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

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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Residual coracoclavicular separation after plate fixation for distal clavicle fractures: comparison between fracture patterns

JSES International ◽

10.1016/j.jseint.2021.04.017 ◽

2021 ◽

Author(s):

Ryogo Furuhata ◽

Noboru Matsumura ◽

Kazuhiko Udagawa ◽

Satoshi Oki ◽

Hideo Morioka

Keyword(s):

Plate Fixation ◽

Distal Clavicle ◽

Fracture Patterns ◽

Clavicle Fractures ◽

Distal Clavicle Fractures

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Comparison of a novel hybrid hook locking plate fixation method with the conventional AO hook plate fixation method for Neer type V distal clavicle fractures

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2019.10.014 ◽

2020 ◽

Vol 106 (1) ◽

pp. 67-75 ◽

Cited By ~ 1

Author(s):

Joongbae Seo ◽

Kang Heo ◽

Seong-Jun Kim ◽

Jun-Kyom Kim ◽

Hee-Jung Ham ◽

...

Keyword(s):

Locking Plate ◽

Plate Fixation ◽

Hook Plate ◽

Fixation Method ◽

Distal Clavicle ◽

Locking Plate Fixation ◽

Clavicle Fractures ◽

Type V ◽

Distal Clavicle Fractures

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Hook versus locking plate fixation for Neer type-II and type-V distal clavicle fractures: a retrospective cohort study

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-020-02658-7 ◽

2020 ◽

Vol 30 (6) ◽

pp. 1027-1031

Author(s):

Michael J. Chen ◽

Malcolm R. DeBaun ◽

Brett P. Salazar ◽

Cara Lai ◽

Julius A. Bishop ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort ◽

Locking Plate ◽

Plate Fixation ◽

Type Ii ◽

Distal Clavicle ◽

Locking Plate Fixation ◽

Clavicle Fractures ◽

Type V ◽

Distal Clavicle Fractures

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Comparative analysis of a locking plate with an all-suture anchor versus hook plate fixation of Neer IIb distal clavicle fractures

Journal of Orthopaedic Surgery ◽

10.1177/2309499020962260 ◽

2020 ◽

Vol 28 (3) ◽

pp. 230949902096226

Author(s):

Joong-Bae Seo ◽

Kwon-young Kwak ◽

Jae-Sung Yoo

Keyword(s):

Suture Anchor ◽

Constant Score ◽

Plate Fixation ◽

Distal Clavicle ◽

Level Of Evidence ◽

Fixation Group ◽

Clavicle Fractures ◽

Suture Anchor Fixation ◽

Anchor Fixation ◽

Distal Clavicle Fractures

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119867920 ◽

2019 ◽

Vol 7 (9) ◽

pp. 232596711986792 ◽

Cited By ~ 1

Author(s):

Gautam P. Yagnik ◽

Charles J. Jordan ◽

Raed R. Narvel ◽

Robert J. Hassan ◽

David A. Porter

Keyword(s):

Postoperative Complications ◽

Surgical Technique ◽

Ligament Reconstruction ◽

Distal Clavicle ◽

Sf 36 ◽

Cortical Button ◽

Clavicle Fractures ◽

The Mean ◽

Radiographic Union ◽

Distal Clavicle Fractures

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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