Treatment for unstable distal clavicle fractures (Neer 2) with locking T-plate and additional PDS cerclage

  • Frank MartetschlägerEmail author
  • Tobias M. Kraus
  • Clara Sophie Schiele
  • Gunther Sandmann
  • Sebastian Siebenlist
  • Karl F. Braun
  • Ulrich Stöckle
  • Thomas Freude
  • Markus Neumaier



The purpose of the current study was to assess the clinical and radiological results after locking T-plate osteosynthesis with coracoclavicular augmentation of unstable and displaced distal clavicle fractures (Neer type 2).


Thirty patients, treated between January 2007 and January 2010 were followed up after a median follow-up time of 12.2 months (range 4.7–37.2). The Constant and DASH scores were used to evaluate the clinical outcome, and anterior–posterior and 30° cephalic view radiographs were performed to assess the bony healing.


In all patients, the fracture healing was achieved within the first 10 weeks after surgery. All patients regained good or excellent shoulder function and returned to previous occupation and activity levels. The mean Constant and DASH scores were 92.3 points and 6.2 points, respectively. We did not observe any severe intra- or post-operative complication within the time of follow-up.


The presented technique turned out to be a reliable method providing good results without showing severe complications.

Level of evidence

Case series, Level IV.


Distal clavicle fracture Clavicle fracture Locking T-plate PDS augmentation 



Neither the author nor the co-authors have to declare any conflicts of interest.

Ethics standard

IRB approval No. 5067/11 (ethics commission University Clinic rechts der Isar, Munich).


  1. 1.
    Badhe SP, Lawrence TM, Clark DI (2007) Tension band suturing for the treatment of displaced type 2 lateral end clavicle fractures. Arch Orthop Trauma Surg 127(1):25–28PubMedCrossRefGoogle Scholar
  2. 2.
    Ballmer FT, Gerber C (1991) Coracoclavicular screw fixation for unstable fractures of the distal clavicle. A report of five cases. J Bone Joint Surg Br 73(2):291–294PubMedGoogle Scholar
  3. 3.
    Baumgarten KM (2008) Arthroscopic fixation of a type II-variant, unstable distal clavicle fracture. Orthopedics 31(12):1236Google Scholar
  4. 4.
    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):524–528PubMedCrossRefGoogle Scholar
  5. 5.
    Chaudry SN, Waseem M (2006) Clavicular hook plate: complications of retaining the implant. Injury 37(7):665PubMedCrossRefGoogle Scholar
  6. 6.
    Checchia SL, Doneux PS, Miyazaki AN, Fregoneze M, Silva LA (2008) Treatment of distal clavicle fractures using an arthroscopic technique. J Shoulder Elbow Surg 17(3):395–398PubMedCrossRefGoogle Scholar
  7. 7.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMedGoogle Scholar
  8. 8.
    Edwards DJ, Kavanagh TG, Flannery MC (1992) Fractures of the distal clavicle: a case for fixation. Injury 23(1):44–46PubMedCrossRefGoogle Scholar
  9. 9.
    Eskola A, Vainionpaa S, Myllynen P, Patiala H, Rokkanen P (1986) Outcome of clavicular fracture in 89 patients. Archives of orthopaedic and traumatic surgery Archiv fur orthopadische und Unfall-Chirurgie 105(6):337–338PubMedCrossRefGoogle Scholar
  10. 10.
    Flinkkila T, Ristiniemi J, Hyvonen P, Hamalainen M (2002) Surgical treatment of unstable fractures of the distal clavicle: a comparative study of Kirschner wire and clavicular hook plate fixation. Acta Orthop Scand 73(1):50–53PubMedCrossRefGoogle Scholar
  11. 11.
    Flinkkila T, Ristiniemi J, Lakovaara M, Hyvonen P, Leppilahti J (2006) Hook-plate fixation of unstable lateral clavicle fractures: a report on 63 patients. Acta Orthop 77(4):644–649PubMedCrossRefGoogle Scholar
  12. 12.
    Gerhardt DC, VanDerWerf JD, Rylander LS, McCarty EC (2011) Postoperative coracoid fracture after transcoracoid acromioclavicular joint reconstruction. J Shoulder Elbow Surg 20(5):e6–e10PubMedCrossRefGoogle Scholar
  13. 13.
    Haidar SG, Krishnan KM, Deshmukh SC (2006) Hook plate fixation for type II fractures of the lateral end of the clavicle. J Shoulder Elbow Surg 15(4):419–423PubMedCrossRefGoogle Scholar
  14. 14.
    Herrmann S, Schmidmaier G, Greiner S (2009) Stabilisation of vertical unstable distal clavicular fractures (Neer 2b) using locking T-plates and suture anchors. Injury 40(3):236–239PubMedCrossRefGoogle Scholar
  15. 15.
    Hessmann M, Kirchner R, Baumgaertel F, Gehling H, Gotzen L (1996) Treatment of unstable distal clavicular fractures with and without lesions of the acromioclavicular joint. Injury 27(1):47–52PubMedCrossRefGoogle Scholar
  16. 16.
    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):879–883PubMedGoogle Scholar
  17. 17.
    Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29(6):602–608PubMedCrossRefGoogle Scholar
  18. 18.
    Jerosch J, Filler T, Peuker E, Greig M, Siewering U (1999) Which stabilization technique corrects anatomy best in patients with AC-separation? An experimental study. Knee Surg Sports Traumatol Arthrosc 7(6):365–372PubMedCrossRefGoogle Scholar
  19. 19.
    Kaipel M, Majewski M, Regazzoni P (2010) Double-plate fixation in lateral clavicle fractures-a new strategy. J Trauma 69(4):896–900PubMedCrossRefGoogle Scholar
  20. 20.
    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):60–62PubMedCrossRefGoogle Scholar
  21. 21.
    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):522–525PubMedCrossRefGoogle Scholar
  22. 22.
    Kashii M, Inui H, Yamamoto K (2006) Surgical treatment of distal clavicle fractures using the clavicular hook plate. Clin Orthop Relat Res 447:158–164PubMedCrossRefGoogle Scholar
  23. 23.
    Katolik LI, Romeo AA, Cole BJ, Verma NN, Hayden JK, Bach BR (2005) Normalization of the constant score. J Shoulder Elbow Surg 14(3):279–285PubMedCrossRefGoogle Scholar
  24. 24.
    Largo RD, Rudin MA, Hotz TK, Valderrabano V, Kach KK (2011) Anatomic reconstruction of unstable lateral clavicular fractures. J Trauma 71(5):1348–1351PubMedCrossRefGoogle Scholar
  25. 25.
    Lee YS, Lau MJ, Tseng YC, Chen WC, Kao HY, Wei JD (2009) Comparison of the efficacy of hook plate versus tension band wire in the treatment of unstable fractures of the distal clavicle. Int Orthop 33(5):1401–1405PubMedCrossRefGoogle Scholar
  26. 26.
    Lyons FA, Rockwood CA Jr (1990) Migration of pins used in operations on the shoulder. J Bone Joint Surg Am 72(8):1262–1267PubMedGoogle Scholar
  27. 27.
    Macheras G, Kateros KT, Savvidou OD, Sofianos J, Fawzy EA, Papagelopoulos PJ (2005) Coracoclavicular screw fixation for unstable distal clavicle fractures. Orthopedics 28(7):693–696PubMedGoogle Scholar
  28. 28.
    Neer CS 2nd (1963) Fracture of the distal clavicle with detachment of the coracoclavicular ligaments in adults. J Trauma 3:99–110PubMedCrossRefGoogle Scholar
  29. 29.
    Neer CS 2nd (1968) Fractures of the distal third of the clavicle. Clin Orthop Relat Res 58:43–50PubMedGoogle Scholar
  30. 30.
    Nourissat G, Kakuda C, Dumontier C, Sautet A, Doursounian L (2007) Arthroscopic stabilization of Neer type 2 fracture of the distal part of the clavicle. Arthroscopy 23(6):e671–e674Google Scholar
  31. 31.
    Pujol N, Philippeau JM, Richou J, Lespagnol F, Graveleau N, Hardy P (2008) Arthroscopic treatment of distal clavicle fractures: a technical note. Knee Surg Sports Traumatol Arthrosc 16(9):884–886PubMedCrossRefGoogle Scholar
  32. 32.
    Robinson CM, Akhtar MA, Jenkins PJ, Sharpe T, Ray A, Olabi B (2010) Open reduction and endobutton fixation of displaced fractures of the lateral end of the clavicle in younger patients. J Bone Joint Surg Br 92(6):811–816PubMedCrossRefGoogle Scholar
  33. 33.
    Takase K, Kono R, Yamamoto K (2012) Arthroscopic stabilization for Neer type 2 fracture of the distal clavicle fracture. Arch Orthop Trauma Surg 132(3):399–403PubMedCrossRefGoogle Scholar
  34. 34.
    Tambe AD, Motkur P, Qamar A, Drew S, Turner SM (2006) Fractures of the distal third of the clavicle treated by hook plating. Int Orthop 30(1):7–10PubMedCrossRefGoogle Scholar
  35. 35.
    Tischer T, Salzmann GM, El-Azab H, Vogt S, Imhoff AB (2009) Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med 37(1):136–139PubMedCrossRefGoogle Scholar
  36. 36.
    Yoo JH, Chang JD, Seo YJ, Shin JH (2009) Stable fixation of distal clavicle fracture with comminuted superior cortex using oblique T-plate and cerclage wiring. Injury 40(4):455–457PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Frank Martetschläger
    • 1
    • 2
    Email author
  • Tobias M. Kraus
    • 1
  • Clara Sophie Schiele
    • 1
  • Gunther Sandmann
    • 1
  • Sebastian Siebenlist
    • 1
  • Karl F. Braun
    • 1
  • Ulrich Stöckle
    • 3
  • Thomas Freude
    • 3
  • Markus Neumaier
    • 1
  1. 1.Clinic for Trauma SurgeryUniversity Hospital Rechts der Isar, Technical University MunichMunichGermany
  2. 2.The Steadman ClinicSteadman Philippon Research InstituteVailUSA
  3. 3.BG Trauma Clinic TübingenUniversity Hospital TübingenTübingenGermany

Personalised recommendations