Open reduction and endobutton fixation of displaced fractures of the lateral end of the clavicle in younger patients

Abstract

Displaced fractures of the lateral end of the clavicle in young patients have a high incidence of nonunion and a poor functional outcome after conservative management. Operative treatment is therefore usually recommended. However, current techniques may be associated with complications which require removal of the fixation device. We have evaluated the functional and radiological outcomes using a novel technique of open reduction and internal fixation. A series of 16 patients under 60 years of age with displaced fractures of the lateral end were treated by open reduction and fixation using a twin coracoclavicular endobutton technique. They were followed up for the first year after their injury. At one year the mean Constant score was 87.1 and the median Disabilities of the Arm, Shoulder and Hand score was 3.3. All fractures had united, except in one patient who developed an asymptomatic fibrous union. One patient had post-traumatic stiffness of the shoulder, which resolved with physiotherapy. None required re-operation. This technique produces good functional and radiological outcomes with a low prevalence of complications and routine implant removal is not necessary.

Treatment for unstable distal clavicle fractures (Neer 2) with locking T-plate and additional PDS cerclage

“…Therefore, these results were comparable to Largo et al [24] and other previously reported open and arthroscopic techniques [19,25,[31][32][33][34] (Table 1). Analysing the postoperative radiographs, we could find bony healing in all cases within 6-10 weeks.…”

Precontoured Superior Locked Plating of Distal Clavicle Fractures: A New Strategy

“…These techniques include Kirschner wires [8], tension band fixation with either wires or sutures [4,16], coracoclavicular fixation with either screws, button, or suture anchors [1,2,17,27,32], and intramedullary pin fixation [11]. Despite the numerous techniques available for distal clavicle fractures, no single one has proven superior (Table 3).…”

Intra- and Interobserver Agreement in the Classification and Treatment of Distal Third Clavicle Fractures

“…11,14,23 Although the current literature describes many procedures for the treatment of these unstable fractures, there has been no consensus or gold standard determined, and many of the treatment options have high complication rates. 13,15,16 Currently, the most widely used options for surgical fixation of these fractures are (1) a soft tissue reconstruction/repair with heavy suture, 10,17,26,31 (2) internal fixation with a plate and screw construct, 1,9 or (3) a Hook plate construct. 2,[5][6][7]12 However, these treatment options are still fraught with complications, and again the decision for treatment choice is very subjective.…”