Coracoclavicular Ligament Suture Augmentation with Anatomical Locking Plate Fixation for Distal Clavicle Fracture

Abstract

Background: For Neer type IIB fracture of distal clavicle with coracoclavicular ligament injury, various surgical treatments have been used in literatures. However, there was no consensus on the optimal treatment. The aim of this study is to report the clinical and radiological results of open reduction and internal fixation of unstable distal clavicle fracture and suture augmentation of disrupted coracoclavicular ligament. Methods: A prospective study was performed in 23 patients with Neer type IIB distal clavicle fracture in Seoul Medical Center, Eulji Hospital, and National Medical Center. Firstly, suture anchors are inserted in the base of coracoid process and preliminary reduction was achieved by tie-off of three suture limbs around the clavicle. Then, the final fixation was completed with anatomical locking plate. Bony union and the distance between coracoclavicular ligaments were evaluated. Clinical results and complications including stiffness and secondary procedures were evaluated. Results: Bony union was achieved in all cases except one (22 of 23). At mean 14.9 months, no significant difference in the mean coracoclavicular distance was observed compared to uninjured shoulder (8.2 ± 7.9 mm versus 7.3 ± 3.4 mm, p=0.14). Pain visual analogue scale, American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were 0.5, 83.4, 78.5, and 6.2, respectively. Revision surgery was performed in one case of nonunion. Four patients who complained of skin irritation underwent implant removal.

Anatomical Locking Plate with Additional K-wire Fixation for Distal Clavicle Fracture

“…Some authors reported additional CC ligament fixation with suture anchor in locking plate fixation with good clinical outcomes. 11,16) Recent biomechanical studies also demonstrated that CC fixation provides improvement of stability in locking plate fixation for type II distal clavicle fracture. 15) However, since this method requires more soft tissue dissection for CC fixation, it increases the possibility of nonunion.…”

“…Several authors therefore suggested modified combined techniques, such as tension band with transacromial K-wire, and CC ligament suture augmentation with locking plate, with satisfactory clinical results. [14][15][16] However, the optimal treatment for type II fracture is still controversial.…”