Orthogonal low profile double-plate osteosynthesis for treatment of Neer type II B distal clavicle fractures / 中华创伤杂志

ABSTRACT

Objective:To evaluate the efficacy of orthogonal low profile double-plate osteosynthesis (DPO) in the treatment of Neer type IIB distal clavicular fractures.Methods:A retrospective case-control study was carried out to analyze the clinical data of 31 patients with Neer type IIB distal clavicular fractures admitted to Second Affiliated Hospital of Zhejiang University School of Medicine from June 2016 to October 2017. There were 23 males and 8 females, aged 45-76 years(mean, 61.8 years). The left side was involved in 24 patients and right sidein 7. Out Of them, 7 patients were treated with hook plate osteosynthesis (HPO) (HPO group), 13 patients with precontoured distal clavicular locking plate osteosynthesis (LPO) (LPO group), and 11 patients with DPO (DPO group). The Constant-Murley shoulder functional outcomes, clavicle-coracoids distance (CCD), complications and hardware related symptomswere compared between groups.Results:All the patients were followed up for 10-27months(mean, 15.1 months). At the latest follow-up, Constant-Murley score was (93.8±5.1)points in LPO group and (94.8±5.8)points in DPO group, better than (84.3±13.2)points in HPO group ( P<0.05), while there was no significant difference between DPO and LPO groups ( P>0.05). CCD was increased(1 patient in HPO group, 5 in LPO group, 3 in DPO group), but there was no significantdifference between groups( P>0.05). No infection or implant breakage occurred in each group. One patient had nonunion in HPO group, 1 had malunion at trapezoid ligament bony end in LPO group and all had bone union in DPO group, showing no significant difference between groups ( P>0.05). Two patients had acromial bone corrosion and 1 had distal clavicle osteolysisin in HPO group, but not in LPO and DPO groups ( P<0.05). Three patients had hardware related symptoms in HPO group, 6 in LPO group, and none in DPO group ( P<0.05). Conclusion:Orthogonal low profile DPO can be a good choice for the treatment of distal clavicle Neer type IIB fractures, for it has advantages of good functional outcomes, lower complications and less hardware related symptoms.