Archives of Orthopaedic and Trauma Surgery

, Volume 132, Issue 3, pp 399–403 | Cite as

Arthroscopic stabilization for Neer type 2 fracture of the distal clavicle fracture

  • Katsumi TakaseEmail author
  • Ryohei Kono
  • Kengo Yamamoto
Arthroscopy and Sports Medicine


The distal clavicle fractures are divided into three types according to Neer’s classification. Types 1 and 3 fractures are treated with a sling to immobilize the upper extremity. However, the treatment of type 2 fractures is controversial. We paid attention to the anatomic basis of type 2 fractures that the disruptions of the conoid ligament lead to the distraction between the two bony fragments. In this study, we describe the arthroscopic procedure to reconstruct the disrupted ligament and stabilize the fracture as a minimally invasive method. The subjects were seven patients with the distal clavicle fractures. According to Neer’s or Rockwood’s classification on plain radiographs, all seven patients were evaluated as type 2 or 2B, respectively. Our surgical procedure was performed with the patient in the beach chair position. We have used the artificial ligament with an EndoButton (Smith & Nephew Endoscopy, Andover, MA) as the substitute ligament to reconstruct the disrupted conoid ligament. The mean duration of postoperative follow-up was 2 years and 5 months. The bony union was achieved in all patients at a final follow-up. When concerning the range of motion at final examinations, mean forward flexion was 171°, mean abduction was 165°, mean internal rotation was Th11, and mean horizontal adduction was 132°. It is possible to treat the distal clavicle fractures by a minimally invasive arthroscopic procedure without opening the fracture site of clavicle.


Distal clavicle fracture Arthroscopic procedure Conoid ligament 


  1. 1.
    Bisbinas I, Mikalef P, Gigis I, Beslikas T, Panou N, Christoforidis I (2010) Management of distal clavicle fractures. Acta Orthop Belg 76(2):145–149PubMedGoogle Scholar
  2. 2.
    Checchia SL, Doneux PS, Miyazaki AN, Fregoneze M, Silva LA (2008) Treatment of distal clavicle fractures using arthroscopic technique. J Shoulder Elbow Surg 17(3):395–398PubMedCrossRefGoogle Scholar
  3. 3.
    Edwards DJ, Kavanagh TG, Flannery MC (1992) Fractures of the distal clavicle: a case for fixation. Injury 23(1):44–46PubMedCrossRefGoogle Scholar
  4. 4.
    Flinkkilä T, Ristiniemi J, Hyvönen P, Hämäläinen 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
  5. 5.
    Goldberg JA, Bruce WJ, Sonnabend DH, Walsh WR (1997) Type 2 fractures of the distal clavicle: a new surgical technique. J Shoulder Elbow Surg 6(4):380–382PubMedCrossRefGoogle Scholar
  6. 6.
    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
  7. 7.
    Klein SM, Badman BL, Keating CJ, Devinney DS, Frankle MA, Mighell MA (2010) Results of surgical treatment for unstable distal clavicular fractures. J Shoulder Elbow Surg 19(7):1049–1055PubMedCrossRefGoogle Scholar
  8. 8.
    Kona J, Bosse MJ, Staeheli JW, Rosseau RL (1990) Type 2 distal clavicle fractures: a retrospective review of surgical treatment. J Orthop Trauma 4(2):115–120PubMedCrossRefGoogle Scholar
  9. 9.
    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
  10. 10.
    Macheras G, Kateros KT, Sawidou OD, Sofianos J, Fawzy EA, Papagelopoulos PJ (2005) Coracoclavicular screw fixation for unstable distal clavicle fractures. Orthopedics 28(7):693–696PubMedGoogle Scholar
  11. 11.
    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):191–194PubMedCrossRefGoogle Scholar
  12. 12.
    Neer CS 2nd (1960) Nonunion of the clavicle. J Am Med Assoc 172:1006–1011PubMedCrossRefGoogle Scholar
  13. 13.
    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):674.e1 674.e4CrossRefGoogle Scholar
  14. 14.
    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):525–533PubMedCrossRefGoogle Scholar
  15. 15.
    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
  16. 16.
    Strauss EJ, Barker LU, McGill K, Verma NN (2010) The evaluation and management of failed distal clavicle excision. Knee Surg Sports Med Arthrosc 18(3):213–219CrossRefGoogle Scholar
  17. 17.
    Takase K (2010) The coracoclavicular ligaments: an anatomic study. Surg Radiol Anat 32(7):683–688PubMedCrossRefGoogle Scholar
  18. 18.
    Yamaguchi H, Arakawa H, Kobayashi M (1998) Results of the Bosworth method for unstable fractures of the distal clavicle. Int Orthop 22(6):366–368PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryTokyo Medical UniversityTokyoJapan

Personalised recommendations