Concomitant glenohumeral injuries in patients with distal clavicle fractures undergoing arthroscopic-assisted surgery: a systematic review

Abstract Background To determine the incidence of concomitant intra-articular glenohumeral injuries in patients undergoing surgical management from distal clavicle fractures (DCF) with shoulder arthroscopy and their impact on outcome. Methods This systematic review was conducted following the PRISMA guidelines. PubMed, EMBASE, and Virtual Health Library databases were accessed in October 2021. All the clinical studies evaluating the surgical management of DCF and using concomitant intra-operatory shoulder arthroscopy were included. Studies that did not specify the concomitant injury type were not eligible. Data from the incidence of intra-articular glenohumeral injuries, injury type, length of the follow-up, and clinical outcomes were retrieved. The quantitative content assessment was performed using the STROBE statement checklist. Evaluation of the publication bias of the included studies was performed using the risk of bias assessment tool for systematic reviews. Results Data from five retrospective and five prospective cohort studies were analyzed. Eight of the included studies were conducted on patient cohorts with Neer type II injuries. Data pooling revealed a mean of 17.70% of concomitant glenohumeral injuries, whereas 84.21% of them required additional surgical management (Table 1). Rotator cuff injuries, labral tears, and biceps pulley lesions were the most common concomitant injuries. Conclusion Preoperative MRI or diagnostic arthroscopy to evaluate glenohumeral associated injuries to DCF should be recommended.

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An evaluation of treatment options for medial, midshaft, and distal clavicle fractures: a systematic review and meta-analysis

JSES International ◽

10.1016/j.jseint.2020.01.010 ◽

2020 ◽

Vol 4 (2) ◽

pp. 256-271 ◽

Cited By ~ 1

Author(s):

Christopher Vannabouathong ◽

Justin Chiu ◽

Rahil Patel ◽

Shreyas Sreeraman ◽

Elias Mohamed ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Treatment Options ◽

Distal Clavicle ◽

Clavicle Fractures ◽

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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A systematic review and meta-analysis comparing the use of hook plates and superior plates in the treatment of displaced distal clavicle fractures

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04287-z ◽

2022 ◽

Author(s):

Shahbaz S. Malik ◽

Muaaz Tahir ◽

Mohammedabbas Remtulla ◽

Sheraz Malik ◽

Robert W. Jordan

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Distal Clavicle ◽

Clavicle Fractures ◽

Distal Clavicle Fractures

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Outcomes, Union Rate, and Complications After Operative and Nonoperative Treatments of Neer Type II Distal Clavicle Fractures: A Systematic Review and Meta-analysis of 2284 Patients

The American Journal of Sports Medicine ◽

10.1177/03635465211053336 ◽

2021 ◽

pp. 036354652110533

Author(s):

Sophie J. Uittenbogaard ◽

Laurian J.M. van Es ◽

Chantal den Haan ◽

Derek F.P. van Deurzen ◽

Michel P.J. van den Bekerom

Keyword(s):

Systematic Review ◽

Functional Outcome ◽

Operative Treatment ◽

Type Ii ◽

Distal Clavicle ◽

Union Rate ◽

Significant Difference ◽

Clavicle Fractures ◽

Coracoclavicular Fixation ◽

Distal Clavicle Fractures

Background: As nonoperative treatment of Neer type II distal clavicle fractures is associated with nonunion rates up to 33%, operative treatment is frequently advocated. However, evidence is lacking regarding which operative treatment to perform and whether this is superior to nonoperative treatment in terms of functional outcome and complication rate. Purpose: (1) To evaluate which surgical technique in the treatment of Neer type II distal clavicle fractures is optimal with regard to patient-reported outcomes and union and complication rates. (2) To review nonoperatively treated patients. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature and meta-analysis were performed on January 27, 2021, in PubMed, Embase, CENTRAL, CINAHL/EBSCO, Web of Science/Clarivate Analytics, and SPORTDiscus/EBSCO. The search included all studies regarding nonoperative and operative treatment of Neer type II distal clavicle fractures with a minimum of 20 patients and follow-up of 12 months. The primary and secondary outcomes were patient-reported outcome measures at 12 months and union, complication, and revision rates. Results: A total of 59 articles were included involving 2284 patients. Coracoclavicular fixation, hook plate, transacromial pins, alternative plate, tension band wire/K-wire, a combination of surgical techniques, and a nonoperative group were described. Hook plates showed lower Constant-Murley scores as compared with coracoclavicular fixation (standard mean difference, –0.77; 95% CI, –1.26 to –0.28; P = .002). However, no significant difference was seen when the hook plate was compared with the locking plate and tension band wire/K-wire groups, and no significant difference in union rate was seen among all operative treatment groups. Operatively treated patients had significantly higher union rates than patients treated nonoperatively (standard mean difference: 0.05; 95% CI, 0.01 to 0.37; P = .004). Conclusion: Patients treated with hook plates showed significantly lower Constant-Murley scores and higher complication and revision rates as compared with those treated with coracoclavicular fixation, without differences in union rate. Higher Constant-Murley scores were seen in those patients with supplemental coracoclavicular fixation when using locking. Nonoperatively treated patients showed good functional outcome despite the 31% nonunion rate, although future studies are necessary to substantiate this conclusion. When using a locking plate, additional craniocaudal fixation showed significant better functional outcome.

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