Comparison of Treatment of Acute Unstable Distal Clavicle Fractures Using Anatomical Locking Plates with Versus without Additional Suture Anchor Fixation

Background: The coracoclavicular fixation with suture anchors adds stability to type IIb distal clavicle fractures fixed with a plate and screws when loaded to failure. The purpose of this study was to compare the clinical and radiological outcomes between the use of a locking compression plate (LCP) with all-suture anchor fixation and hook LCP fixation of Neer IIb distal clavicle fractures. Methods: A total of 82 consecutive patients who underwent plate fixation for Neer IIb distal clavicle fractures were included. The subjects were divided into two groups: an LCP with all-suture anchor fixation group and hook LCP fixation group. For clinical assessments, the American Shoulder and Elbow Surgeons score, Korean shoulder score (KSS), and Constant score were recorded. A percentage of the coracoclavicular distance (CCD%) was used to evaluate fracture reduction. Typical reported complications, such as secondary dislocation, implant failure or loosening, peri-implant fracture, acromion osteolysis, stiffness, peri-anchor osteolysis, postoperative acromioclavicular joint arthrosis, nonunion, or delayed union, were also analyzed. Results: There were no differences in the clinical and radiological outcomes at the final follow-up between the two groups. The period for bone union and CCD% showed no significant differences between groups. Stiffness at 3 months after surgery of LCP with all-suture anchor fixation ( n = 3, 10.7%) was less than that of hook LCP fixation ( n = 17, 31.5%). The complication rate also showed no significant differences between groups. However, LCP with all-suture anchor fixation had anchor-related complications, although it can reduce hook-related complications. Conclusion: LCP with all-suture anchor fixation showed satisfactory outcomes in comparison with hook LCP fixation. In Neer IIb distal clavicle fractures, LCP with all-suture anchor fixation is a useful method for the maintenance of reduction, avoiding implant removal, and hook-related complications. However, anchor fixation should be carefully used, especially in osteoporotic patients or patients with underlying diseases. Level of Evidence: Level III, retrospective study.

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Comparison of the efficacy of a distal clavicular locking plate with and without a suture anchor in the treatment of Neer IIb distal clavicle fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2892-6 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Hua Xu ◽

Wen Jun Chen ◽

Xiao Cheng Zhi ◽

Shi Chang Chen

Keyword(s):

Clinical Outcomes ◽

Locking Plate ◽

Suture Anchor ◽

Early Stage ◽

Locking Plates ◽

Suture Anchors ◽

Distal Clavicle ◽

Application Procedure ◽

Clavicle Fractures ◽

Distal Clavicle Fractures

Abstract Background To compare the clinical outcomes between the use of a distal clavicular locking plate alone and the combined use of a plate and a coracoclavicular suture anchor in the treatment of Neer IIb distal clavicle fractures and to discuss the application procedure of suture anchors. Methods This is a retrospective study. Thirty-four patients with unilateral Neer IIb distal clavicle fractures who underwent open reduction and internal fixation with a distal clavicular locking plate only (16 patients) or with both a plate and a coracoclavicular suture anchor (18 patients) were evaluated. The main observation data included the Constant-Murley Shoulder Function Score (CMS), rate of postoperative complications, and union time. Results The distal clavicular locking plate and coracoclavicular suture anchor combination group had better outcomes in the Constant-Murley score (94.6 ± 4.5 vs. 90.1 ± 9.5) (P < 0.05) and a shorter union time (13.9 ± 2.3 vs. 16.1 ± 3.0) (P < 0.05) than the locking plate only group did, and the rate of complications showed no significant difference, 16.7% vs. 31.2% (5/16) (P>0.05). Conclusions Both methods achieved good results in the treatment of Neer IIb distal clavicle fractures; however, the use of both locking plates and coracoclavicular suture anchors can provide more stability in the early stage after operation than can the use of locking plates alone, which can make the sped of union quicker and result in better clinical outcomes. For elderly patients with comminuted Neer IIb distal clavicle fractures, a locking plate combined with a suture anchor is recommended to provide more stability in the early stage after the operation.

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Addition of a Suture Anchor for Coracoclavicular Fixation to a Superior Locking Plate Improves Stability of Type IIB Distal Clavicle Fractures

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2013.02.024 ◽

2013 ◽

Vol 29 (6) ◽

pp. 998-1004 ◽

Cited By ~ 26

Author(s):

Wes Madsen ◽

Zaneb Yaseen ◽

Russell LaFrance ◽

Tony Chen ◽

Hani Awad ◽

...

Keyword(s):

Locking Plate ◽

Suture Anchor ◽

Distal Clavicle ◽

Clavicle Fractures ◽

Coracoclavicular Fixation ◽

Distal Clavicle Fractures

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Comparative analysis of locking plates versus hook plates in the treatment of Neer type II distal clavicle fractures

Journal of International Medical Research ◽

10.1177/0300060520918060 ◽

2020 ◽

Vol 48 (4) ◽

pp. 030006052091806

Author(s):

Hong-Kai Wang ◽

Li-Sheng Liang ◽

Ren-Gao He ◽

Yu-Bin Su ◽

Peng Mao ◽

...

Keyword(s):

Postoperative Pain ◽

Operation Time ◽

Clinical Effects ◽

Locking Plates ◽

Type Ii ◽

Intraoperative Blood Loss ◽

Distal Clavicle ◽

Incision Length ◽

Clavicle Fractures ◽

Distal Clavicle Fractures

Objective This study was performed to compare the clinical effects of locking plates (LPs) with those of hook plates (HPs) in the treatment of Neer type II distal clavicle fractures. Methods From August 2014 to April 2018, 64 patients with Neer type II distal clavicle fractures were treated in our department. The clinical effects were assessed with respect to the operation time, intraoperative blood loss, incision length, fracture healing, postoperative pain, postoperative complications, and postoperative shoulder joint function. Results There were no significant differences in the healing time, operation time, or intraoperative blood loss between the LP and HP groups. The incision length was significantly shorter in the LP than HP group, and the postoperative complication rate was significantly lower in the LP than HP group. The visual analog scale score, Constant–Murley score, and University of California Los Angeles score were significantly better in the LP than HP group. Conclusions Compared with HPs, the use of LPs involves a smaller incision in the treatment of Neer type II distal clavicle fractures and significantly reduces postoperative pain and complications. Therefore, priority can be given to the use of LPs in the treatment of Neer type II distal clavicle fractures.

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