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Outcomes after locking plate fixation of distal clavicle fractures with and without coracoclavicular ligament augmentation

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

The need for coracoclavicular (CC) ligament augmentation when performing locking plate fixation of unstable distal clavicle fractures is controversial. The purpose of this study was to compare the results after locking plate fixation for treatment of Neer type-II and type-V distal clavicle fractures with and without suture suspensory augmentation of the CC ligaments.

Methods

This was a retrospective case series of all Neer type-II and type-V distal clavicle fractures treated with locking plates at a single Level I trauma center. Patients were separated into locking plate-only and locking plate with CC ligament augmentation groups. Postoperative complications and fracture healing rates were recorded. Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores were recorded as functional outcomes during follow-up phone interviews. Standard descriptive statistics were performed.

Results

Sixteen patients were treated with locking plate fixation-only, and seven patients were treated with additional CC ligament augmentation. There was a similar distribution of Neer fracture types with each group. All fractures in both groups went onto union without loss of reduction or implant failure. There were no cases of infection or wound complications in either group. QuickDASH scores were comparable between locking plate-only fixation (mean 4.1 ± 3.9) and additional suspensory suture fixation (mean 4.5 ± 3.6).

Conclusion

This comparative study of Neer type-II and type-V distal clavicle fractures demonstrated comparable outcomes after locking plate fixation with and without CC ligament augmentation. CC ligament augmentation may not be necessary when treating unstable distal clavicle fractures if locking plate fixation is used.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA, 94063-6342, USA

    Brett P. Salazar, Michael J. Chen, Julius A. Bishop & Michael J. Gardner

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  1. Brett P. Salazar
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  2. Michael J. Chen
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  3. Julius A. Bishop
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  4. Michael J. Gardner
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Correspondence to Brett P. Salazar.

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Conflict of interest

Dr. Gardner receives personal fees from Pacira Pharmaceuticals, Biocomposites, BoneSupport AB, Conventus, Globus Medical, StabilizOrtho, Synthes, and from KCI outside of the submitted work. Dr. Bishop receives personal fees from Globus Medical and Innomed outside of the submitted work. None of the remaining authors have any disclosures to report. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors, and no material support of any kind was received.

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Institutional Review Board (IRB) of Stanford University approved this study.

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Salazar, B.P., Chen, M.J., Bishop, J.A. et al. Outcomes after locking plate fixation of distal clavicle fractures with and without coracoclavicular ligament augmentation. Eur J Orthop Surg Traumatol 31, 473–479 (2021). https://doi.org/10.1007/s00590-020-02797-x

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