Treatment of distal clavicle fracture: a systematic review of treatment modalities in 425 fractures

Abstract

The Neer type II distal clavicle fracture is notorious for its high nonunion rate, and surgical treatment is usually recommended. We reviewed articles from January 1990 to September 2009, and among them, 425 cases from 21 studies were included. According to the 425 cases in the literature, sixty patients were treated nonsurgically and 365 surgically. From 365 patients who were treated surgically, 105 were identified as receiving the coracoclavicular stabilization, 162 hook plate, 42 intramedullary fixation, 16 interfragmentary fixation, and 40 K-wire plus tension band wiring. The nonsurgical treatment resulted in 20 (33.3%) nonunions and 4 (6.7%) other complications. The surgical treatment resulted in 6 (1.6%) nonunions, 81 (22.2%) complications other than nonunion. The nonunion rate was significantly high with nonsurgical treatment (p < 0.001), and the complication rate was statistically high with surgery (p = 0.002). With surgical treatment, the nonunion rate was not significantly different among the modalities (p = 0.391). The complication rate was significantly higher in cases of the hook plate (40.7%) and the K-wire plus tension band wiring (20.0%) than those of the coracoclavicular stabilization (4.8%), the intramedullary (2.4%) and the interfragmentary fixation (6.3%). For the nonsurgical treatment, the functional outcomes were generally acceptable despite the high nonunion rate. The nonsurgical treatment could be considered as the first line treatment after sufficient counsel with the patient. The nonunion rate is high, however, the functional outcome is acceptable in most of the cases with nonunion. If the surgical treatment is considered, the intramedullary screw fixation, CC stabilization and interfragmentary fixation would be preferred because of their low complication rate.

A Distal Clavicle Fracture With Unusual Displacement of the Medial Part: A Case Report

“…Oh et al, found no statistical differences in union/non-union rates but more complications in the group treated with a hook plate or Kirschner wires in combination with Tension Band Wiring (TBW). 6 They advised using intramedullary screw fixation, CC stabilization or interfragmentary fixation. Although they do state that the results should be interpreted with caution, 'as the validity of the observational studies is limited by the lack of a control group (case series), imbalances between the comparison groups because of the lack of randomization (retrospective case control studies), and potentially biased assessment of out-come measures due to the lack of blinding'.…”

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

“…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.…”

Coracoclavicular Ligament Suture Augmentation with Anatomical Locking Plate Fixation for Distal Clavicle Fracture

“…10) On the other hand, this method may induce the complications such as subacromial impingement, rotator cuff damage, acromion fracture, and hook cut-out. 3) There are some patients who suffer from severe shoulder pain after hook plate fixation. Because a forward elevation is limited over a period of time, the patients sometimes complain of postoperative stiffness.…”

“…1,2) In particular, distal clavicle fracture represents approximately 10 to 15% of all clavicle fractures. 3) Of these, especially,…”

“…1,4) Therefore, surgical treatment is generally considered for Neer type IIB clavicle fracture. 3,5) Various surgical procedures for the treatment of this have been reported and in recent years. Treatment options include transacromial K-wires, 6) temporary CC screw fixation, 7) tension band suturing, 8) and arthroscopic stabilization.…”