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Archives of Orthopaedic and Trauma Surgery

, Volume 131, Issue 4, pp 525–533 | Cite as

Treatment of distal clavicle fracture: a systematic review of treatment modalities in 425 fractures

  • Joo Han Oh
  • Sae Hoon KimEmail author
  • Jung Ha Lee
  • Seung Han Shin
  • Hyun Sik Gong
Trauma Surgery

Abstract

The Neer type II distal clavicle fracture is notorious for its high nonunion rate, and surgical treatment is usually recommended. We reviewed articles from January 1990 to September 2009, and among them, 425 cases from 21 studies were included. According to the 425 cases in the literature, sixty patients were treated nonsurgically and 365 surgically. From 365 patients who were treated surgically, 105 were identified as receiving the coracoclavicular stabilization, 162 hook plate, 42 intramedullary fixation, 16 interfragmentary fixation, and 40 K-wire plus tension band wiring. The nonsurgical treatment resulted in 20 (33.3%) nonunions and 4 (6.7%) other complications. The surgical treatment resulted in 6 (1.6%) nonunions, 81 (22.2%) complications other than nonunion. The nonunion rate was significantly high with nonsurgical treatment (p < 0.001), and the complication rate was statistically high with surgery (p = 0.002). With surgical treatment, the nonunion rate was not significantly different among the modalities (p = 0.391). The complication rate was significantly higher in cases of the hook plate (40.7%) and the K-wire plus tension band wiring (20.0%) than those of the coracoclavicular stabilization (4.8%), the intramedullary (2.4%) and the interfragmentary fixation (6.3%). For the nonsurgical treatment, the functional outcomes were generally acceptable despite the high nonunion rate. The nonsurgical treatment could be considered as the first line treatment after sufficient counsel with the patient. The nonunion rate is high, however, the functional outcome is acceptable in most of the cases with nonunion. If the surgical treatment is considered, the intramedullary screw fixation, CC stabilization and interfragmentary fixation would be preferred because of their low complication rate.

Keywords

Distal clavicle fracture Nonunion Complication Functional result 

Notes

Conflict of interest

There is no conflict of interest among the authors.

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Joo Han Oh
    • 1
  • Sae Hoon Kim
    • 1
    Email author
  • Jung Ha Lee
    • 1
  • Seung Han Shin
    • 1
  • Hyun Sik Gong
    • 1
  1. 1.Department of Orthopedic SurgerySeoul National University College of Medicine, Seoul National University HospitalSeoulKorea

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