Effectiveness of Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor in treatment of Cho type ⅡC distal clavicle fractures / 中国修复重建外科杂志

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.

Comparison of anatomical locking plate fixation with versus without reconstruction of coracoclavicular ligament in treatment of acute and old Neer Ⅱb distal clavicle fractures / 中华创伤骨科杂志

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.

Cerclaje coracoclavicular y banda de tensión con sutura en el tratamiento de fracturas del tercio externo de la clavícula tipos II y V / Coraco-clavicular loop and tension band suture in type II and type V distal-third clavicle fractures

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.

Effectiveness of anatomical locking plate internal fixation combined with coracoclavicular ligament reconstruction for Neer type Ⅱb distal clavicle fractures / 中国修复重建外科杂志

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.

Reconstrucción artroscópica de fracturas del extremo distal de clavícula / Arthroscopic reconstruction of distal clavicle fractures

La fractura de clavícula representa 35 a 45 % de las fracturas de la cintura escapular, y de ellas el 15-25% comprometen el extremo distal de ella. El objetivo de esta publicación es describir nuestra técnica de reconstrucción artroscópica de las fracturas del extremo distal de clavícula con sistema AC TigthRope o sistema DogBone con sutura fibertape. La reconstrucción y estabilización artroscópica de las fracturas inestables del extremo distal de la clavícula con sistema AC TigthRope o sistema Dogbone ambos con sutura FiberTape mas la estabilización del fragmento distal de la fractura mediante suturas transósea permite una fijación estable para la consolidación de la misma. La técnica descripta permite rápida recuperación funcional y el retorno a las actividades de la vida diaria. Tipo de Trabajo: Técnica Quirúrgica. Nivel de Evidencia: V.

Fractures of the clavicle represent between 35 to 45% of all the fractures of the shoulder girdle, and 15 to 25% of these are of the distal clavicle. The purpose of this study is to describe our arthroscopic reconstruction technique of the distal clavicle using the AC Tightrope or DogBone Systems with fibertape. The arthroscopic reconstruction and stabilization of ustable distal clavicle fractures with the AC TightRope or DogBone Systems both with Fibertape with stabilization of the unstable bone fragments with trans oseous sutures allow a stable fixation until it consolidates. The technique described allows a fast recovery and retour to the activities of daily living. Type of Study: Surgical Technique. Level of Evidence: V.

Fractura de clavícula distal con cortical superior indemne: cirugía mínimamente invasiva / Distal clavicle fracture with intact upper cortex: minimally invasive surgery

INTRODUCCIÓN Las fracturas de clavícula distal desplazadas son manejadas generalmente de manera quirúrgica dada la alta probabilidad de no-unión con el tratamiento ortopédico. El propósito de este trabajo es evaluar el uso del sistema de fijación con doble botón cortical para la reducción y estabilización de la fractura de clavícula distal que presenten indemnidad de la cortical superior. MÉTODOS: Estudio retrospectivo observacional clínico-imagenológico de pacientes con fractura desplazada de clavícula distal operados con técnica mínimamente invasiva mediante reducción con sistema de fijación con doble botón cortical. Se describe como criterio radiológico de "Cortical Superior Indemne (CSI)" la presencia del rasgo de fractura a 1cm o más, hacia distal desde el tubérculo conoide, identificándose ese criterio como característica necesaria para la indicación del tratamiento propuesto. Se describen las complicaciones post-operatorias, progresión radiológica y resultados funcionales. RESULTADOS: 21 pacientes fueron tratados con esa técnica con un seguimiento promedio de 23,4 meses. No hubo casos de no unión, infección o herida dehiscente y ningún paciente requirió el retiro del dispositivo. Se encontró un Simple Shoulder Test (SST) promedio de 79,4 (66 - 91,7) y QuickDASH de 11 (6,8 - 15,9). El 87,5% de las fracturas desplazadas de clavícula distal tenían indemnidad de la cortical superior. CONCLUSIÓN: La técnica mínimamente invasiva para la reducción y fijación de la fractura de clavícula distal desplazada con botones corticales es una alternativa simple, reproducible, con pocas complicaciones y excelentes resultados funcionales.

BACKGROUND: Displaced distal clavicle fractures are commonly managed through surgery due to a high probability of nonunion with conservative treatments. The purpose of this study is to evaluate the use of Flip-buttons as a minimally invasive method for fixing and stabilizing displaced distal clavicle fractures when the upper cortical it́s intact. METHODS: A retrospective observational study of radiological and clinical results of patients with displaced distal clavicle fracture that were treated with the Flip-button technique. The indication for using this surgical method was based on the radiological criteria of "Intact Upper Cortical (IUC)" described by the authors as the presence of the fracture 1cm or more, distally to de conoid tubercle. Post-operative complications, radiologic and functional progress were recorded. RESULTS: 21 patients were treated with this technique, all with complete bony union. No patients presented infection or wound dehiscence and implant removal was not necessary in any case. The mean follow-up was of 23,4 months. The mean score in Simple Shoulder Test (SST) was 79,4 (66 - 91,7) and a mean QuickDASH of 11 (6,8 - 15,9). 87,5% of all the displaced distal clavicle fractures had IUC. CONCLUSION: The minimally invasive technique for the reduction and fixation of the displaced distal clavicle fracture with cortical buttons is a simple and reproducible alternative, with few complications and excellent functional results.

Anatomical Locking Plate with Additional K-wire Fixation for Distal Clavicle Fracture

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.

Efficacy of anatomical locking plate combined with anchor nail in the treatment of Neer Ⅱ distal clavicle fracture / 中国综合临床

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.

Anatomical Locking Plate with Additional K-wire Fixation for Distal Clavicle Fracture

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.

Coracoclavicular ligament reconstruction with the autogenous anterior half of the peroneus longus tendon for distal clavicle fracture (Neer type Ⅱ-b): A report of 26 cases / 解放军医学杂志

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.

Arthroscopic Stabilization for Displaced Lateral Clavicular Fractures: Can It Restore Anatomy?

BACKGROUND: The purpose of our study was to evaluate the accuracy of reduction based on postoperative computed tomography (CT) images after arthroscopic stabilization using tightrope system for unstable distal clavicle fracture. METHODS: Twelve patients with distal clavicle fracture combined with coracoclavicular (CC) ligament injury (type II, V) who received arthroscopically assisted fixation using a flip button device were evaluated for accuracy of reduction using 3-dimensional postoperative CT scan by measuring the degree of distal clavicular angulation and clavicular shortening. RESULTS: Immediate postoperative plain radiograph confirmed restoration of the CC distance (CCD) in 10 patients. At final follow-up, the CCD remained reduced anatomically on plain radiographs in these patients. All patients showed excessive posterior angulation and shortening compared to the opposite side. The average Constant score recovered to 94.8 at final follow-up. CONCLUSIONS: Indirect reduction and arthroscopic subacromial approach with flip button fixation of unstable distal clavicle fractures demonstrated favorable clinical results despite unavoidable posterior angulation of distal clavicle and shortening the total length of clavicle.

Usefulness of the Additional K-Wire Fixation and Suture for Reinforce the Treatment of Distal Clavicle Fracture Using Modified Tension Band Wiring

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.

Arthroscopic Stabilization for Displaced Lateral Clavicular Fractures: Can It Restore Anatomy?

BACKGROUND: The purpose of our study was to evaluate the accuracy of reduction based on postoperative computed tomography (CT) images after arthroscopic stabilization using tightrope system for unstable distal clavicle fracture. METHODS: Twelve patients with distal clavicle fracture combined with coracoclavicular (CC) ligament injury (type II, V) who received arthroscopically assisted fixation using a flip button device were evaluated for accuracy of reduction using 3-dimensional postoperative CT scan by measuring the degree of distal clavicular angulation and clavicular shortening. RESULTS: Immediate postoperative plain radiograph confirmed restoration of the CC distance (CCD) in 10 patients. At final follow-up, the CCD remained reduced anatomically on plain radiographs in these patients. All patients showed excessive posterior angulation and shortening compared to the opposite side. The average Constant score recovered to 94.8 at final follow-up. CONCLUSIONS: Indirect reduction and arthroscopic subacromial approach with flip button fixation of unstable distal clavicle fractures demonstrated favorable clinical results despite unavoidable posterior angulation of distal clavicle and shortening the total length of clavicle.

The Surgical Outcome of Unstable Distal Clavicle Fractures Treated with 2.4 mm Volar Distal Radius Locking Plate

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.

Internal Fixation Using Clavicle Hook Plates for Distal Clavicle Fractures

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.

Associated Factors of Nonunion Following Conservative Management of Distal Clavicle Fractures / 대한정형외과학회잡지

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.

Internal Fixation Using Clavicle Hook Plates for Distal Clavicle Fractures

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.

Arthroscopic Resection of The Distal Clavicle With Concomitant Subacromial Decompression: A Case Series

Shoulder impingement syndrome and acromioclavicular joint osteoarthritis often occur simultaneously and easily missed. Kay et al. reported excellent results with combined arthroscopic subacromial decompression and resection of the distal end of the clavicle in patients with both disorders1 . Arthroscopic treatment of these disorders produces more favourable results than open procedures. We report two patients who were not responding to conservative management and were treated with direct arthroscopic distal clavicle excision and subacromial decompression in single setting. Both patients gained good postoperative outcome in terms of pain score, function and strength improvement assessed objectively with visual analogue score (VAS) and University of California Los Angeles Score (UCLA).

Analysis the therapy effect of clavicular hook plate on Neer Ⅱ distal clavicle fractures and tossy Ⅲ acromioclavicular joint dislocation / 中国综合临床

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.

Complications of Hook-Plate Fixation for Distal Clavicle Fractures

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.