Comparison of Treatment of Acute Unstable Distal Clavicle Fractures Using Anatomical Locking Plates with Versus without Additional Suture Anchor Fixation

Abstract

BackgroundSurgical managements were recommended for unstable distal clavicle fracture owing to the high incidence of nonunion. The present study compared the efficacy of anatomical locking plate with versus without additional suture anchor fixation for the treatment of unstable Neer type II distal clavicle fractures.Material/MethodsBetween January 2013 to January 2015, 28 consecutive patients with unstable Neer type II fractures were treated by using anatomical locking plate with or without additional suture anchor fixation. The patients were divided into anatomical locking plate group (group A) and anatomical locking plate combined with suture anchor group (group B) according to the surgical method. The operative-related parameters such as operation time, blood loss, length of hospitalization, union time, functional outcomes (Constant score, UCLA score and DASH score) and CC distance were compared.ResultsThe mean follow-up period of the 28 patients was 19.60 months (21.80 versus 18.39 months, respectively). No statistical differences in general and peri-operative parameters were found between 2 groups. The group B had significant higher Constant score than group A (P=0.004, 91.67 versus 83.10). While no statistical differences were reached in the UCLA score and DASH score between 2 groups (P=0.112 and 0.163, respectively). The group A had longer CC distance than group B (11.67 versus 8.94 mm), while no statistic difference was found (P=0.067).ConclusionsFor the treatment of acute unstable Neer type II distal clavicle fractures, both surgical methods could offer satisfactory outcome. However, anatomical locking plate combined with additional suture anchor fixation had a better functional and radiographic outcome than that without additional suture anchor fixation.

Residual coracoclavicular separation after plate fixation for distal clavicle fractures: comparison between fracture patterns

“… 16 , 30 , 29 , 31 In recent years, there have been an increasing number of reports on the addition of C-C ligament augmentation using a suture anchor or suture button to plate fixation for unstable distal clavicle fractures. 8 , 27 , 33 , 34 While it had been reported that the addition of C-C ligament augmentation provided better functional outcomes, 8 , 33 a report indicated comparable outcomes after plate fixation with and without C-C ligament augmentation 27 ; therefore, the benefit of using additional C-C ligament augmentation compared with plate fixation alone is controversial. In addition, there are concerns about complications owing to the addition of C-C ligament augmentation, such as clavicle fracture 1 , 5 , 7 , 14 , 15 and coracoid process fracture 3 , 17 , 35 at the suture hole and brachial plexus injury.…”

“…Plate fixation has recently become an established surgical treatment for distal clavicle fractures and yields satisfactory outcomes. 8 , 9 , 13 , 18 However, even with stable plate fixation, C-C separation can remain postoperatively because of the functional loss of the integrity of the C-C ligament and may affect the likelihood of postoperative complications. Although there have been studies that focused on the presence or absence of bone union, residual C-C separation after osteosynthesis for an unstable distal clavicle fracture has rarely been discussed.…”

Treatment of distal clavicle fractures using a Scorpion plate and influence of timing on surgical outcomes: a retrospective cohort study of 105 cases

“…Plate fixation for distal clavicular fractures has been reported to achieve satisfactory bone union rates [8][9][10][11][12][13][14]; however, one of the important clinical problems is the rate of postoperative complications. While hook plates showed good outcomes for fractures with comminuted distal bone fragments, various complications, such as peri-implant fracture, dislocation, and limited range of motion were reported [6,10,15].…”

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%).…”