Abstract
Introduction
The purpose of this retrospective study was to compare the clinical results of three different fixation techniques for the treatment of Neer Type IIb fractures. We hypothesized that anatomic locking plate and coracoclavicular stabilization with suture endo-button technique provides more stable and biomechanically superior fixation among others with low complication rates.
Methods
Thirty six patients with Neer Type IIb fractures treated were evaluated. Patients were divided into three groups according to surgical choice that was performed: tension band and coracoclavicular suture stabilization with k-wires was defined as Group 1, anatomic locking plate and coracoclavicular stabilization with screw was defined as Group 2, and anatomic locking plate and coracoclavicular stabilization with suture endo-button (LPES) was defined as group 3. Mean age was 36.1 years, and mean follow-up period was 32.4 months. Radiological follow-ups and constant were recorded and compared at 3, 6, 12 and 24 months.
Results
At 3rd and 12th month follow-up in the LPES group, mean constant scores were statistically higher than other two groups (p < 0.01). The difference between other two groups was insignificant (p > 0.05). At 6th month follow-up, mean constant scores in LPES group were higher than other groups; there was less statistical significance than other time zones (p < 0.05).
Conclusion
Anatomic locking plate combined with suture endo-button for CC ligament reinforcement is a reliable method to achieve osteosynthesis and stabilization for Neer Type IIb distal clavicle fractures without compromising physiology of shoulder.
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References
Banerjee R, Waterman B, Padalecki J, Robertson W (2011) Management of distal clavicle fractures. Am Acad Orthop Surg 19(7):392–401
Kalamaras M, Cutbush K, Robinson M (2008) A method for internal fixation of unstable distal clavicle fractures: early observations using a new technique. J Shoulder Elbow Surg 17(1):60–62
Mazzocca AD, Arciero RA, Bicos J (2007) Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med 35:316–329
Robinson CM (1998) Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br 80:476–484
Chun JM, Kim SY (2011) Modified tension band fixation for unstable distal clavicle fractures. J Trauma 70(5):E88–E92
Hsu TL, Hsu SK, Chen HM, Wang ST (2010) Comparison of hook plate and tension band wire in the treatment of distal clavicle fractures. Orthopedics 33(12):879
Kao FC, Chao EK, Chen CH, Yu SW, Chen CY, Yen CY (2001) Treatment of distal clavicle fracture using Kirschner wires and tension-band wires. J Trauma 51(3):522–525
Tsuei YC, Au MK, Chu W (2010) Comparison of clinical results of surgical treatment for unstable distal clavicle fractures by transacromial pins with and without tension band wire. J Chin Med Assoc 73(12):638–643
Muramatsu K, Shigetomi M, Matsunaga T, Murata Y, Taguchi T (2007) Use of the AO hook-plate for treatment of unstable fractures of the distal clavicle. Arch Orthop Trauma Surg 127(3):191–194
Jin CZ, Kim HK, Min BH (2006) Surgical treatment for distal clavicle fracture associated with coracoclavicular ligament rupture using a cannulated screw fixation technique. J Trauma 60(6):1358–1361
Esenyel CZ, Ceylan HH, Ayanoğlu S, Kebudi A, Adanir O, Bülbül M (2011) Treatment of Neer Type 2 fractures of the distal clavicle with coracoclavicular screw. Acta Orthop Traumatol Turc 45(5):291–296
Jou IM, Chiang EP, Lin CJ, Lin CL, Wang PH, Su WR (2011) Treatment of unstable distal clavicle fractures with Knowles pin. J Shoulder Elbow Surg 20(3):414–419
Hohmann E, Hansen T, Tetsworth K (2012) Treatment of Neer type II fractures of the lateral clavicle using distal radius locking plates combined with TightRope augmentation of the coraco-clavicular ligaments. Arch Orthop Trauma Surg 132(10):1415–1421
Motta P, Bruno L, Maderni A, Tosco P, Mariotti U (2014) Acute lateral dislocated clavicular fractures: arthroscopic stabilization with TightRope. J Shoulder Elbow Surg 23(3):e47–e52
Bezer M, Aydin N, Guven O (2005) The treatment of distal clavicle fractures with coracoclavicular ligament disruption: a report of 10 cases. J Orthop Trauma 19(8):524–528
Andersen JR, Willis MP, Nelson R, Mighell MA (2011) Precontoured superior locked plating of distal clavicle fractures: a new strategy. Clin Orthop 469(12):3344–3350
Oh JH, Kim SH, Lee JH, Shin SH, Gong HS (2011) Treatment of distal clavicle fracture: a systematic review of treatment modalities in 425 fractures. Arch Orthop Trauma Surg 131(4):525
Chen CH, Chen WJ, Shih CH (2002) Surgical treatment for distal clavicle fracture with coracoclavicular ligament disruption. J Trauma 52(1):72–78
Herrmann S, Schmidmaier G, Greiner S (2009) Stabilization of vertical unstable distal clavicular fractures (Neer 2b) using locking T-plates and suture anchors. Injury 40(3):236–239
Rieser GR, Edwards K, Gould GC, Markert RJ, Goswami T, Rubino LJ (2013) Distal-third clavicle fracture fixation: a biomechanical evaluation of fixation. J Shoulder Elbow Surg 22(6):848–855
Shin SJ, Roh KJ, Kim JO, Sohn HS (2009) Treatment of unstable distal clavicle fractures using two suture anchors and suture tension bands. Injury 40(12):1308–1312
Conflict of interest
No outside funding was received in support of this research or in the preparation of this article. Neither author has received financial or any other support relevant to the implant used in this study or in this study’s preparation. The authors declare that they have no conflict of interest.
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Seyhan, M., Kocaoglu, B., Kiyak, G. et al. Anatomic locking plate and coracoclavicular stabilization with suture endo-button technique is superior in the treatment of Neer Type II distal clavicle fractures. Eur J Orthop Surg Traumatol 25, 827–832 (2015). https://doi.org/10.1007/s00590-015-1617-2
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DOI: https://doi.org/10.1007/s00590-015-1617-2