Clinical Results of Treatment Using a Clavicular Hook Plate Versus a T-plate in Neer Type II Distal Clavicle Fractures

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 (P5.207 and P5.398, 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 (P5.001, P5.011, P5.038, and P5.001, 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 (P5.001).

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

“…It is therefore important to exercise caution when using hook plate [6][7][8][9][10][11][12][13]. In a recent study, Tan et al [26] reported 74 % of patients in the hook plate group had mild to severe shoulder pain. Kashii et al [8] observed one patient had acromial fracture, and hook cutout occurred in 19 of 34 patients who underwent hook plate fixation.…”

“…Studies have reported excellent results of distal clavicle fractures treated with locking plate [14,15,17,26,29,30]. Treatment for unstable distal clavicle fractures using a locking T-plate and a CC PDS (polydioxansulfate) cerclage can provide good and reliable clinical results and a 100 % union rate [16].…”

Fracture of distal end clavicle: A review

“…48e50 In other two level 3 studies hook plate was compared with distal radius plate and locking plate where hook plate seemed to have higher complication rate and resurgery rate for implant removal. 52,53 One level 2 study comparing hook plate with tension band wiring showed both the techniques to have comparable results. 55 Overall it seems that in spite of giving good functional outcome hook plate tend to produce major complications and there is a definite need for implant removal which again puts the patient under risk of one more general anaesthesia.…”

“…11,12,26e30 As already mentioned the one level 3 study which compared this implant with the hook plate showed it to have lesser complication and re-surgery rate. 52 Technically speaking there should be no need for implant removal as there is no breach into the AC joint. But hardware symptoms and implant failure can occur which needs an implant removal surgery.…”

“…52 Coracoclavicular fixation was achieved with either endobutton device, suture anchors or coracoid cerclage. There was no significant difference in functional scorings between the two group although return to recreational activity was early in the second group.…”