is not rare, and also it does not significantly affect shoulder function.
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Hyun YS, Kim GL, Choi SM, Shin WJ, Seo DY. A Novel Fluoroscopic View for Positioning the AO Clavicle Hook Plate Decreases Its Associated in situ Complications. Clin Shoulder Elb 2016. [DOI: 10.5397/cise.2016.19.1.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Periprosthetic Fracture after Hook Plate Fixation in Neer Type II Distal Clavicle Fracture: A Report of 3 Cases. ACTA ACUST UNITED AC 2016. [DOI: 10.12671/jkfs.2016.29.1.55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mechchat A, Elidrissi M, Shimi M, Elibrahimi A, Elmrini A. [Neer type II distal clavicle fractures: hook plate versus transacromial pin]. Pan Afr Med J 2015; 20:105. [PMID: 26090053 PMCID: PMC4458316 DOI: 10.11604/pamj.2015.20.105.4532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 06/10/2014] [Indexed: 11/28/2022] Open
Abstract
Cette étude a été menée afin de faire une comparaison entre deux techniques chirurgicales différentes: la plaque à crochet et l'embrochage dans les fractures instables du quart externe de la clavicule. Nous avons mené une étude prospective entre 2009 et 2013, incluant deux groupes de patients: un premier groupe de 14 patients traités par plaque à crochet par voie d'abord antéro-inférieure, un second de 12 patients traités par brochage. Tous les patients ont été hospitalisés 24 h après la chirurgie et ont été suivi pendant 1 an. Nous avons comparé les résultats des deux techniques en étudiant: le temps opératoire, le saignement, délai de consolidation, la douleur et la fonction selon le score de constant. L'analyse statistique des résultats fonctionnels et radiologiques a montré la supériorité d'une technique par rapport à l'autre; ainsi l’âge moyen global était de 32,6 ans (+/- 13,7), le sex-ratio (H/F) était de 1. Le temps opératoire moyen est de 35 min pour la plaque à crochet contre 45 minutes pour le brochage, le délai moyen de consolidation était de 6,1 (+/-0,7) semaines dans le groupe traité par plaque vissée, et de 6 (+/-0,7) semaines dans le groupe traité par embrochage (p = 0,5), le score de Constant absolu moyen était respectivement de 86 (+/-10,4) et de 90,92 (+/-2,5) (p = 0,04). L'analyse uni variée a montré une association statistiquement significative entre les paramètres d’évaluation et les deux techniques chirurgicales étudiées. Par conséquent, l’étude a noté la supériorité de la plaque à crochet contre l'embroche dans les fractures instables du quart externe de la clavicule.
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Affiliation(s)
- Atif Mechchat
- Department of Orthopaedics and Trauma Surgery B4, UH Hassan II, Fez, Morocco
| | - Mohammed Elidrissi
- Department of Orthopaedics and Trauma Surgery B4, UH Hassan II, Fez, Morocco
| | - Mohammed Shimi
- Department of Orthopaedics and Trauma Surgery B4, UH Hassan II, Fez, Morocco
| | | | - Abdelmajid Elmrini
- Department of Orthopaedics and Trauma Surgery B4, UH Hassan II, Fez, Morocco
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Abstract
This article reports on a technique to treat unstable type II distal clavicle fractures using fracture-specific plates and coracoclavicular augmentation with a suture button. Six patients with clinically unstable type II distal clavicle fractures underwent treatment using the above technique. All fractures demonstrated radiographic union at 9.6 (8.4-11.6) weeks with a mean follow-up of 15.6 (12.4-22.3) months. American Shoulder and Elbow Surgeons, Penn Shoulder Score, and Single Assessment Numeric Evaluation scores were 97.97 (98.33-100), 96.4 (91-99), and 95 (90-100), respectively. One patient required implant removal. Fracture-specific plating with suture-button augmentation for type II distal clavicle fractures provides reliable rates of union without absolute requirement for implant removal.
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Sambandam B, Gupta R, Kumar S, Maini L. Fracture of distal end clavicle: A review. J Clin Orthop Trauma 2014; 5:65-73. [PMID: 25983473 PMCID: PMC4085358 DOI: 10.1016/j.jcot.2014.05.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 05/16/2014] [Indexed: 10/25/2022] Open
Abstract
Management of fracture distal end clavicle has always puzzled the orthopaedic surgeons. Now-a-days with a relatively active lifestyle, patients want better results both cosmetically and functionally. Despite so much literature available for the management of this common fracture, there is no consensus regarding the gold standard treatment for this fracture. In this article, we reviewed the literature on various techniques of management for this fracture, both conservative as well as surgical, and their merits and demerits.
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Affiliation(s)
- Balaji Sambandam
- Senior Resident, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India,Corresponding author.
| | - Rajat Gupta
- Senior Resident, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Santosh Kumar
- Third Year Post Graduate in Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Lalit Maini
- Professor, Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Zhang C, Huang J, Luo Y, Sun H. Comparison of the efficacy of a distal clavicular locking plate versus a clavicular hook plate in the treatment of unstable distal clavicle fractures and a systematic literature review. INTERNATIONAL ORTHOPAEDICS 2014; 38:1461-8. [PMID: 24728348 DOI: 10.1007/s00264-014-2340-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 03/20/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to retrospectively compare and review the clinical outcomes between the distal clavicular locking plate and clavicular hook plates in the treatment of unstable distal clavicle fractures; moreover, the relevant literature of the two fixation methods was reviewed systematically to identify the non-union, complications, or functional scores, according to the treatment methods and determine which treatment method is better. METHODS Sixty-six patients with 66 unstable distal clavicle fractures who underwent open reduction and internal fixation with either a distal clavicular locking plate (36 patients) or a clavicular hook plate (30 patients ) were evaluated. The main outcome comparisons included Constant score, rate of non-union, rate of complication, and rate of returning to work three months postoperatively. RESULTS No significant difference was found between locking plate and hook plate groups in union rate and Constant score (P > 0.05). However, the results indicated that the distal clavicular locking plate group had a significantly lower rate of complications (P < 0.05) and symptomatic hardware (P < 0.05). In addition, the distal clavicular locking plate facilitated the return to work better than the clavicular hook plate (P < 0.05). CONCLUSIONS Both distal clavicular locking plate and clavicular hook plate achieved good results in the treatment of unstable distal clavicle fractures; however, internal fixation with a distal clavicular locking plate had greater ability to return to their previous work after surgery in three months and fewer complications than the clavicular hook plate.
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Affiliation(s)
- Chunlin Zhang
- Department of Orthopaedic Surgery, Shanghai Tenth People's Hospital, Affiliated with Tongji University, 301 YanChang Zhong Road, Shanghai, China, 200072,
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Lin HY, Wong PK, Ho WP, Chuang TY, Liao YS, Wong CC. Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion--dynamic sonographic evaluation. J Orthop Surg Res 2014; 9:6. [PMID: 24502688 PMCID: PMC3922330 DOI: 10.1186/1749-799x-9-6] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 01/28/2014] [Indexed: 01/28/2023] Open
Abstract
Background Clavicular hook plates are effective fixation devices for distal clavicle fractures and severe acromioclavicular joint dislocations. However, increasing number of studies has revealed that subacromial portion of the hook may induce acromial bony erosion, shoulder impingement, or even rotator cuff damage. By sonographic evaluation, we thus intended to determine whether the presence of hook plate may induce subacromial shoulder impingement and its relationship relative to surrounding subacromial structures. Methods We prospectively followed 40 patients with either distal clavicle fracture or acromioclavicular joint dislocation that had surgery using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate. All patients were evaluated by monthly clinical and radiographic examinations. Static and dynamic musculoskeletal sonography examinations were performed at final follow-up before implant removal. Clinical results for pain, shoulder function, and range of motion were evaluated using Constant-Murley and Disability of Arm, Shoulder, and Hand (DASH) scores. Results Clinically, 15 out of 40 patients (37.5%) presented with subacromial impingement syndrome and their functional scores were poorer than the non-impinged patients. Among them, six patients were noted to have rotator cuff lesion. Acromial erosion caused by hook pressure developed in 20 patients (50%). Conclusions We demonstrated by musculoskeletal sonography that clavicular hook plate caused subacromial shoulder impingement and rotator cuff lesion. The data also suggest an association between hardware-induced impingement and poorer functional scores. To our knowledge, the only solution is removal of the implant after bony consolidation/ligamentous healing has taken place. Thus, we advocate the removal of the implant as soon as bony union and/or ligamentous healing is achieved.
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Affiliation(s)
| | | | | | | | | | - Chin-Chean Wong
- Department of Orthopaedic Surgery, Wan Fang Hospital, Taipei Medical University, No, 111, Sec, 3, Xinglong Road, Taipei 11696, Taiwan.
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Drijfhout van Hooff CC, Haverlag R, Willems WJ. Evaluation of the use of the hook plate in Neer type 2 lateral clavicle fractures and Rockwood types 3-5 acromioclavicular joint dislocations. Eur J Trauma Emerg Surg 2013; 39:619-26. [PMID: 26815546 DOI: 10.1007/s00068-013-0303-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 05/19/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE For most types of acromioclavicular (AC) injuries, treatment is well established. For Neer type 2 lateral clavicle fractures and Rockwood types 3-5 AC dislocations, the ideal treatment is still a point of debate. The purpose of this study was to evaluate the functional and radiological outcome in patients treated for one of these two lesions in our hospital. METHODS Our study group consisted of 30 patients with a Neer type 2 lateral clavicle fracture (n = 19) or Rockwood types 3-5 AC dislocation (n = 11) treated with the clavicle hook plate. All implants were removed after healing. At a mean follow-up of 40 months (12-92), data were collected by the analysis of questionnaires (DASH, NSST, OSS, SF-36), clinical examination (Constant-Murley score), and radiological evaluation (Zanca view). RESULTS The mean Constant score was 88 [standard deviation (SD) 8] compared to 92 (SD 6) on the contralateral non-operated side. The questionnaires resulted in the following scores: median DASH: 4.5 (0-70); median NSST: 100 (8-100); mean OSS: 41 (SD 8); mean SF-36: 81 (SD 12). The mean coracoclavicular (CC) and AC distances were not significantly different. CONCLUSIONS This study suggests that hook plate fixation is a reliable treatment for Neer type 2 lateral clavicle fractures and Rockwood types 3-5 AC injuries. It results in a good and comparable function of the shoulder when compared to the contralateral side, high union rate, good to excellent objective and subjective results, and allows early active motion with limited abduction. A disadvantage is the necessity to remove the plate.
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Affiliation(s)
| | - R Haverlag
- General Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - W J Willems
- Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Schliemann B, Roßlenbroich SB, Schneider KN, Petersen W, Raschke MJ, Weimann A. Surgical treatment of vertically unstable lateral clavicle fractures (Neer 2b) with locked plate fixation and coracoclavicular ligament reconstruction. Arch Orthop Trauma Surg 2013; 133:935-9. [PMID: 23589063 DOI: 10.1007/s00402-013-1737-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The present study evaluates the outcome of patients treated with a combination of locked plate fixation and minimal-invasive coracoclavicular (CC) ligament reconstruction for unstable lateral clavicle fractures type IIb according to Neer. PATIENTS AND METHODS Fourteen patients with an unstable lateral clavicle fracture were treated with a combination of locked plate fixation and a minimal-invasive CC ligament reconstruction. At a mean follow-up of 38 months, patients were re-evaluated using the Constant-Murley score, the Acromioclavicular (AC) joint instability score and the TAFT score. Furthermore, anterior-posterior (ap) stress radiographs and axillary views were performed in order to detect any recurrent instability. RESULTS Bony union was achieved in all cases within 6-10 weeks. The mean Constant-Murley score of the affected shoulder was 93.5 points compared to 97.2 of the contralateral unaffected shoulder. The mean Taft score was 11.2 points and the mean AC joint instability score was 92 points in comparison to 96 points on the unaffected side. The mean CC distance at the time of the injury was 21 mm compared to 8.5 mm after surgery and 12 mm a the final follow-up examination. The CC distance did not differ between the postoperative X-rays and those at the time of follow-up (p = 0.068). Three plates had to be removed because of implant irritation. CONCLUSION A combination of locked plate fixation and CC ligament augmentation in a minimal-invasive manner can be regarded as suitable for the treatment of vertically unstable lateral clavicle fractures and is associated with excellent clinical and radiological outcomes and a low complication rate.
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Affiliation(s)
- Benedikt Schliemann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149 Münster, Germany.
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Abstract
BACKGROUND Approximately 25% of distal clavicle fractures are unstable. Unstable patterns have longer times to union and higher nonunion rates. Stable restoration of the distal clavicle is important in decreasing the nonunion rate in distal clavicle fractures. The purpose of this study was to biomechanically compare operative constructs for the treatment of unstable, comminuted distal-third clavicle fractures in a cadaveric model using a locking plate and coracoclavicular reconstruction. We hypothesized that the combination of coracoclavicular reconstruction and a distal clavicle locking plate is biomechanically superior to either construct used individually. MATERIALS AND METHODS An unstable distal clavicle fracture was created in 21 thawed fresh-frozen cadaveric specimens. The 21 specimens were divided into 3 treatment groups of 7: distal-third locking plate, acromioclavicular (AC) TightRope (Arthrex, Naples, FL, USA), and distal-third locking plate and AC TightRope together. After fixation, each specimen was cyclically tested with recording of displacement to determine the stiffness and stability of each construct, followed by load-to-failure testing in tension and compression to determine the maximum load. RESULTS The combined construct of the locking distal clavicle plate and coracoclavicular reconstruction resulted in increased stiffness, maximum resistance to compression, and decreased displacement compared with either construct alone. CONCLUSION Greater fracture stability was achieved with the combination of the AC TightRope and locking clavicle plate construct than with either alone, suggesting a possibility for increased fracture-healing rates.
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Martetschläger F, Kraus TM, Schiele CS, Sandmann G, Siebenlist S, Braun KF, Stöckle U, Freude T, Neumaier M. Treatment for unstable distal clavicle fractures (Neer 2) with locking T-plate and additional PDS cerclage. Knee Surg Sports Traumatol Arthrosc 2013; 21:1189-94. [PMID: 22752470 DOI: 10.1007/s00167-012-2089-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 06/01/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of the current study was to assess the clinical and radiological results after locking T-plate osteosynthesis with coracoclavicular augmentation of unstable and displaced distal clavicle fractures (Neer type 2). METHODS Thirty patients, treated between January 2007 and January 2010 were followed up after a median follow-up time of 12.2 months (range 4.7-37.2). The Constant and DASH scores were used to evaluate the clinical outcome, and anterior-posterior and 30° cephalic view radiographs were performed to assess the bony healing. RESULTS In all patients, the fracture healing was achieved within the first 10 weeks after surgery. All patients regained good or excellent shoulder function and returned to previous occupation and activity levels. The mean Constant and DASH scores were 92.3 points and 6.2 points, respectively. We did not observe any severe intra- or post-operative complication within the time of follow-up. CONCLUSION The presented technique turned out to be a reliable method providing good results without showing severe complications. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Frank Martetschläger
- Clinic for Trauma Surgery, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Lin HH, Wang CS, Chen CF, Chiang CC, Huang CK, Chen WM, Liu CL. Treatment of displaced distal clavicle fractures with a single cortical screw. Orthopedics 2013; 36:199-202. [PMID: 23464937 DOI: 10.3928/01477447-20130222-04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The authors retrospectively evaluated the effects of a single cortical screw in the open reduction and internal fixation of displaced distal clavicle fractures. Fifteen patients without associated acromioclavicular joint dislocation were treated by open reduction and internal fixation with a single cortical screw (4.5-mm diameter, 60-mm length) between 2004 and 2011. Mean follow-up was 39.2 months (range, 13-84 months). Reduction with a fracture gap of less than 1 mm and solid union were achieved in all cases. Delayed superficial infection developed in 1 patient. All other patients had good to excellent final Constant-Murley functional results.
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Affiliation(s)
- Hsi-Hsien Lin
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei City, Taiwan 11217, Republic of China
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Wu CC. Tension band wiring versus Knowles pinning for non-union of type-2 distal clavicle fractures. J Orthop Surg (Hong Kong) 2012; 20:297-301. [PMID: 23255633 DOI: 10.1177/230949901202000306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED PURPOSE; To compare tension band wiring (TBW) with Knowles pinning for non-union of type-2 distal clavicle fractures. METHODS 22 men and 6 women aged 23 to 62 (mean, 39) years underwent TBW (n=17) or Knowles pinning (n=11) for non-union of type-2 distal clavicle fractures. Both techniques were supplemented with autogenic cancellous bone grafting. Functional outcome of the shoulder was evaluated using the Constant scoring system (maximum score, 100). Excellent (≥ 90) and good (≥ 80) scores were defined as satisfactory. RESULTS Of the 28 patients, 25 were followed up for a mean of 2.6 (range, 1.1-4.2) years, whereas 3 were lost to follow-up. The median times to union were not significantly different between the TBW (n=15) and Knowles pinning (n=10) groups (4.0 vs. 4.3 months, p=0.94). Five non-unions treated with TBW had migration of the Kirschner wires, which was resolved by further restriction of shoulder motion. There were no other complications such as deep infection, non-unions, or malunions. All 25 patients achieved satisfactory full range of shoulder motion with minimal pain. CONCLUSION Both techniques achieved high rates of satisfactory outcome. TBW may result in Kirschner wire migration but is preferred for cases with a small distal fragment.
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Affiliation(s)
- Chi-Chuan Wu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Good DW, Lui DF, Leonard M, Morris S, McElwain JP. Clavicle hook plate fixation for displaced lateral-third clavicle fractures (Neer type II): a functional outcome study. J Shoulder Elbow Surg 2012; 21:1045-8. [PMID: 22014616 DOI: 10.1016/j.jse.2011.07.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 06/27/2011] [Accepted: 07/10/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Controversy exists with the use of the acromioclavicular hook plate for the treatment of lateral-third clavicle fractures (Neer type II). This is thought to stem from problems associated with the hook plate causing impingement symptoms, which can cause long-term limitation of movement and pain. Our aim was to evaluate the functional outcomes of patients with lateral-third clavicle fractures treated with the hook plate. METHODS We prospectively reviewed all patients who underwent surgery from July 2005 to August 2009 using our prospectively recorded electronic patient information database. All patients were assessed in the clinic to determine both Oxford and Constant shoulder scores. RESULTS We identified 36 patients who underwent surgery with the hook plate, 26 men and 10 women. The mean age was 36.2 years (range, 22-60 years). Of the patients, 46% were smokers. The median length of hospital stay was 2 days (interquartile range [IQR], 1-3). The median follow-up was 28 months (IQR, 23-37). The median time from date of injury to surgery was 7 days (IQR, 4-76). The mean time to union was 3 months (IQR, 2-4), and the union rate was 95%. In total, 92% of plates were removed. The median time to removal was 4.5 months (IQR, 3-8.75). There were no complications. Two patients presented months later after falls with fractures around the medial end of the hook plate. CONCLUSION Hook plates are an effective form of treatment for lateral third clavicle fractures. The best outcomes occur with plate removal before 6 months postoperatively, provided that the fracture has healed.
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Affiliation(s)
- Daniel W Good
- Department of Trauma Orthopaedics, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Dublin, Ireland
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Tan HL, Zhao JK, Qian C, Shi Y, Zhou Q. Clinical results of treatment using a clavicular hook plate versus a T-plate in neer type II distal clavicle fractures. Orthopedics 2012; 35:e1191-7. [PMID: 22868604 DOI: 10.3928/01477447-20120725-18] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AO clavicular hook plate fixation provides more rigid fixation and good bony union rates for Neer type II distal clavicular fractures. However, the hook may cause rotator cuff tears and subacromial impingement, which adversely affect the clinical results. T-plate fixation is another surgical method of treatment for unstable clavicle fractures, and its clinical efficacy has been demonstrated. The purpose of this study was to compare the clinical outcomes of AO clavicular hook plate and T-plate fixation for Neer type II distal clavicular fractures. Forty-two patients with Neer type II fractures were divided into 2 groups. The hook plate group comprised 23 patients who underwent hook plate fixation, and the T-plate group comprised 19 patients who underwent distal radius volar locking T-plate fixation. Hook plates were removed 3 to 14 months postoperatively in 15 patients because of shoulder function limitations. All patients were evaluated postoperatively for shoulder pain, activities of daily living, range of motion, strength, and satisfaction according to the University of California, Los Angeles (UCLA) Shoulder rating scale. All fractures in the 2 groups achieved stable fixation and bony union. Both groups yielded similar outcomes with regard to shoulder strength and patient satisfaction (P=.207 and P=.398, respectively). Significant differences existed between the 2 groups in the mean scores of shoulder pain, activities of daily living, range of motion, and total UCLA score (P=.001, P=.011, P=.038, and P=.001, respectively). More patients (74%) in the hook plate group had mild to severe shoulder pain than in the T-plate group (16%). However, shoulder pain was relieved and function improved significantly after removal of the hook plate (P=.001).
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Affiliation(s)
- Hong-Lve Tan
- Department of Orthopedic Surgery, Changzhou Wujin Hospital, Jiangsu University, Changzhou, China
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40
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Rijal L, Sagar G, Joshi A, Joshi KN. Modified tension band for displaced type 2 lateral end clavicle fractures. INTERNATIONAL ORTHOPAEDICS 2012; 36:1417-22. [PMID: 22392259 DOI: 10.1007/s00264-012-1514-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 02/06/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Displaced type 2 lateral end clavicle fractures have a tendency to delayed union or non-union. Various methods of stabilisation of the displaced lateral end fractures are described. The increasing use of implants to fix such fractures also necessitates extensive dissection for implant retrieval. Adequate reduction and minimal tissue trauma during implant placement and removal would be ideal modalities for fixation of such fractures. METHODS All displaced type 2 lateral end clavicle fractures fulfilling our inclusion criteria were reduced with a small anterosuperior incision. Anteroposterior drill holes were made in both the fragments and a nonabsorabable polyester suture was passed through. The fracture was reduced and fixed with transacromial smooth Kirshner wires. The suture was tied with the knot superiorly in a figure-eight manner. The arm was supported in an arm pouch for six weeks. The Kirshner wire was routinely removed after six weeks in an out-patient department. Clinico-radiological outcome was studied at six weeks, and monthly intervals thereafter until union. RESULTS All 16 fractures united. The mean average age of patients was 36.25 years with a SD of 11.35. There was no loss of reduction even after removal of Kirshner wires at six weeks. The mean average time of union was 10.75 weeks with a SD of 3.92. All patients regained near normal range of motion, and the mean average constant score at the end of one year was 98.37 with a SD of 2.87. All patients returned to preinjury level by the one-year follow-up. The range of motion remained the same in those who were followed up in successive years. Skin impingement with bent Kirshner wires were noted in four cases. Kirshner wires backed out in one case before six weeks but there was no loss of reduction. Infection and Kirshner wire breakage were not noted in our series. CONCLUSION The clinico-radiological outcomes with our modified tension band fixation for displaced type 2 lateral end clavicle fractures were encouraging and comparable with earlier studies.
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Affiliation(s)
- Laxman Rijal
- Department of Orthopaedics, Civil Service Hospital, Minbhawan, Kathmandu, Nepal.
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Tiren D, van Bemmel AJM, Swank DJ, van der Linden FM. Hook plate fixation of acute displaced lateral clavicle fractures: mid-term results and a brief literature overview. J Orthop Surg Res 2012; 7:2. [PMID: 22236647 PMCID: PMC3313877 DOI: 10.1186/1749-799x-7-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 01/11/2012] [Indexed: 12/11/2022] Open
Abstract
Background The clavicle hook plate achieves like most other operative techniques, a high percentage of union and a low percentage of complications however concerns about long term complications still exist, particularly the involvement of the acromioclavicular joint. Methods To evaluate the results and long term effects in use of this plate we performed a retrospective analysis with a mean follow up of 65 months (5.4 years) of 28 consecutive patients with acute displaced lateral clavicle fractures, treated with the clavicle hook plate. Results Short term functional results in all patients were good to excellent. All but one patient had a united fracture (96%). Nine patients (32%) developed impingement symptoms and in 7 patients (25%) subacromial osteolysis was found. These findings resolved after plate removal. Twenty-four patients were re-evaluated at a mean follow-up period of 5.4 years. The Constant-Murley score was 97 and the DASH score was 3.5. Four patients (14%) developed acromioclavicular joint arthrosis of which one was symptomatic. Three patients (11%) had extra articular ossifications of which one was symptomatic. There was no relation between the impingement symptoms, subacromial osteolysis and development of acromioclavicular joint arthrosis or extra articular ossifications. Conclusions The clavicle hook plate is a good primary treatment option for the acute displaced lateral clavicle fracture with few complications. At mid term the results are excellent and no long term complications can be addressed to the use of the plate.
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Affiliation(s)
- Davut Tiren
- Department of Surgery, Amphia Ziekenhuis, Breda, The Netherlands.
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Wu K, Chang CH, Yang RS. Comparing hook plates and Kirschner tension band wiring for unstable lateral clavicle fractures. Orthopedics 2011; 34:e718-23. [PMID: 22049952 DOI: 10.3928/01477447-20110922-17] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to compare outcomes and complications of clavicular hook plate and Kirschner tension band wiring for fixation of unstable lateral clavicle fractures. The surgical outcomes of 92 consecutive patients (mean age, 49.30 ± 15.54 years) with unstable fractures of the lateral clavicle treated using AO clavicle hook plates were compared with those of 24 patients (mean age, 50.67 ± 17.58 years) treated using K-wire tension banding. Patients in the hook plate and K-wire groups were followed up for 22.76 ± 2.22 and 25.67 ± 2.75 months, respectively (P<.001). The time to hardware removal was significantly shorter (P<.001) in the hook plate group (5.20 ± 1.93 months) compared with the K-wire group (7.58 ± 2.00 months), whereas the Constant-Murley score was significantly higher (P<.001) in the hook plate group (90.43 ± 4.78) compared with the K-wire group (85.63 ± 5.38) at final follow-up. There were 12 complications in the hook plate group and 7 in the K-wire group (P=.069). Complications in the hook plate group included 7 periprosthetic fractures, 4 plate removals, and 1 plate malposition. Complications in the K-wire group included 3 K-wire migrations, 3 losses of reduction, and 1 wire breakage. We found that hook plate fixation of unstable lateral clavicle fractures was associated with statistically better shoulder function and earlier implant removal than K-wire tension band fixation, with an equivalent rate of complications. Our findings suggest that hook plates are useful for treating unstable lateral clavicular fractures.
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Affiliation(s)
- Karl Wu
- Department of Orthopaedics, Division of Surgery, Far Eastern Memorial Hospital, Ban-Chaio, China
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Soh C, Sivapathasundaram N, Parthiban R, Ramanand A. A technique of distal clavicle fracture fixation using the tightrope procedure. Malays Orthop J 2011; 5:20-3. [PMID: 25279031 DOI: 10.5704/moj/1111.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
ABSTRACT We present here a technique of fracture stabilization using the Tightrope procedure in a patient with a widely displaced Neer type IIB distal clavicle fracture. The Tightrope system, typically used for stabilization of acromioclavicular joint dislocation, has not been widely described for distal clavicle fractures. The patient achieved satisfactory results after surgery; we feel that this technique is appealing as it is simple, reproducible and avoids the complications associated with extensive metalwork. This technique may also appeal to the arthroscopic surgeon. KEY WORDS Neer Type Ii Distal Clavicle Fracture, Tightrope Procedure, Arthroscopy.
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Affiliation(s)
- Cj Soh
- Department of Orthopaedic Surgery, Hospital Melaka, Melaka, Malaysia
| | | | | | - A Ramanand
- Department of Orthopaedic Surgery, Hospital Melaka, Melaka, Malaysia
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Ding M, Ni J, Hu J, Song D. Rare complication of clavicular hook plate: clavicle fracture at the medial end of the plate. J Shoulder Elbow Surg 2011; 20:e18-20. [PMID: 21831666 DOI: 10.1016/j.jse.2011.06.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 05/24/2011] [Accepted: 06/05/2011] [Indexed: 02/01/2023]
Affiliation(s)
- Muliang Ding
- Department of Orthopaedics, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
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Abstract
Most clavicle fractures heal without difficulty. However, radiographic nonunion after distal clavicle fracture has been reported in 10% to 44% of patients. Type II distal clavicle fractures, which involve displacement, are associated with the highest incidence of nonunion. Several studies have questioned the clinical relevance of distal clavicle nonunion, however. Nonsurgical and surgical management provide similar results. The decision whether to operate may be influenced by the amount of fracture displacement and the individual demands of the patient. Surgical options to achieve bony union include transacromial wire fixation, a modified Weaver-Dunn procedure, use of a tension band, screw fixation, plating, and arthroscopy. Each technique has advantages and disadvantages; insufficient evidence exists to demonstrate that any one technique consistently provides the best results.
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47
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Kim KC, Shin HD, Cha SM, Jeon YS. Hook Plate Fixation for Unstable Distal Clavicle Fractures: A Prospective Study. ACTA ACUST UNITED AC 2011. [DOI: 10.5397/cise.2011.14.1.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jou IM, Chiang EP, Lin CJ, Lin CL, Wang PH, Su WR. Treatment of unstable distal clavicle fractures with Knowles pin. J Shoulder Elbow Surg 2011; 20:414-9. [PMID: 21106398 DOI: 10.1016/j.jse.2010.08.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 08/03/2010] [Accepted: 08/07/2010] [Indexed: 02/01/2023]
Abstract
BACKGROUND Unstable distal clavicle fractures often need surgical treatment. This report describes a new intramedullary extra-articular Knowles pin fixation method to treat these unstable fractures. MATERIALS AND METHODS Twelve patients with unstable distal clavicle fractures (Neer type II) had surgery with intramedullary extra-articular Knowles pin fixation. We retrospectively reviewed clinical results for pain, shoulder function, and range of motion, as well as radiographic results, for this institutional review board-approved study. Each patient's operated arm was in a sling for 4 weeks postoperatively. The University of California, Los Angeles shoulder rating scale score was used to evaluate shoulder function. RESULTS All patients showed radiographically confirmed bony union. The mean period required for healing was 11.5 weeks, and patients were followed up for 6 to 24 months (mean, 15.2 months), during which University of California, Los Angeles scores (mean, 33.9) indicated good clinical results. Three patients had the complication of proximal or distal skin irritation caused by the thread and hub of the Knowles pin. CONCLUSIONS The Knowles pin fixation method is useful for treating unstable distal clavicle fractures. However, sufficient familiarity with the technique and careful preoperative planning to determine the appropriate length of the pin are necessary to prevent complications and to effect a high union rate.
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Affiliation(s)
- I-Ming Jou
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
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Oh JH, Kim SH, Lee JH, Shin SH, Gong HS. Treatment of distal clavicle fracture: a systematic review of treatment modalities in 425 fractures. Arch Orthop Trauma Surg 2011; 131:525-33. [PMID: 20967548 DOI: 10.1007/s00402-010-1196-y] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Indexed: 11/29/2022]
Abstract
The Neer type II distal clavicle fracture is notorious for its high nonunion rate, and surgical treatment is usually recommended. We reviewed articles from January 1990 to September 2009, and among them, 425 cases from 21 studies were included. According to the 425 cases in the literature, sixty patients were treated nonsurgically and 365 surgically. From 365 patients who were treated surgically, 105 were identified as receiving the coracoclavicular stabilization, 162 hook plate, 42 intramedullary fixation, 16 interfragmentary fixation, and 40 K-wire plus tension band wiring. The nonsurgical treatment resulted in 20 (33.3%) nonunions and 4 (6.7%) other complications. The surgical treatment resulted in 6 (1.6%) nonunions, 81 (22.2%) complications other than nonunion. The nonunion rate was significantly high with nonsurgical treatment (p < 0.001), and the complication rate was statistically high with surgery (p = 0.002). With surgical treatment, the nonunion rate was not significantly different among the modalities (p = 0.391). The complication rate was significantly higher in cases of the hook plate (40.7%) and the K-wire plus tension band wiring (20.0%) than those of the coracoclavicular stabilization (4.8%), the intramedullary (2.4%) and the interfragmentary fixation (6.3%). For the nonsurgical treatment, the functional outcomes were generally acceptable despite the high nonunion rate. The nonsurgical treatment could be considered as the first line treatment after sufficient counsel with the patient. The nonunion rate is high, however, the functional outcome is acceptable in most of the cases with nonunion. If the surgical treatment is considered, the intramedullary screw fixation, CC stabilization and interfragmentary fixation would be preferred because of their low complication rate.
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Affiliation(s)
- Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea
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Tsuei YC, Au MK, Chu W. Comparison of clinical results of surgical treatment for unstable distal clavicle fractures by transacromial pins with and without tension band wire. J Chin Med Assoc 2010; 73:638-43. [PMID: 21145512 DOI: 10.1016/s1726-4901(10)70139-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 07/15/2010] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND An unstable distal clavicle fracture (Neer type II) is an indication that surgical intervention is required. Numerous treatment options have been introduced, but there is no gold standard. METHODS We report on our experience of 29 consecutive cases, between 2002 and 2008, of acute unstable distal clavicle fracture (Neer type II) and operative treatment using transacromial pins with tension band wire, and compare the use of this treatment with that of traditional transacromial Kirschner wire fixation. All patients were given postoperative radiological and clinical evaluations at 4, 8 and 12 weeks, and then the final clinical outcome, based on the University of California at Los Angeles shoulder rating, was recorded. RESULTS The fractures in both groups were clinically united at a mean follow-up of 8.62 weeks (range, 6-20 weeks). Six of the 14 patients (43%) with traditional transacromial Kirschner wire fixation suffered from pin migration and discomfort of skin erosion, 3 had residual displacement, and 1 had a recurrent fracture. In contrast, only 1 patient (7%) in the tension band wire group had residual displacement and pin migration causing skin tenting, and this was made comfortable by pin removal. The complication rate and the University of California at Los Angeles shoulder rating were significantly different between the 2 groups. CONCLUSION Transacromial pins with tension band wire provide superior fixation for a type 2 fracture of the distal clavicle, compared with traditional transacromial Kirschner wire fixation.
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Affiliation(s)
- Yu-Chuan Tsuei
- Department of Orthopedics, Cheng Hsin Rehabilitation Medical Center, Taipei, Taiwan, R.O.C
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