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

Abstract

Purpose The purpose of the current study was to assess the clinical and radiological results after locking T-plate osteosynthesis with coracoclavicular augmentation of unstable and displaced distal clavicle fractures (Neer type 2). Methods Thirty patients, treated between January 2007 and January 2010 were followed up after a median followup time of 12.2 months (range 4.7-37.2). The Constant and DASH scores were used to evaluate the clinical outcome, and anterior-posterior and 30°cephalic view radiographs were performed to assess the bony healing. Results In all patients, the fracture healing was achieved within the first 10 weeks after surgery. All patients regained good or excellent shoulder function and returned to previous occupation and activity levels. The mean Constant and DASH scores were 92.3 points and 6.2 points, respectively. We did not observe any severe intra-or post-operative complication within the time of followup. ConclusionThe presented technique turned out to be a reliable method providing good results without showing severe complications. Level of evidence Case series, Level IV.

Comparison of the efficacy of a distal clavicular locking plate versus a clavicular hook plate in the treatment of unstable distal clavicle fractures and a systematic literature review

“…We observed a high rate of union (97.2 %) and a low complication rate (5.6 %) using this treatment strategy. Our results were compatible with the results of literature [14][15][16][17][18][19][20] and only one nonunion occurred in six months in our series. Although the functional shoulder score showed no difference between the distal clavicular locking plate and clavicular hook plate groups, the distal clavicular locking plate group had greater ability to return to their previous work in three months after surgery compared to the clavicular hook plate group.…”

“…Studies have reported excellent results of distal clavicle fractures treated with locking plate [14,15,17,26,29,30]. Treatment for unstable distal clavicle fractures using a locking T-plate and a CC PDS (polydioxansulfate) cerclage can provide good and reliable clinical results and a 100 % union rate [16]. Internal fixation with a 2.4-mm distal clavicle T-plate, coracoclavicular ligament repair, and augmentation of the ruptured coracoclavicular ligaments using a PDS cord holds anatomic reduction and allows early full mobilization of the injured shoulder girdle to accomplish a fast return of shoulder function.…”

“…Since not all studies reported the functional outcome scores of the distal clavicle fractures and they used different functional evaluation instruments, it was difficult to analyse and compare the function between the different treatment modalities. Consequently, we reviewed and compared the functional outcome scores evaluated by Constant score between the hook plate group (nine studies) [6,7,[9][10][11][12][13]31, present study] and the locking plate group (eight studies) [14][15][16][17][18][19][20]30, present study] in distal clavicle fractures. The mean Constant scores were 91.9 and 93.6 in the hook plate and locking plate groups, respectively.…”

“…Today, there is a wide variety of surgical techniques for the treatment for these fractures. If surgery of distal clavicle fractures is indicated, many implants or surgical methods are available, including Kirschner wires [3], coracoclavicular screw fixation [4,5], hook plate fixation [6][7][8][9][10][11][12][13], or locking plate fixation [14][15][16][17][18][19][20]. Although there are many types of operative procedures, no procedures are considered to be the gold standard treatment.…”

Under-coracoid-around-clavicle (UCAC) loop in type II distal clavicle fractures

“…2,4,6,7,9,20 The techniques used can be classified according to the plane of fixation into: 1) horizontal fixation in the form of K-wires, either transarticular across the acromioclavicular joint or extraarticular, using a hook plate 15 ; or locking plates; 2) vertical fixation in the form of coracoclavicular screws, 21 suture anchors 17 or tension band wires 4 ; and 3) a combination of both horizontal and vertical fixation in the form of plates augmented with tension bands or coracoclavicular screws. 10,[22][23][24] In this study we used the UCAC loop for acute distal clavicle fractures, and achieved excellent results with no major complications. This simple technique produced anatomical reduction and provided adequate fixation to hold the medial clavicle in proximity to the lateral fragment in order to achieve union.…”