Treatment of Unstable Distal Clavicle Fractures (Neer type IIb): A Modified System using a Miniature Locking Plate with a Single Button

Background: Distal clavicle fractures were common in shoulder injuries. This study described the novel fixation technique using a miniature locking plate with a single button and reported its clinical outcomes obtained in patients with distal clavicle fractures associated with coracoclavicular ligaments disruption. Methods: Seven patients with distal clavicle fractures were included with a follow-up period of 12 months. All patients were diagnosed type IIb fractures according to the Neer classification. Distal clavicle fracture was fixed with a miniature locking plate and coracoclavicular ligaments were reconstructed using a single button. Functional outcomes were assessed at the final follow-up visit.Results: At 1-year follow-up, all patients had achieved radiographic union. There were no cases of nonunion or osteolysis. Mean Constant score at final follow-up was 88±5.13 (range, 78-93). Mean DASH score was 19.17±7.70 (range, 11.67-25). Mean UCLA score was 30±2.52 (range, 25-33).Conclusions: Internal fixation using a miniature locking plate and coracoclavicular reconstruction with a single button were reliable surgical techniques for restoring stability in patients with Neer type IIb distal clavicle fractures.

Inestabilidad de la cintura escapular secundario a fractura de acromion asociada a luxación acromioclavicular. A propósito de un caso. Hospital Luis Vernaza

Introduction The superior suspensory complex (SSSC) described by Goss, is a ring composed of the glenoid, the coracoid process, the coracoclavicular ligaments, the distal clavicle, the acromioclavicular joint and the acromial process. A double disruption of the upper suspensory complex of the shoulder produces an instability between the complex of the scapular waist and the axial skeleton, called "floating shoulder". Objective. It establishes the importance of the study of cases concerning the instability of the shoulder girdle Materials and methods Here is shown the case of a patient with double disruption of the SSSC, Results for displaced fracture of acromion associated with acromioclavicular dislocation, treated surgically with satisfactory results. Discussion Although surgical indications have been reported, the fixation techniques of these fractures is limited. Conclusions We present this case that is not frequent in our professional practice.

Shoulder crane: a concept of suspension, stability, control and motion

Framework and suspensory cascadeThis novel model uses the structure and workings of the industrial crane as a simile to explain the function of the human shoulder. As a crane consists of a base, axial tower, boom and suspensory cascade that move and position loads in space, the base consists of the pelvic platform, with outriggers (legs) that provide stability in human body. The axial tower consists of an articulated spinal column and thoracic platform, which are stabilised by the core muscles. The clavicular boom articulates with the anterior thoracic platform and is elevated by the trapezius from the posterior tower. The ‘suspensory cascade’ extends from the skull and cervical spine to the trapezius and on to the clavicle, coracoclavicular ligaments, coracoid process, coracohumeral ligament and humeral head.MotionThe rotator cuff muscles take origin from the scapula and coalesce with each other to form a multilayered rotator cuff tendon and cable, which cups to closely contain the humeral head. The four muscles insert into the common tendon and together share the load to stabilise and mobilise the arm in space. The coracoid is a pulley that allows the scapula to swivel on the coracoclavicular ligaments to enable adjustment of the angle of force transmission delivered by the rotator cuff to the humeral head.Stability and controlThe inferior glenoid and labrum are a fixed organ of compression, which coalesces with the hammock formed by the static inferior glenohumeral ligaments. The rotator cuff and deltoid compress the humeral head onto this static structure.The biceps tendon passes adjacent to the condensations of the coracohumeral ligament to insert into the mobile superior labrum and glenoid. Contraction of the biceps pulls the mobile superior labrum onto the humeral head and tightens the glenohumeral ligaments that wrap around the humeral head at the extremes of motion. The coracohumeral ligament is a sensory organ that interfaces with these structures and is well positioned to work as a servomechanism to redirect the rotator cuff in providing stability, control and motion.Level of evidenceLevel V.