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

Abstract

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.

EDITORIAL : Is Flip Button Fixation a Viable Alternative Treatment Option for Unstable Lateral Clavicle Fractures?

“…They concluded that indirect reduction and arthroscopic subacromial approach with flip button fixation of unstable lateral clavicle fractures demonstrated favorable clinical results despite unavoidable posterior angulation of the distal clavicle and shortening the total length of clavicle. However, these results reported by Khan et al 5) need to be treated cautiously. First, 2 patients (16.7%) underwent revision surgery due to incomplete reduction.…”

“…[2][3][4] In this issue, the study "Arthroscopic stabilization for displaced lateral clavicular fractures: Can it restore anatomy?" by Khan et al 5) presented a series of 12 patients who were treated with arthroscopically assisted CC stabilization using a flip button device. Ten patients had complete restoration of the CC distance and bony union without loss of reduction at the serial plain radiographs.…”