Evaluation of the modified CC stabilization using LARS artificial ligament in unstable distal clavicle fracture

Abstract

Purpose: Unstable distal clavicle fracture is common, and there is no consensus regarding the gold standard treatment for this fracture. The purpose of this study was to report a new surgical technique for the treatment of unstable distal clavicle fracture with modified coracoclavicular (CC) stabilization using ligament augmentation and reconstruction system (LARS) artificial ligament, and evaluate the clinical and radiographic outcomes. Methods: From January 2009 to June 2018, eighteen patients with acute unstable distal clavicle fractures (type Ⅱb) treated by modified CC stabilization using LARS artificial ligament were retrospectively reviewed. Indexes for evaluation included fracture healing, quality of reduction, and complications (infections, nerve injuries, iatrogenic clavicle or coracoid fracture, the fixation loop failure, loss of reduction, etc.). Shoulder function was evaluated using the Constant-Murley score. Results: The patients were assessed at a mean time of 31.8 months follow-up. All 18 patients experienced radiographic union. Follow-up radiographs showed anatomical reduction in 15 patients and slight loss of reduction in 3 patients. There were 2 cases of calcification of CC ligament, 1 case of degenerative change around the acromioclavicular (AC) joint, and 1 case of clavicular osteolysis around screws noted during the follow-up. The Constant scores were 91.2 ± 6.9 at last. Conclusions: The modified CC stabilization using LARS artificial ligament resulted in a high union rate, satisfactory fracture reduction, a low complication rate, and excellent shoulder function for unstable distal clavicle fractures (type Ⅱb). We consider this simple surgical technique that naturally restores stability to the distal clavicle fracture is an efficient method for treating the fracture.