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OBJECTIVE@#To evaluate the effectiveness of Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor in the treatment of Cho type ⅡC distal clavicle fractures.@*METHODS@#The data of 17 patients with Cho type ⅡC distal clavicular fractures, who were treated with Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor between June 2019 and June 2021, was retrospectively analyzed. There were 11 males and 6 females with an average age of 38.7 years (range, 19-72 years). The fractures were caused by falling in 12 cases and traffic accident in 5 cases. All patients had fresh closed fractures. The interval from injury to operation was 1-5 days (mean, 2.6 days). The preoperative injury severity score (ISS) was 6-27 (mean, 10.2). The operation time, intraoperative blood loss, hospital stay, fracture healing, and postoperative complications were analyzed. The shoulder joint function was evaluated by disabilities of the arm, shoulder, and hand (DASH) score and Constant score at last follow-up.@*RESULTS@#All operations were completed successfully. The operation time was 20-50 minutes (mean, 31.6 minutes). The intraoperative blood loss was 30-100 mL (mean, 50.6 mL). The hospital stay was 4-9 days (mean, 5.3 days). All incisions healed by first intention. All patients were followed up 12-16 months (mean, 13 months). All clavicle fractures healed, and the healing time was 8-15 weeks (mean, 11 weeks). No complications such as fracture displacement or nonunion caused by internal fixation failure occurred. During the follow-up, skin irritation caused by the Kirschner wire withdrawal occurred in 3 cases. The Kirschner wires were removed after fracture healing in 17 patients. At last follow-up, the Constant score of shoulder joint was 90-100 (mean, 98.2). The DASH score was 0-10 (mean, 1.5).@*CONCLUSION@#Kirschner wire fixation combined with coracoclavicular ligament reconstruction with suture anchor in the treatment of Cho type ⅡC distal clavicle fractures has less postoperative complications and slight complications. It is convenient to remove the internal fixator. The Kirschner wire does not fix the distal clavicle fracture through the acromion, which has little effect on shoulder joint function and can obtain good effectiveness.
Subject(s)
Male , Female , Humans , Adult , Bone Wires , Clavicle/injuries , Suture Anchors , Blood Loss, Surgical , Retrospective Studies , Fractures, Bone/surgery , Fracture Fixation, Internal , Ligaments, Articular/surgery , Postoperative Complications , Treatment OutcomeABSTRACT
Objective:To compare anatomical locking plate fixation with versus without reconstruction of the coracoclavicular ligament in the treatment of acute and old Neer Ⅱb unstable distal clavicle fractures.Methods:From January 2015 to November 2020, 80 Neer Ⅱb distal clavicle fractures were treated at Department of Orthopaedics, The First Hospital Affiliated to China Pharmaceutical University. There were 49 males and 31 females, aged from 32 to 78 years (average, 47.8 years). Of the 50 fresh fractures, 25 were treated by internal fixation with anatomical locking plate of distal clavicle plus reconstruction of the coracoclavicular ligament with suture anchor (reconstruction group A) while the other 25 by only internal fixation with anatomical locking plate of distal clavicle (non-reconstruction group A). Of the 30 old fractures which had not got united over 3 weeks after injury, 15 were treated by internal fixation with anatomical locking plate of distal clavicle plus reconstruction of the coracoclavicular ligament with suture anchor (reconstruction group B) while the other 15 by only internal fixation with anatomical locking plate of distal clavicle (non-reconstruction group B). At 1, 3 and 6 months postoperatively, Constant-Murley scale and visual analogue scale (VAS) were used to evaluate shoulder function and pain. X-ray follow-ups were conducted to measure the coracoclavicular distance and observe fracture union and complications at the last follow-up.Results:All the 80 patients were followed up for 6 to 24 months (average, 13.8 months). For reconstruction group A and non-reconstruction group A, respectively, the union time for fresh fractures was (11.7±2.8) weeks versus (13.4±1.3) weeks, the rate of coracoclavicular distance increase 12.7%±6.2% versus 14.2%±8.0%, the Constant-Murley score 92.2±4.4 versus 90.9±5.7, showing no statistically significant difference between the 2 groups (all P>0.05). For reconstruction group B and non-reconstruction group B, respectively, the union time for old fractures was (12.8±1.9) weeks versus (19.4±6.7) weeks, the rate of coracoclavicular distance increase 12.3%±6.7% versus 21.5%±13.1%, the Constant-Murley score 93.0±5.9 versus 83.5±8.5, showing statistically significant differences between the 2 groups (all P<0.05). Conclusions:For fresh Neer Ⅱb distal clavicle fractures, simple anatomical locking plate fixation can achieve satisfactory curative efficacy without additional reconstruction of the coracoclavicular ligament. However, for old Neer IIb distal clavicle fractures, additional reconstruction of the coracoclavicular ligament can better maintain the stability of the acromioclavicular joint, reduce the risk of internal fixation failure, and achieve better outcomes.
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Resumen: Se han descrito diferentes técnicas quirúrgicas para el tratamiento de las fracturas inestables del tercio distal de la clavícula. Las complicaciones asociadas y la necesidad de retirar los implantes siguen siendo motivo de preocupación. Proponemos una técnica quirúrgica que utiliza suturas de alta resistencia para restaurar la estabilidad vertical y horizontal en las fracturas del tercio distal de la clavícula de tipo II y V de la clasificación de Neer. Esta técnica se ha utilizado en tres casos; dos de tipo V y uno de tipo II. En todos se obtuvo la consolidación ósea y todos reanudaron sus actividades previas a la lesión, incluyendo actividad deportiva, a los seis meses de la cirugía. La técnica de cerclaje coracoclavicular y banda de tensión con sutura es un procedimiento sencillo que permite la estabilización vertical y horizontal de la fractura. Permite obtener buenos resultados clínicos y puede ser una alternativa coste-efectiva eficaz en el tratamiento de estas lesiones aunque se requiere una serie más larga y un seguimiento a largo plazo para evaluar adecuadamente los resultados.
Abstract: Many surgical techniques have been used to address unstable distal third clavicle fractures. Complications and the need for hardware removal are still a concern. We propose a surgical technical using high-strength sutures to restore vertical and horizontal stability in Neer type II and Neer type V distal-third clavicle fractures. It has been used in three cases; two type V and one type II. In all cases, bone healing was achieved uneventfully and all patients resumed their pre-injury activities including sports at six-months postoperatively. The coraco-clavicular loop and tension band suture technique is a simple procedure that allows vertical and horizontal stabilization of the fracture. It achieves good clinical results and it may be a cost-effective alternative to other techniques although a longer series and long-term follow-up is required to adequately assess the results.
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Objective: To investigate the effectiveness of anatomical locking plate internal fixation combined with coracoclavicular ligament reconstruction in treatment of the Neer type Ⅱb distal clavicle fractures by comparing with the simple anatomical locking plate internal fixation. Methods: The clinical data of 40 patients with Neer type Ⅱb distal clavicle fractures who met the criteria between February 2013 and January 2017 were analyzed. Eighteen cases were treated with anatomical locking plate internal fixation and coracoclavicular ligament reconstruction by using a suture anchor (reconstruction group), and 22 cases were treated only with anatomical locking plate internal fixation (non-reconstruction group). There was no significant difference in gender, age, injured side, causes of injury, associated injuries, time from injury to operation between 2 groups ( P>0.05). The operation time, medical expense, postoperative coracoclavicular distance, Constant-Murley scores of injured side, and complications were recorded and compared between 2 groups. Results: All patients were followed up 12-27 months (mean, 16.3 months). One patient in reconstruction group had superficial wound infection. One patient in non-reconstruction group had pullout of screws from the distal fragment and reduction loss at 1 month postoperatively. The operation time and medical expense in reconstruction group significantly increased when compared with those in non-reconstruction group ( P0.05). Conclusion: Both anatomical locking plate internal fixation with and without coracoclavicular ligament reconstruction can achieve good effectiveness for the Neer type Ⅱb distal clavicle fractures. Therefore, the coracoclavicular ligament reconstruction does not need, except for comminuted fractures with the length of lateral fragment less than 1 cm or the patients with poor compliance.
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Objective To explore the clinical effect of coracoclavicular ligament reconstruction with the autogenous anterior half of peroneus longus tendon (AHPLT) for distal clavicle fracture (Neer type Ⅱ-b).Methods The clinical data were retrospectively analyzed of 26 Neer type Ⅱ-b distal clavicle fracture surgically treated by coracoclavicular ligament reconstruction with autogenous AHPLT in Ganyu District People's Hospital of Lianyungang from June 2012 to May 2015.Among the 26 cases,16 males and 10 females,aged from 19-56 years (average 38.7 years).Fracture occurred in left side in 18 cases and in right side in 8 cases.Postoperative observations were done on fracture healing,shoulder and ankle-foot function recovery.Results For all the 26 cases,surgical incisions were healed well,and no infection,vascular and peroneal nerve injury and iatrogenic fracture occurred.Follow-up was carried out for 10-24 months with average of 15.3 months.All the fractures were healed within 12-20 weeks with an average of 14.6 weeks.One patient was found of losing the fracture reduction part during the follow-up process,and then got eventual healing by extending the limb brake time.Another patient was found of slight tendon sensation disorder with no significant effect on daily life and exercise,and the symptoms disappeared 6 months later.At the last follow-up,the Constant-Murley score was 92-100 with an average of 97.8 points.The ankle-hind foot score of American Society of Ankle and Orthopedics was excellent.Conclusion Reconstruction of coracoclavicular ligament with autogenous AHPLT is an effective treatment for Neer type Ⅱ-b distal clavicle fracture with good safety and without negative effect on the ankle-foot function,and thus it is worthy of wider clinical use.
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Objective To observe the efficacy of anatomical locking plate combined with anchor nail internal fixation and clavicular hook plate in the treatment of Neer Ⅱ distal clavicle fracture and their impact on shoulder function.Methods Eighty patients with Neer Ⅱ distal clavicular fracture treated in the Eighth People's Hospital in Shanghai from January 2015 to December 2016 were divided into observation group and control group,each group 40 cases.The observation group was treated with anatomical locking plate combined with anchor nail,the control group was treated with clavicular hook plate.The efficacy,operation time,intraoperative blood loss,fracture healing time,postoperative hospital stay,shoulder function score and incidence of complication were observed in the two groups.Results The excellent rate was in the observation group was higher than that in the control group (97.50%(39/40) vs.80.00%(31/40),χ2=2.477,P0.05);the fracture healing time in the observation group was longer than that of the control group ((23.65±2.19) w vs.(26.9±3.46) w,P<0.01).The shoulder joint Constant-Murley score in the observation group was (86.02±5.19) points,control group (68.46± 6.94) points,the difference was statistically significant (P<0.01).Observation group showed 2 cases of pain around acromion,the incidence rate of complications was 5.00%(2/40);7 cases in the control group had pain around acromion,2 cases suffered from impingement syndrome and 1 cases had delayed union,the incidence rate of complications was 25.00% (10/40).Conclusion Anatomical locking plate combined with anchor nail internal fixation is effective in the treatment of Neer II distal clavicle fracture.It has the advantages of fast fracture healing,good functional recovery of shoulder joint and less complications.
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BACKGROUND: Neer type II distal clavicle fractures have the drawback of coracoclavicular instability and insufficient distal bony fragment, thereby making it difficult to achieve adequate fixation. Although various surgical treatments have been described for Neer type II fracture, the optimal treatment remains controversial. This study reports the clinical results and usefulness of anatomical locking plate with additional K-wire fixation. METHODS: A totally of 21 patients with type II distal clavicle fracture were included in the study. The surgical procedure reduced the fracture temporarily; it included insertion of one or two K-wire from the lateral margin of the distal fragment to the proximal fragment through the fracture site, followed by application and fixation of the locking plate. The bony union and migration of K-wire was evaluated in the follow-up radiography. The coracoclavicular distance and acromioclavicular joint arthrosis were assessed at the final follow-up. The Constant Score (CS) and Korean Shoulder Score (KSS) were evaluated for clinical scoring. RESULTS: Bone union was achieved in all cases. At the final follow-up, coracoclavicular distance of the injured shoulder was increased, as compared to the intact shoulder (p=0.002), with no accompanying clinical symptoms. No K-wire migration was observed. At the final follow-up, K-wire irritation was observed in two cases and acromioclavicular arthrosis in one case, with no other adverse effects. Pain visual analogue scale, CS, and KSS were improved in all cases. CONCLUSIONS: The method of anatomical locking plate with additional K-wire fixation could be useful in achieving beneficial clinical results.
Subject(s)
Humans , Acromioclavicular Joint , Clavicle , Follow-Up Studies , Methods , Radiography , ShoulderABSTRACT
BACKGROUND: Neer type II distal clavicle fractures have the drawback of coracoclavicular instability and insufficient distal bony fragment, thereby making it difficult to achieve adequate fixation. Although various surgical treatments have been described for Neer type II fracture, the optimal treatment remains controversial. This study reports the clinical results and usefulness of anatomical locking plate with additional K-wire fixation. METHODS: A totally of 21 patients with type II distal clavicle fracture were included in the study. The surgical procedure reduced the fracture temporarily; it included insertion of one or two K-wire from the lateral margin of the distal fragment to the proximal fragment through the fracture site, followed by application and fixation of the locking plate. The bony union and migration of K-wire was evaluated in the follow-up radiography. The coracoclavicular distance and acromioclavicular joint arthrosis were assessed at the final follow-up. The Constant Score (CS) and Korean Shoulder Score (KSS) were evaluated for clinical scoring. RESULTS: Bone union was achieved in all cases. At the final follow-up, coracoclavicular distance of the injured shoulder was increased, as compared to the intact shoulder (p=0.002), with no accompanying clinical symptoms. No K-wire migration was observed. At the final follow-up, K-wire irritation was observed in two cases and acromioclavicular arthrosis in one case, with no other adverse effects. Pain visual analogue scale, CS, and KSS were improved in all cases. CONCLUSIONS: The method of anatomical locking plate with additional K-wire fixation could be useful in achieving beneficial clinical results.
Subject(s)
Humans , Acromioclavicular Joint , Clavicle , Follow-Up Studies , Methods , Radiography , ShoulderABSTRACT
PURPOSE: We attempted to evaluate the clinical results of modified tension band wiring (MTBW) with additional K-wire fixation and suture for distal clavicle fracture. MATERIALS AND METHODS: Fifty-nine patients with a distal clavicle fracture from May 2009 to December 2013 treated with MTBW were enrolled in this study. Their fracture types were type 2, 12; and type 3, 33; type 4, 8; and type 5, 6 according to Craig classification group II; average age was 47.2 years with a mean follow-up period of 27.9 months. The operations were performed within a mean of 3.1 days a fter t rauma. The c linical results were evaluated u sing University of California at Los Angeles scores (UCLA), American Shoulder and Elbow Surgeons scores (ASES) and Korean Shoulder Society scores (KSS) at 1 year after surgery. RESULTS: Radiographic bone union was achieved at a mean of 3.7 months after the operation. In the last observation, their range of motion was forward flexion 159.0°, external rotation 59.8°, and internal rotation 4.3 points, and there were 2 cases of nonunion. Each average functional score was UCLA 31.3 points, KSS 91.6 points, and ASES 93.0 points. CONCLUSION: For the surgical treatment of distal clavicle fractures, MTBW with additional K-wire fixation and suture is a useful technique allowing early range of motion exercises, minimizing soft tissue damage, and preserving the acromio-clavicular joint.
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Humans , California , Classification , Clavicle , Elbow , Exercise , Follow-Up Studies , Joints , Range of Motion, Articular , Shoulder , SuturesABSTRACT
PURPOSE: The purpose of this study was to evaluate radiological and clinical outcomes and to analyze factors associated with nonunion after conservative management in patients with distal clavicle fracture. MATERIALS AND METHODS: We analyzed 29 cases. Neer type, coracoclavicular distance (CCD), initial displacement, comminution, union, and presence of bony union were evaluated by plain radiographs. Clinical outcomes according to University of California at Los Angeles (UCLA), American Shoulder and Elbow Surgeons (ASES), and subjective shoulder value (SSV) scores were assessed. RESULTS: Six cases (20.7%) had developed nonunion. Three cases had asymptomatic nonunion. Mean UCLA, ASES, and SSV scores were 30.9, 88.3, and 87.0 in the union group and 26.7, 76.2, and 70.8 in the nonunion group. Although the nonunion group had inferior clinical outcome compared to the union group, there was no significant difference between the two groups. Older age and more CCD showed correlation with nonunion (p=0.047, p=0.007). CONCLUSION: Conservative management of distal clavicle fractures provided satisfactory clinical outcomes. The rate of symptomatic nonunion was 10.4%. Occurrence of nonunion showed correlation with older age and more CCD.
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Humans , California , Clavicle , Elbow , ShoulderABSTRACT
PURPOSE: This study evaluated the surgical outcomes of unstable distal clavicular fractures treated with a 2.4 mm volar distal radius locking plate. MATERIALS AND METHODS: From August 2009 to August 2012, 16 patients with distal clavicle fractures underwent surgical treatment. Mean age was 36 years (18-62 years) and mean follow-up period was 12.9 months (6-32 months). Two cases were Neer type I, six cases IIa, three cases IIb, three cases III, and two cases V. For the radiologic assessment, union time and metal failure were evaluated, and coracoidiologic assessment, union time and metal failure were evaluatethe acromioclavicular joint. The clinical results were evaluated by range of motion, postoperative complication, and University of California at Los Angeles (UCLA) score. RESULTS: Mean time to fracture union was 7.4 weeks (6-14 weeks) in all cases. No statistical difference in coracoid-clavicle distance was observed between immediate post-operation group and contra-lateral group (p=0.6), but an increase of 2.1 mm was observed in the last follow up group compared with the contra-lateral group (p<0.01). The UCLA scoring system showed excellent results in 15 cases and good results in one case. Acromial-clavicle instability occurred in one case so that metal removal and distal clavicle resection were performed. CONCLUSION: A 2.4 mm volar distal radius locking plate can provide rigid fixation through several screw fixation in the short distal fragment and lead to satisfactory clinical outcomes in unstable distal clavicular fractures.
Subject(s)
Humans , Acromioclavicular Joint , California , Clavicle , Follow-Up Studies , Postoperative Complications , Radius , Range of Motion, ArticularABSTRACT
BACKGROUND: To report the radiological and clinical outcomes of internal fixation using distal clavicle hook plates for distal clavicle fractures. METHODS: From April 2008 to December 2012, 32 patients with distal clavicle fractures underwent surgery using an AO hook plate. The reduction was qualified and evaluated according to the radiological findings. The evaluation of the clinical outcomes was performed with the University of California at Los Angeles (UCLA) score, the Korean Shoulder score, and the visual analogue scale (VAS) pain score. RESULTS: By radiological evaluation, we found that 31 of 32 patients showed anatomical reduction and solid bone union. Although we obtained satisfactory UCLA scores, Korean Shoulder Scale scores, and VAS pain scores, 12 cases of complications were present. We found 4 cases of osteolysis of the acromion, 1 case of nonunion, 3 cases of periprosthetic fractures, 3 cases of subacromial pain, and 1 case of skin irritation. We performed re-operations in 2 patients. CONCLUSIONS: To avoid complications associated with clavicle hook plates, choosing the appropriate hook size and bending of the hook according to the slope of the acromion undersurface is critical. Also, we believe that early removal of clavicle plates may help reduce complications.
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Humans , Acromion , California , Clavicle , Osteolysis , Periprosthetic Fractures , Shoulder , SkinABSTRACT
BACKGROUND: To report the radiological and clinical outcomes of internal fixation using distal clavicle hook plates for distal clavicle fractures. METHODS: From April 2008 to December 2012, 32 patients with distal clavicle fractures underwent surgery using an AO hook plate. The reduction was qualified and evaluated according to the radiological findings. The evaluation of the clinical outcomes was performed with the University of California at Los Angeles (UCLA) score, the Korean Shoulder score, and the visual analogue scale (VAS) pain score. RESULTS: By radiological evaluation, we found that 31 of 32 patients showed anatomical reduction and solid bone union. Although we obtained satisfactory UCLA scores, Korean Shoulder Scale scores, and VAS pain scores, 12 cases of complications were present. We found 4 cases of osteolysis of the acromion, 1 case of nonunion, 3 cases of periprosthetic fractures, 3 cases of subacromial pain, and 1 case of skin irritation. We performed re-operations in 2 patients. CONCLUSIONS: To avoid complications associated with clavicle hook plates, choosing the appropriate hook size and bending of the hook according to the slope of the acromion undersurface is critical. Also, we believe that early removal of clavicle plates may help reduce complications.
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Humans , Acromion , California , Clavicle , Osteolysis , Periprosthetic Fractures , Shoulder , SkinABSTRACT
Objective To investigate therapy effect and its clinical complications of the clavicular hook plate internal fixation for the treatment of Type Neer Ⅱ distal clavicle fracture and tossy Ⅲ acromioclavicular joint dislocation.Methods Twenty-two patients of Neer Ⅱ distal clavicle fracture and 16 patients of Tossy Ⅲ acromioclavicular joint dislocation were selected as our subjects.All patients were hospitalized and treated by using clavicular hook plate fixation form August 2007 to Februay 2012.The clinical effect and complications were analyzed retrospectively.Results All patients were showed the primary healing in terms of incision.Of all patients,30 cases were being following up,and follow-up periods was 6.0 to 18.0 months (average of (10.45 ±3.78) months).All patients underwent implant removal surgery at postoperative 6-14 months.No refracture or acromioclavicular joint separation again occurred.Four patients were with complications,of which,2 patients were clavicular hook plate decoupling at 7 days or 3 weeks after operation; One patient occurred clavicle stress fracture at more than 3 months after operation.All mentioned 3 cases were treated with re-operation.1 patient was with shoulder abnormal sound after operation and abnormal sound disappear after internal fixation removed.The shoulder functions were evaluated according to University of California-Los Angeles (UCLA) score system at before and after clavicular hook plate was taken out.The scores of pain and function of the shoulder,forward lateral flexion range were significant difference between before and after clavicular hook plate removed ((7.90 ±1.20) vs.(9.20±1.03),t =-2.327,P=0.045;(8.00±0.94) vs.(9.40 ±0.97),t=-3.280,P=0.001 ; (4.00 ±0.47) vs.(4.70 ± 0.48),t =-4.583,P =0.001).After the hook plate was removed,all shoulder functions showed improvement.The overall efficacy was excellent in 15 cases,good in 13 cases,and poor in 2 cases,and the recovery of excellent and good rate were 93.33％.Conclusion The clinical efficacy is well in terms of using clavicular hook plate internal fixation to treat Type Neer Ⅱ distal clavicle fracture and Tossy Ⅲ acromioclavicular joint dislocation.Prevention and treatment of complications should paid more attention.
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PURPOSE: To report on the complications of hook-plate fixation for distal clavicle fractures. MATERIALS AND METHODS: Eighteen patients who underwent surgery for distal clavicle fracture with a hook-plate from April 2008 to April 2011 were enrolled with a minimum of 4 months follow-up. The reduction was qualified and evaluated according to the radiologic findings. We analyzed the results by UCLA score, Kona's functional evaluation, and VAS pain score. RESULTS: By radiologic evaluation, 17 of 18 cases showed anatomical reduction and solid unions. Although satisfactory results were found in the clinical study as shown by the UCLA score, Kona's functional evaluation, and VAS pain score, complications arose in 7 cases, including osteolysis of the acromion in 2 cases, nonunion in 1 case, periprosthetic fracture in 2 cases, subacromial pain in 1 case, and skin irritation in 1 case. 2 cases of all required reoperation. CONCLUSION: To reduce the complications of the hook-plate, a precise surgical technique and the choice of an appropriate size for the hook-plate are needed. We suggest that early removal of the plate is necessary to decrease the risk of subacromial impingement and erosion in hook-plate fixation.
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Humans , Acromion , Clavicle , Follow-Up Studies , Osteolysis , Periprosthetic Fractures , SkinABSTRACT
Objective To explore the clavicular hook plate in the treatment of distal clavicle fracture dislocation acromioclavicular joint clinical effects.Methods Twenty-three cases of Neer Ⅱ type distal clavicle fracture and 28 cases of Allman Ⅲ acromioclavicular joint dislocation line with open reduction and clavicular hook plate fixation.Results Fifty-one patients in this group have received 6-24 months of follow-up,an average of 18 months.2-3 weeks after the activities returned to normal off the shoulder,clavicle fractures were 3-12 months after bone healing and no-dislocation of acromioclavicular joint occur.According to Karlsson evaluation criteria:excellent in 40 cases,good in 9 cases and poor in 2 cases,excellent rate of 96.1％.Conclusion The clavicular hook plate fixation strength in the design and in line with the anatomical acromioclavicular joint physiological characteristics,surgical trauma,and has a fixed precise,allows early functional exercise.It is the ideal way to lock joint dislocation.
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PURPOSE: To evaluate the result of distal clavicle fracture treated by Hook plate (LCP clavicle hook plate, Synthes(R), Paoli, Switzerland). MATERIALS AND METHODS: 10 patients with distal clavicle fracture treated by Hook plate from April 2008 to March 2010 were analyzed. The average follow-up period was 10 (range 4 to 26) months. The reduction was qualified and evaluated according to the immediate post-operative, final radiographs. We analyze the result by UCLA score and Kona's functional evaluation. RESULTS: By radiologic evaluation, all cases showed anatomical reduction and solid union. By Kona's functional evaluation, there are 7 cases with excellent results, 3 cases with good results. The UCLA score was average 33.3 (range 29 to 35) points followed by 6 excellent cases, 4 good cases. As complication, 1 case showed post-operative clavicle shaft fracture and 1 case showed acromial osteolysis on X-rays. We found no complications such as skin irritation, infection, loosening of screws, and plate failure. CONCLUSION: The Hook plate fixation for distal clavicle fracture is considered effective method for satisfactory reduction and rigid fixation, a lower incidence of nonunion and excellent clinical result.
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Humans , Clavicle , Follow-Up Studies , Incidence , Osteolysis , SkinABSTRACT
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.
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Clavicular fracture is common injury in the upper extremity, but ipsilateral proximal, distal or middle-third clavicular fractures which occur simultaneously are an extremely rare. Seven cases have been reported in the English and Japanese literatures, but it has never been reported in Korea. We report a case of ipsilateral proximal and distal clavicular fracture caused by fall from height and describe its presumed mechanism, diagnosis, treatment with a review of literatures.
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Humans , Asian People , Clavicle , Korea , Upper ExtremityABSTRACT
PURPOSE: Unstable distal clavicle fractures should be treated surgically but may be difficult in firm fixation because of small distal fragment. Although a variety of fixation methods have been currently used, none of the methods seem to be firm fixation and little pain. We present a new technique using a spring plate which was modified from one third tubular plate and report the early results. MATERIALS AND METHODS: Modified spring plate was made from one third tubular plate and the distal hole of the plate was cutting and sharpened by rasp. The sharp edge was bent just like an animal claw (C shape). Between May 2007 and June 2009, a total of six patients with distal clavicle fracture were treated using modified spring plate. A sling was applied in the immediate post operative period for six weeks and exercises were started immediately. RESULTS: Union was achieved in all cases with excellent results without complication (mean Constant score, 96). All patients had returned to ordinary daily activities but mild limitation of abduction (150 degrees ) by seven weeks after surgery. After six months, the plate was removed. CONCLUSION: The modified spring plate has provided stable fixation for unstable distal clavicle fixation without disturbance to the acromioclavicular joint, subacromial space, or rotator cuff.