Distal Clavicle Fracture Repair: Clinical Outcomes of a Surgical Technique Utilizing a Combination of Cortical Button Fixation and Coracoclavicular Ligament Reconstruction

Background: When treated conservatively, unstable distal clavicle fractures demonstrate a high symptomatic nonunion rate. While a variety of surgical techniques have been described, many of these techniques are associated with high failure rates and hardware-related complications. The surgical technique used in this study has shown promising biomechanical results; however, long-term clinical results have not yet been described. Purpose: To assess the clinical and radiological outcomes of a surgical technique for fixing displaced distal clavicle fractures using a combination of cortical button fixation and coracoclavicular (CC) ligament reconstruction. Study Design: Case series; Level of evidence, 4. Methods: We conducted a retrospective review of 22 consecutive patients with displaced, unstable Neer type II or V distal clavicle fractures who underwent this surgical technique from 2012 to 2019. Primary outcome variables were radiographic union, patient satisfaction, and postoperative shoulder function. Preoperative and postoperative University of California, Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) scores were compared. Secondary outcome variables included intraoperative complications, postoperative complications, time to radiographic union, and preoperative and postoperative CC distance. Quality of life was assessed using preoperative and postoperative 36-Item Short Form Health Survey (SF-36) scores. Results: Nearly all (21/22) patients were available for a final review; 1 patient was lost to follow-up at 2 weeks. All 21 patients achieved radiographic union by 4 months (mean, 60.38 days; range, 41-84 days; 95% CI, 53.80-66.96 days). All patients were satisfied with the surgical procedure and their functional outcome. The mean UCLA score improved from 5.36 (95% CI, 4.14-6.60) preoperatively to 32.52 (95% CI, 30.56-34.48) postoperatively (mean difference, 27.14; P < .001). The mean ASES score improved from 16.23 (95% CI, 9.79-22.67) preoperatively to 88.11 (95% CI, 81.82-94.40) postoperatively (mean difference, 71.91; P < .001). Statistically significant improvements in SF-36 scores were seen in the physical functioning, role limitations due to physical health, pain, social functioning, and emotional well-being categories. There were 3 postoperative complications, including 1 patient with a minor complication secondary to hardware irritation, 1 patient with adhesive capsulitis, and 1 patient with wound dehiscence requiring wound closure. Conclusion: We describe a surgical technique for fixing displaced distal clavicle fractures using a combination of cortical button fixation and CC ligament reconstruction that resulted in a 100% union rate and excellent clinical outcomes with acceptable complications.

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Treatment of Distal Clavicle Fractures using a Scorpion Plate and Influence of Timing on Surgical Outcomes: A Retrospective Cohort Study of 105 Cases

10.21203/rs.2.16276/v1 ◽

2019 ◽

Author(s):

Ryogo Furuhata ◽

Masaaki Takahashi ◽

Teppei Hayashi ◽

Miyu Inagawa ◽

Aki Kono ◽

...

Keyword(s):

Treatment Group ◽

Postoperative Complications ◽

Surgical Outcomes ◽

Plate Fixation ◽

Delayed Union ◽

Distal Clavicle ◽

Delayed Treatment ◽

Clavicle Fractures ◽

The Difference ◽

Distal Clavicle Fractures

Abstract Background Plate fixation is the established method of treating unstable distal clavicle fractures. However, the appropriate timing of surgery for acute distal clavicle fractures remains unclear. The present study aimed to evaluate the clinical outcomes of osteosynthesis using a Scorpion plate and to assess the influence of surgery timing on the surgical outcomes for acute unstable distal clavicle fractures. Methods We retrospectively reviewed 105 patients who underwent fixation for acute unstable distal clavicle fractures (Neer type II and V) using the Scorpion plate between 2008 and 2018. Patients were divided into early (45 patients) and delayed (60 patients) treatment groups based on the timing of the surgical intervention (within or after seven days). The outcomes were postoperative complications (delayed union, peri-implant fracture, plate loosening, plate-related pain, and stiffness). We evaluated the outcomes from X-ray radiographs and clinical notes.Results Among the 105 patients, delayed union, plate loosening, plate-related pain, and stiffness were observed in six patients (5.7%), four patients (3.8%), seven patients (6.7%), and one (1.0%) patient, respectively. The delayed union rate was significantly higher in the delayed treatment group than that in the early treatment group (P=0.036). Although the difference was not significant, plate loosening and stiffness were only observed in the delayed treatment group. Conclusion Our results demonstrated that osteosynthesis using Scorpion plates achieved satisfactory surgical outcomes for unstable distal clavicle fractures . In addition, this study suggested that performing surgery within six days after injury is recommended to reduce postoperative complications .

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Treatment of Distal Clavicle Fractures using a Scorpion Plate and Influence of Timing on Surgical Outcomes: A Retrospective Cohort Study of 105 Cases

10.21203/rs.2.16276/v2 ◽

2020 ◽

Author(s):

Ryogo Furuhata ◽

Masaaki Takahashi ◽

Teppei Hayashi ◽

Miyu Inagawa ◽

Aki Kono ◽

...

Keyword(s):

Treatment Group ◽

Postoperative Complications ◽

Surgical Outcomes ◽

Plate Fixation ◽

Distal Clavicle ◽

Delayed Treatment ◽

Surgery Timing ◽

Clavicle Fractures ◽

The Difference ◽

Distal Clavicle Fractures

Abstract Background Plate fixation is an established method for treating unstable distal clavicle fractures. However, the appropriate timing of surgery for acute distal clavicle fractures remains unclear. The present study aimed to evaluate the clinical outcomes of osteosynthesis using a Scorpion plate and to assess the influence of surgery timing on the surgical outcomes for acute unstable distal clavicle fractures. Methods We retrospectively reviewed 105 patients who underwent fixation for acute unstable distal clavicle fractures (Neer type II and V) using the Scorpion plate between 2008 and 2018. Patients were divided into early (45 patients) and delayed (60 patients) treatment groups based on the timing of the surgical intervention (within or after seven days). The outcomes were postoperative complications (nonunion, peri-implant fracture, plate loosening, plate-related pain, and stiffness). We evaluated the outcomes from X-ray radiographs and clinical notes. Results Among the 105 patients, nonunion, plate loosening, plate-related pain, and stiffness were observed in six patients (5.7%), four patients (3.8%), seven patients (6.7%), and one patient (1.0%), respectively. The nonunion rate was significantly higher in the delayed treatment group than that in the early treatment group (P=0.036). Although the difference was not significant, plate loosening and stiffness were only observed in the delayed treatment group. Conclusion Our results demonstrated that osteosynthesis using Scorpion plates achieved satisfactory surgical outcomes for unstable distal clavicle fractures . In addition, this study suggested that performing surgery within six days after injury is recommended to reduce postoperative complications .

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A Minimally Invasive Surgical Technique to Treat Distal Clavicle Fractures

Orthopedics ◽

10.3928/01477447-20090527-19 ◽

2009 ◽

Vol 32 (7) ◽

pp. 509-511 ◽

Cited By ~ 6

Author(s):

Kyle E. Swanson ◽

Britta L. Swanson

Keyword(s):

Surgical Technique ◽

Minimally Invasive ◽

Distal Clavicle ◽

Minimally Invasive Surgical ◽

Clavicle Fractures ◽

Distal Clavicle Fractures

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Treatment of unstable distal clavicle fractures (Neer type IIb): a modified system using a miniature locking plate with a single button

Journal of International Medical Research ◽

10.1177/03000605211022505 ◽

2021 ◽

Vol 49 (6) ◽

pp. 030006052110225

Author(s):

Hua Ying ◽

Jihuan Wang ◽

Yuehua Sun ◽

Kerong Dai ◽

Chao Yu ◽

...

Keyword(s):

Los Angeles ◽

Locking Plate ◽

Constant Score ◽

Shoulder Injuries ◽

Distal Clavicle ◽

Clavicle Fractures ◽

The Mean ◽

Neer Type Iib ◽

Distal Clavicle Fractures

Distal clavicle fractures are common in patients with shoulder injuries. We retrospectively evaluated the clinical outcomes of a novel fixation technique using a miniature locking plate with a single button in patients with distal clavicle fractures associated with coracoclavicular ligament disruption. The study involved seven patients with distal clavicle fractures with a follow-up period of 12 months. All patients were diagnosed with type IIb fractures according to the Neer classification. The distal clavicle fracture was fixed with a miniature locking plate, and the coracoclavicular ligaments were reconstructed using a single button. Functional outcomes were assessed at the final follow-up visit. At the 1-year follow-up, all patients had achieved radiographic union. There were no cases of nonunion or osteolysis. The mean Constant score at the final follow-up was 88 ± 5.13 (range, 78–93); the mean Disabilities of the Arm, Shoulder and Hand score was 19.17 ± 7.70 (range, 11.67–25); and the mean University of California Los Angeles score was 30 ± 2.52 (range, 25–33). In summary, internal fixation using a miniature locking plate and coracoclavicular reconstruction with a single button is a reliable surgical technique for restoring stability in patients with Neer type IIb distal clavicle fractures.

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Locking plate combined with titanium cable for Neer type II distal clavicle fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04137-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Fan Zhang ◽

Qiang Fu ◽

Yongchuan Li ◽

Nan Lu ◽

Aimin Chen ◽

...

Keyword(s):

Complication Rate ◽

Locking Plate ◽

Type Ii ◽

Distal Clavicle ◽

Union Rate ◽

Clavicle Fractures ◽

The Mean ◽

One Year ◽

Distal Clavicle Fractures

Abstract Background There is controversy about the optimal strategy treatment of unstable distal clavicle fractures. We explored use of a surgical strategy: combination of a distal clavicle locking plate and a titanium cable. The purpose of this retrospective case series study was to evaluate the clinical outcomes of this new strategy in treating Neer type II distal clavicle fractures. Methods Twenty-one patients with Neer type II distal clavicle fracture were treated with a distal clavicle locking plate and a titanium cable. All patients were followed for at least one year. We retrospectively collected and reviewed follow-up data. The clinical outcomes were assessed for union rate, functional score, and complication rate. Results All patients achieved bony union within 6 months. The average follow-up period was 20.6 months (range12–48 months). The mean Constant score at one-year follow-up was 94.6 ± 3.3 (range 84–98), and the mean UCLA (University of California, Los Angeles) score was 33.3 ± 2.6 (range 27–35). Only one complication (wound infection) was observed during follow-up. Two patients received another operation for implant removal due to local irritation. Conclusions Use of a distal clavicle locking plate in combination with a titanium cable for treatment of Neer type II fractures results in high union rate, a low complication rate, and good shoulder function. This combined surgical strategy can be considered an effective method for treating unstable distal clavicle fractures.

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Arthroscopically assisted coraco-clavicular ligament reconstruction in treatment of acute displaced distal clavicle fractures provides good to excellent shoulder function despite low union rates and high complication rates. A systematic review.

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2021.06.034 ◽

2021 ◽

Author(s):

Shahbaz S. Malik ◽

Muaaz Tahir ◽

Sheraz Malik ◽

Adam Kwapisz ◽

Robert W. Jordan

Keyword(s):

Systematic Review ◽

Ligament Reconstruction ◽

Shoulder Function ◽

Complication Rates ◽

Distal Clavicle ◽

Arthroscopically Assisted ◽

Clavicle Fractures ◽

Distal Clavicle Fractures

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211001773 ◽

2021 ◽

Vol 9 (5) ◽

pp. 232596712110017

Author(s):

Gautam P. Yagnik ◽

Jacob R. Seiler ◽

Luis A. Vargas ◽

Anshul Saxena ◽

Raed I. Narvel ◽

...

Keyword(s):

Systematic Review ◽

Surgical Technique ◽

Complication Rate ◽

Functional Outcomes ◽

Bony Union ◽

Distal Clavicle ◽

Major Complications ◽

Arthroscopic Fixation ◽

Clavicle Fractures ◽

Distal Clavicle Fractures

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.

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