Comparison of the efficacy of hook plate versus tension band wire in the treatment of unstable fractures of the distal clavicle

Abstract

Fifty-two patients with unstable fractures of distal clavicle treated by open reduction and internal fixation with hook plates or tension band wires were retrospectively reviewed. The 52 patients were divided into two groups based on the method of treatment. The hook plate (HP) group included 32 patients and the tension band wire (TBW) group included 20 patients. Both groups were similar in respect to injury mechanisms, compounding medical conditions, and shoulder score (p>0.1). However, hook plating had a significantly lower rate of complication (p=0.01) and symptomatic hardware (p=0.001). In addition, hook plating better facilitated the return to work and athletic activity (p=0.004 and p=0.003, respectively). In conclusion, if surgery of distal clavicular fractures is indicated, internal fixation with a hook plate has more advantages than with tension band wires.Résumé 52 patients présentant une fracture instable de la clavicule ont été traités par réduction sanglante et fixation interne par plaques crochet. Les 52 patients ont été revus et ont été divisés en deux groupes en fonction de la méthode de traitement. L'ostéosynthèse par plaques crochet HP groupe 1 incluait 32 patients et le haubannage TBW 20 patients. Les deux groupes sont identiques en ce qui concerne le mécanisme des traumatismes, les problèmes médicaux, les scores épaule (p>0,1). Cependant le traitement par crochetplaque permet une diminution significative des complications (p=0,01) notamment matérielles (p=0,001). Par ailleurs cette ostéosynthèse par crochet-plaque permet une reprise plus rapide du travail et des activités sportives (p=0,004, 0,003 respectivement). En conclusion, si il existe une indication chirurgicale dans les fractures distales de la clavicule, il est indiqué de réaliser l'ostéosynthèse par crochet-plaque. Cette ostéosynthèse présente beaucoup plus d'avantages que l'ostéosynthèse par hauban.

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

“…Complications reported with this design have also been relatively frequent, including implant failure and metaphyseal fracture, impingement, rotator cuff tears or even hook migration and acromial fracture as the implant penetrates the subacromial space and require plate removal. 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.…”

“…Since not all studies reported the functional outcome scores of the distal clavicle fractures and they used different functional evaluation instruments, it was difficult to analyse and compare the function between the different treatment modalities. Consequently, we reviewed and compared the functional outcome scores evaluated by Constant score between the hook plate group (nine studies) [6,7,[9][10][11][12][13]31, present study] and the locking plate group (eight studies) [14][15][16][17][18][19][20]30, present study] in distal clavicle fractures. The mean Constant scores were 91.9 and 93.6 in the hook plate and locking plate groups, respectively.…”

“…Today, there is a wide variety of surgical techniques for the treatment for these fractures. If surgery of distal clavicle fractures is indicated, many implants or surgical methods are available, including Kirschner wires [3], coracoclavicular screw fixation [4,5], hook plate fixation [6][7][8][9][10][11][12][13], or locking plate fixation [14][15][16][17][18][19][20]. Although there are many types of operative procedures, no procedures are considered to be the gold standard treatment.…”

Modified tension band for displaced type 2 lateral end clavicle fractures

“…However, Lee at al. [26] described the advantageous role of hook plate fixation in their comparative study between hook plate and tension band. Andersen et al [27] reported 94% union rate with precountered superior locking plate fixation for displaced distal clavicle fractures.…”

Clavicle fractures: a comparison of five classification systems and their relationship to treatment outcomes

“…More recent studies have reported that mid-shaft fractures have a higher incidence of symptomatic non-union than previously thought [12][13][14][15]. Some authors now recommend acute fixation of displaced mid-shaft fractures [12,13], and some recommend acute fixation of some lateral third fractures [16,17]. Most clavicle fractures are treated 'conservatively' in our institution, and we wanted to review this policy.…”