Outcomes of Arthroscopic Fixation of Unstable Distal Clavicle Fractures: A Systematic Review

Abstract

Background: Surgical management of unstable distal clavicle fractures (DCFs) remains controversial. Traditional open techniques result in acceptable union rates but are fraught with complications. In response to these limitations, arthroscopic techniques have been developed; however, clinical outcome data are limited. Purpose: The primary purpose was to systematically evaluate the clinical and radiographic outcomes of arthroscopic fixation of unstable DCFs. The secondary purpose was to characterize the overall complication rate, focusing on major complications and subsequent reoperations. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included a search of the PubMed, Web of Science, Cochrane Register of Controlled Trials, EMBASE, and Scopus databases. English-language studies between 2008 and 2019 that reported on outcomes of patients with DCFs who underwent operative fixation using an arthroscopic or arthroscopically assisted surgical technique were included. Data consisted of patient characteristics, fracture type, surgical technique, concomitant injuries, union rates, functional outcomes, and complications. Results: A total of 15 studies consisting of 226 DCFs treated using an arthroscopically based technique were included in the systematic review. The majority of fractures were classified as Neer type II. Most (97%) of the fractures underwent arthroscopic fixation using a cortical button coracoclavicular stabilization surgical technique. Bony union was reported in 94.1% of the fractures. Good to excellent outcomes were recorded in most patients at the final follow-up. The Constant-Murley score was the most widely used functional outcome score; the pooled mean Constant score was 93.06 (95% CI, 91.48-94.64). Complications were reported in 14 of the 15 studies, and the overall complication rate was 27.4%. However, only 12% of these were considered major complications, and only 6% required a reoperation for hardware-related complications. Conclusion: Arthroscopic fixation of DCFs resulted in good functional outcomes with union rates comparable to those of traditional open techniques. While the overall complication profile was similar to that of other described techniques, there was a much lower incidence of major complications, including hardware-related complications and reoperations.

Different internal fixation methods for unstable distal clavicle fractures in adults: a systematic review and network meta-analysis

“…CC rupture is the main factor in fracture displacement in proximal fractures; therefore, CC reconstruction is very important for fracture reduction and maintenance reduction [ 69 – 71 ]. Yagnik et al [ 22 ] reported that arthroscopy-assisted CC reconstruction of UDCFs reduced implant-related complications and the risk of reoperation, with the same good functional outcomes and union rates as LCP and HP fixation. For UDCFs, especially fractures with a comminuted distal fragments, CC fixation that only fixes the proximal end of the fracture is obviously not enough to achieve the standard of fracture healing.…”

“…There is still controversy regarding the optimal internal fixation method for UDCFs. Several meta-analyses have compared the effectiveness and safety of different internal fixation methods for UDCFs [19,[22][23][24][25][26]. However, published meta-analyses did not include combined fixation methods (i.e., LCP + CC) and had a low level of evidence and high heterogeneity among the outcome parameters due to the small number of papers included.…”

Comparative analysis of arthroscopic-assisted Tight-rope technique and clavicular hook plate fixation in the treatment of Neer type IIB distal clavicle fractures

“…Numerous surgical techniques used for the fixation of distal clavicle fractures, like using a K-wire or hook plate for direct osteosynthesis and using various suture materials or tendon grafts for indirect stabilization of the coracoclavicular ligament, were without a gold standard procedure [ 7 ]. More evidence suggests that the arthroscopic assisted treatment of displaced distal clavicle fractures is superior to the open surgical techniques because it is relatively durable and minimally invasive procedures with fewer complications [ 8 , 9 ], In addition, the Tight-rope system can self-propelled adjust the reconstructed length, which has been proven to resist higher loads [ 10 ]. In line with previous studies, the present study showed successful clinical and radiological outcomes results for the displaced distal clavicle fractures patients who were treated with arthroscopic assisted fixation using a Tight-rope system, with a statistically significant difference between the preoperative and postoperative constant score, ASES score and VAS score.…”

Clinical and Radiological Outcomes of Closed-Loop, Double Button, Coracoclavicular Fixation for Extralateral (Neer Type IIC) Fractures of the Distal Clavicle

“…Levy et al (15) compared these two techniques (plate and open CC suture stabilization) in the unique type IIC fracture and found better results with the CC stabilization. The superiority of open CC fixation techniques has been recently demonstrated by both Malik et al [ 20 ] and Yagnik et al [ 11 ] who systematically reviewed the arthroscopic-assisted CC stabilization techniques; despite the overall good to excellent shoulder function in both reports, the first one found lower union rates of up to 70% and overall complication rates as high as 28.6%, and the second reported overall complication rates of 27.4%.…”