Comparative analysis of a locking plate with an all-suture anchor versus hook plate fixation of Neer IIb distal clavicle fractures

Abstract

Background: The coracoclavicular fixation with suture anchors adds stability to type IIb distal clavicle fractures fixed with a plate and screws when loaded to failure. The purpose of this study was to compare the clinical and radiological outcomes between the use of a locking compression plate (LCP) with all-suture anchor fixation and hook LCP fixation of Neer IIb distal clavicle fractures. Methods: A total of 82 consecutive patients who underwent plate fixation for Neer IIb distal clavicle fractures were included. The subjects were divided into two groups: an LCP with all-suture anchor fixation group and hook LCP fixation group. For clinical assessments, the American Shoulder and Elbow Surgeons score, Korean shoulder score (KSS), and Constant score were recorded. A percentage of the coracoclavicular distance (CCD%) was used to evaluate fracture reduction. Typical reported complications, such as secondary dislocation, implant failure or loosening, peri-implant fracture, acromion osteolysis, stiffness, peri-anchor osteolysis, postoperative acromioclavicular joint arthrosis, nonunion, or delayed union, were also analyzed. Results: There were no differences in the clinical and radiological outcomes at the final follow-up between the two groups. The period for bone union and CCD% showed no significant differences between groups. Stiffness at 3 months after surgery of LCP with all-suture anchor fixation ( n = 3, 10.7%) was less than that of hook LCP fixation ( n = 17, 31.5%). The complication rate also showed no significant differences between groups. However, LCP with all-suture anchor fixation had anchor-related complications, although it can reduce hook-related complications. Conclusion: LCP with all-suture anchor fixation showed satisfactory outcomes in comparison with hook LCP fixation. In Neer IIb distal clavicle fractures, LCP with all-suture anchor fixation is a useful method for the maintenance of reduction, avoiding implant removal, and hook-related complications. However, anchor fixation should be carefully used, especially in osteoporotic patients or patients with underlying diseases. Level of Evidence: Level III, retrospective study.

Different internal fixation methods for unstable distal clavicle fractures in adults: a systematic review and network meta-analysis

“…The baseline characteristics of the included studies are presented in Table 1 . Of the 41 included studies, 28 [ 15 , 20 , 33 – 36 , 39 , 42 , 44 – 48 , 53 – 68 ] were from China, 3 [ 14 , 21 , 52 ] were from the USA, 3 [ 37 , 38 , 43 ] were from Germany, 2 [ 40 , 41 ] were from Finland and 1 each was from Korea [ 51 ], Australia [ 33 ], Turkey [ 16 ], Morocco [ 49 ], and the Netherlands [ 50 ]. There were 1969 Neer type II (1642/1969, 83.4%; type II B, 709/1969, 36%) and unclear type (type II or type V, 327/1969, 16.6%) distal clavicle fractures that were fixed with HP (hook plate, 923/1969, 46.9%), LCP (locking compression plate, 384/1969, 19.5%), CC (coracoclavicular reconstruction, 255/1969, 13.0%), LCP + CC (combination of locking compression plate and coracoclavicular reconstruction, 260/1969, 13.2%), KWTB (Kirshner wire and tension band, 123/1969, 6.2%), KWTB + CC (combination of Kirshner wire and tension band and coracoclavicular reconstruction, 10/1969, 0.5%), or KW (Kirshner wire, 14/1969, 0.7%).…”

“…There were 1969 Neer type II (1642/1969, 83.4%; type II B, 709/1969, 36%) and unclear type (type II or type V, 327/1969, 16.6%) distal clavicle fractures that were fixed with HP (hook plate, 923/1969, 46.9%), LCP (locking compression plate, 384/1969, 19.5%), CC (coracoclavicular reconstruction, 255/1969, 13.0%), LCP + CC (combination of locking compression plate and coracoclavicular reconstruction, 260/1969, 13.2%), KWTB (Kirshner wire and tension band, 123/1969, 6.2%), KWTB + CC (combination of Kirshner wire and tension band and coracoclavicular reconstruction, 10/1969, 0.5%), or KW (Kirshner wire, 14/1969, 0.7%). Twelve studies [ 21 , 34 , 36 , 38 , 47 , 50 , 52 , 53 , 56 , 58 , 60 , 65 ] provided data on HP versus LCP (number of patients: 274 vs. 286), 11 studies [ 20 , 35 , 40 , 44 , 48 , 52 , 58 , 59 , 62 , 63 , 67 ] provided data on HP versus CC (number of patients: 281 vs. 255), 7 studies [ 33 , 42 , 43 , 51 , 64 , 66 , 68 ] provided data on HP versus LCP + CC (number of patients: 178 vs. 148), 6 studies [ 14 , 15 , 37 , 39 , 54 , 61 ] provided data on LCP versus LCP + CC (number of patients: 98 vs. 98), 5 studies [ 45 , 46 , 49 , 57 ] provided data on HP versus KWTB (number of patients: 190 vs. 108), 1 study [ 55 ] provided data on KWTB versus KW (number of patients: 15 vs. 14), and 1 study [ 16 ] provided data on LCP + CC versus KWTB + CC (number of patients: 14 vs. 10).The included studies were published from 2002 to 2021, and the research period of the included studies was from 1988 to 2019. The proportion of women ranged from 4.7 to 70.1%.…”

“…The NMA of the CMS comprised 25 studies [ 15 , 16 , 20 , 37 – 40 , 42 – 44 , 46 – 49 , 51 , 54 , 56 , 57 , 60 – 62 , 64 – 66 , 68 ] with 25 direct comparisons of 6 different internal fixation methods (HP, LCP, CC, LCP + CC, KWTB, and KWTB + CC) (Fig. 2 A).…”

“…The advantage of LCP is that its lateral section increases the number of locking screws and the angle of fixation of the screws, increasing the grip and resistance to extraction of the distal fracture block and increasing the effectiveness of fixation of the fracture [ 72 ]. In contrast to HP, LCP does not invade the subacromial space and the acromioclavicular joint, reducing complications such as osteoarthritis of the acromioclavicular joint, rotator cuff injury, subacromial impingement and osteolysis [ 51 , 56 ]. The plate requires a smaller incision and does not require a second operation to remove the internal fixation device.…”

“…Of the 41 included studies, 28 [15, 20, 33-36, 39, 42, 44-48, 53-68] were from China, 3 [14,21,52] were from the USA, 3 [37,38,43] were from Germany, 2 [40,41] were from Finland and 1 each was from Korea [51], Australia [33], Turkey [16], Morocco [49], and the Netherlands [50]. There were 1969 [21,34,36,38,47,50,52,53,56,58,60,65] provided data on HP versus LCP (number of patients: 274 vs. 286), 11 studies [20,35,40,44,48,52,58,59,62,63,67] provided data on HP versus CC (number of patients: 281 vs. 255), 7 studies [33,42,43,51,64,66,68] provided data on HP versus LCP + CC (number of patients: 178 vs. 148), 6 studies [14,15,37,…”