Clinical therapeutic effects of AO/ASIF clavicle hook plate on distal clavicle fractures and acromioclavicular joint dislocations

Abstract

Objective: The aim of this study was to evaluate the security and effectiveness of AO/ASIF clavicle hook plate in the treatment of distal clavicle fractures and acromioclavicular joint dislocations. Methods: One hundred patients with distal clavicle fractures and acromioclavicular joint dislocations who were admitted in our hospital from January 2012 to January 2013 were selected as the study subjects. They were then randomly divided into a control group and an observation group (n=50). The observation group was treated with AO/ASIF clavicle hook plates, and the control group was treated with Kirschner-wire tension bands. The outcomes were recorded and compared. Results: The JOA scores of the two groups were similar before surgery (P>0.05). The two groups both had obviously increased JOA scores in the postoperative 6th and 12th weeks, and the score in the postoperative 12th week was higher. There were statistically significant intra-group differences (P<0.05). The postoperative 6th-week and 12th-week JOA scores of the observation group were (83.2±1.8) and (97.4±1.5) respectively, and those of the control group were (71.6±2.2) and (82.3±2.6) respectively, with statistically significant inter-group differences (P<0.05). Significantly more patients in the observation group (100%) were evaluated as excellent or good outcomes after fixation than those in the control group (60%). After removal of the surgical apparatus, the recurrence rates of bone fracture and joint dislocation in the observation group were significantly lower than those of the control group (P<0.05). Conclusion: AO/ASIF clavicle hook plate functioned more effectively than Kirschner-wire tension band in clinical treatment of distal clavicle fractures and acromioclavicular joint dislocations. The former protocol enjoyed small incisions, firm fixation and early shoulder mobility. Therefore, it is a safe and effective surgical method that is worthy of being widely applied in clinical practice.

Fifteen-degree clavicular hook plate achieves better clinical outcomes in the treatment of acromioclavicular joint dislocation

“…Use of this leverage helps to push the plate downward and allows the distal hook to produce sustained and stable upward pressure, assisting in fixing the dislocated AC joint as well as providing a stable environment for the healing of ligaments and joint capsules. 6 Use of the hook plate is also helpful for early functional improvement exercises to avoid muscle atrophy and shoulder joint adhesion caused by long-term fixation. The hooked end of the hook plate is located close to the acromion bone and is inserted into the back of the acromion to decrease its impact on the rotator cuff and decrease the incidence of subacromial impingement syndrome.…”

Clinical and radiological results on the fixation of Neer type 2 distal clavicle fractures with a hook plate

“…The optimal time to remove the hook plate still remains controversial. 7 , 8 , 10 , 11 , 12 , 13 , 16 , 20 , 23 , 24 , 26 Physical examination and conventional radiographic modalities are not very specific to diagnose the accurate ligamentous healing. Thus, studies focus on the question of ‘how to optimize the design of hook plate and what is the optimal time to remove the hook plate in order to decrease the incidence of acromial osteolysis.…”

“…Regarding the higher rate of early major complications like acromial osteolysis, implant failure and refracture, surgical fixation of Neer type 2 clavicle fractures with a hook plate is controversial. 7 , 8 , 11 , 12 , 16 , 18 , 19 , 20 , 21 , 22 , 23 In a meta-analysis by Stegeman et al 8 the hook plate and other fixation methods in the treatment of fractures were compared. There was no difference between the hook plate and other methods with respect to functional results and time to union.…”

“…All fixation methods have superiorities or deficiencies when compared to each other and none of them has been nominated as the ‘gold standard’. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 …”

“…In the last decade, the clavicular hook plate has been used extensively in the treatment of displaced lateral clavicle fractures. 6 , 7 , 9 , 10 , 11 , 12 , 13 , 15 , 16 , 19 , 20 , 23 Although this plate achieved a high percentage of union, implant-related complications such as acromial osteolysis and peri-implant fracture are well recognized by the orthopaedic surgeons and many of them have advised against prolonged retaining of the implants. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 15 , 16 , 19 , 20 , 24 , 25 , 26 , 27 However shortening the time of hook plate fixation may lead to incomplete healing of the fracture site or ligaments.…”