Distal-third clavicle fracture fixation: a biomechanical evaluation of fixation

Rieser, G. Ryan; Edwards, Kenny; Gould, Gregory C.; Markert, Ronald J.; Goswami, Tarun; Rubino, L. Joseph

doi:10.1016/j.jse.2012.08.022

Cited by 85 publications

(72 citation statements)

References 57 publications

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“…In addition, 12% of patients were found to have coracoclavicular heterotopic ossification. 26 Either arthroscopy assisted or in open fashion, numerous techniques have been described in coracoclavicular repair and reconstruction. Fixation techniques involve sutures, anchors, TightRope systems, and button devices, yet with limited number of studies in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…32 Although the cerclage of the clavicle around coracoid is one of the therapeutic options in long oblique fractures, it may not provide an effective fixation against distraction forces in comminuted fractures. 26 In a biomechanical study on fresh frozen cadaver, Rieser et al found the fixation using combination of locked plate with TightRope to be biomechanically superior to other techniques. 26 Another study with five patients reported successful results after button-assisted coracoclavicular fixation performed with locked plate.…”

Section: Discussionmentioning

confidence: 99%

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Results of minimal invasive coracoclavicular fixation by double button lift-up system in Neer type II distal clavicle fractures

Dedeoğlu

İmren

Çabuk

et al. 2017

J Orthop Surg (Hong Kong)

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Aim: We aimed to evaluate clinical and functional outcomes of indirect fracture reduction performed by coracoclavicular fixation with minimal invasive double button lift-up system in Neer type IIa unstable fractures of distal clavicle. Material and methods: 22 patients with Neer type 2 distal clavicle fracture were enrolled in that prospective study. All patients underwent indirect reduction and osteosynthesis performed by coracoclavicular fixation with minimal invasive double button lift-up system. Postoperative follow-up was carried out clinically and radiologically with plain X-rays and utilization of Constant and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) shoulder scores. Mean follow-up time was 15 months. A standard sling was applied for 2 weeks, postoperatively. Rehabilitation program was started on postoperative day 1. Results: Mean age was 39 (range: 21-60), 18 of the patients were male. Right dominant extremity was affected in 14 patients. Mean duration of the surgical intervention was 40 min (range: 30-55 min). Mean union time was found to be 14 weeks (range: 7-21 weeks). Mean postoperative ASES and Constant scores were 79.9 (66.9-88.3) and 82.2 (71-100), respectively. The duration of return to normal daily activities were found to be 4.5 months. Any loss of reduction, AC joint arthrosis, and clavicular shortening were not detected in X-rays. Conclusion: This study has demonstrated that indirect osteosynthesis performed by coracoclavicular fixation with double button lift-up system in the treatment of unstable Neer type IIa fractures of the distal clavicle had successful clinical, radiological, and functional outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Results of minimal invasive coracoclavicular fixation by double button lift-up system in Neer type II distal clavicle fractures

Dedeoğlu

İmren

Çabuk

et al. 2017

J Orthop Surg (Hong Kong)

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“…Even though Loriaut et al 13) and Motta et al 14) reported satisfactory radiologic outcomes after arthroscopic stabilization based on plane radiographs, malreduction/posterior angulation, an occult complication and its effect on clinical outcome has never been mentioned previously as it is not evident on routine Xrays. Rieser et al, 22) in a biomechanical evaluation, showed that combination of a locking plate and tightrope was superior to either method alone as a result of greater construct strength and stiffness. Though fracture consolidation can be achieved without inter fragmentary fixation, arthroscopic stabilization using a double button device may not be sufficient to maintain anatomical reduction especially in the horizontal plane due to deforming forces exerted by muscle pull and gravity on fracture fragments as evidenced by shortening and increased posterior angulation of the distal clavicle in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Stabilization for Displaced Lateral Clavicular Fractures: Can It Restore Anatomy?

Khan

Yoo

Kim³

et al. 2016

Clinics in Shoulder and Elbow

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Background: The purpose of our study was to evaluate the accuracy of reduction based on postoperative computed tomography (CT) images after arthroscopic stabilization using tightrope system for unstable distal clavicle fracture. Methods: Twelve patients with distal clavicle fracture combined with coracoclavicular (CC) ligament injury (type II, V) who received arthroscopically assisted fixation using a flip button device were evaluated for accuracy of reduction using 3-dimensional postoperative CT scan by measuring the degree of distal clavicular angulation and clavicular shortening. Results: Immediate postoperative plain radiograph confirmed restoration of the CC distance (CCD) in 10 patients. At final follow-up, the CCD remained reduced anatomically on plain radiographs in these patients. All patients showed excessive posterior angulation and shortening compared to the opposite side. The average Constant score recovered to 94.8 at final follow-up. Conclusions: Indirect reduction and arthroscopic subacromial approach with flip button fixation of unstable distal clavicle fractures demonstrated favorable clinical results despite unavoidable posterior angulation of distal clavicle and shortening the total length of clavicle.

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“…1,[4][5][6] With modern operative techniques, the healing rates are improved; however, multiple surgical techniques exist (K-wire fixation, clavicular hook-plate fixation, modified tension-band fixation, Bosworth-type screw fixation), each associated with its own set of complications either as a result of the fixation itself or due to spanning the AC joint and Fig 2. (A) A pectoralis button is screwed onto the cannulated insertion device.…”

Section: Discussionmentioning

confidence: 99%

“…thus limiting its natural micromotion. [4][5][6][7][8] Currently, there is no consensus regarding the most reliable surgical treatment for the treatment of these injuries.…”

Section: Discussionmentioning

confidence: 99%

Open Reduction Internal Fixation of Distal Clavicle Fracture With Supplementary Button Coracoclavicular Fixation

Hanflik

Hanypsiak

Greenspoon

et al. 2014

Arthroscopy Techniques

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Distal clavicle fractures are common, and no standard treatment exists. Many different surgical modalities exist. This report describes an open reduction internal fixation technique that achieves both plate and coracoclavicular stabilization using a button device. A precontoured superior-lateral plate is secured to the clavicle. A 3.2-mm spade-tipped drill bit is drilled across the clavicle and coracoid, passing through 4 cortices. The button is loaded onto an insertion device, passed across the 4 cortices, and captured on the undersurface of the coracoid under fluoroscopic guidance. This construct is linked to the distal clavicle plate by heavy sutures using a second button that sits in the plate. The lateral locking holes are then filled to finalize fixation. This technique provides for a simplified way to achieve coracoclavicular stabilization when using a plate for fixation of distal clavicle fractures.

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Distal-third clavicle fracture fixation: a biomechanical evaluation of fixation

Cited by 85 publications

References 57 publications

Results of minimal invasive coracoclavicular fixation by double button lift-up system in Neer type II distal clavicle fractures

Results of minimal invasive coracoclavicular fixation by double button lift-up system in Neer type II distal clavicle fractures

Arthroscopic Stabilization for Displaced Lateral Clavicular Fractures: Can It Restore Anatomy?

Open Reduction Internal Fixation of Distal Clavicle Fracture With Supplementary Button Coracoclavicular Fixation

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