TightRope versus clavicular hook plate fixation for unstable distal clavicular fractures

  • Tapio FlinkkiläEmail author
  • Akseli Heikkilä
  • Kai Sirniö
  • Harri Pakarinen
Original Article



This retrospective study aimed to compare the fracture union and functional results of clavicular hook plate fixation versus arthroscopy-assisted TightRope fixation of unstable fractures of the distal clavicle.

Materials and methods

Forty patients with unstable (Neer II) distal clavicular fracture were treated surgically using either a clavicular hook plate (n = 19) or arthroscopy-assisted TightRope fixation (n = 21) between 2007 and 2012 in our hospital. Medical records were retrospectively reviewed. Clinical and radiological results after an average period of 62 months for the clavicular hook plate and 32 months for TightRope were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) score, the Constant score, and the RAND 36-item health questionnaire.


One fracture in each group was failed to unite. The mean Constant score was 93 in the TightRope group and 89 in the clavicular hook plate group, with mean DASH scores of 6 and 11, respectively. According to data from the RAND 36-item questionnaire, health-related quality of life returned to normal in both groups. Removal of the plate was the main reason for reoperation.


TightRope and clavicular hook plate repairs of unstable distal clavicular fractures result in similar fracture union and good clinical outcomes.


Clavicular fractures Plate fixation Arthroscopy Comparative study Retrospective studies 


Conflict of interest



  1. 1.
    Aalto A-M, Aro AR, Teperi J (1999) RAND36 as a measure of health-related quality of life. Reliability, construct validity and reference values in the Finnish general population. Stakes, Research Reports 101, Helsinki English summaryGoogle Scholar
  2. 2.
    Checcia SL, Doneux PS, Miyazaki AN, Fregoneze M, Silva LA (2008) Treatment of distal clavicle fractures using an arthroscopic technique. J Shoulder Elbow Surg 17:395–398. doi: 10.1016/j.jse.2007.08.011 CrossRefGoogle Scholar
  3. 3.
    Chiang CL, Yang SW, Tsai SW, Kuen-Huang Chen C (2010) Acromion osteolysis and fracture after hook plate fixation for acromioclavicular joint dislocation: a case report. J Shoulder Elbow Surg 19:e13–e15. doi: 10.1016/j.jse.2009.12.005 CrossRefPubMedGoogle Scholar
  4. 4.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop 214:160–164PubMedGoogle Scholar
  5. 5.
    Ding M, Ni J, Hu J, Song D (2011) Rare complication of clavicular hook plate: clavicle fracture at the medial end of the plate. J Shoulder Elbow Surg 20:e18–e20. doi: 10.1016/j.jse.2011.06.005 CrossRefPubMedGoogle Scholar
  6. 6.
    Flinkkilä T, Ristiniemi J, Lakovaara M, Hyvönen P, Leppilahti J (2006) Hook plate fixation of unstable lateral clavicle fractures: a report on 63 patients. Acta Orthop 77:644–649. doi: 10.1080/17453670610012737 CrossRefPubMedGoogle Scholar
  7. 7.
    Flinkkilä T, Ihanainen E (2013) Results of arthroscopy-assisted TightRope repair of acromioclavicular dislocations. Shoulder Elbow. doi: 10.1111/sae.12040 Google Scholar
  8. 8.
    Gilbart MK, Gerber C (2007) Comparison of the subjective shoulder value and the constant score. J Shoulder Elbow Surg 16:717–721. doi: 10.1016/j.jse.2007.02.123 CrossRefPubMedGoogle Scholar
  9. 9.
    Good DW, Lui DF, Leonard M, Morris S, McElwain JP (2012) Clavicle hook plate for displaced lateral- third clavicle fractures (Neer type II): a functional outcome study. J Shoulder Elbow Surg 21:1045–1048. doi: 10.1016/j.jse.2011.07.020 CrossRefPubMedGoogle Scholar
  10. 10.
    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 15:419–423. doi: 10.1016/j.jse.2005.11.012 CrossRefPubMedGoogle Scholar
  11. 11.
    Hoffler CE, Karas SG (2010) Transacromial erosion of a locked subacromial hook plate: case report and review of literature. J Shoulder Elbow Surg 19:e12–e15. doi: 10.1016/j.jse.2009.10.019 CrossRefPubMedGoogle Scholar
  12. 12.
    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 132:1415–1421. doi: 10.1007/s00402-012-1570-z CrossRefPubMedGoogle Scholar
  13. 13.
    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 33:879. doi: 10.3928/01477447-20101021-04 CrossRefPubMedGoogle Scholar
  14. 14.
    Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608CrossRefPubMedGoogle Scholar
  15. 15.
    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 33:1401–1405. doi: 10.1007/s00264-008-0696-7 CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Milewski MD, Tompkins M, Jm Giugale, Carson EW, Miller MD, Diduch DR (2012) Complications related to anatomic reconstruction of the coracoclavicular ligaments. Am J Sports Med 40:1628–1634. doi: 10.1177/0363546512445273 CrossRefPubMedGoogle Scholar
  17. 17.
    Motta P, Bruno L, Maderni A, Tosco P, Mariotti U (2013) Acute lateral dislocated clavicular fractures: arthroscopic stabilization with TightRope. J Shoulder Elbow Surg. doi: 10.1016/j.jse.2013.05.016 Google Scholar
  18. 18.
    Nourissat G, Kakuda C, Dumontier C, Sutet A, Doursounian L (2007) Arthroscopic stabilization of Neer type 2 fracture of the distal part of the clavicle. Arthroscopy 23:e1–e4. doi: 10.1016/j.arthro.2006.08.028 Google Scholar
  19. 19.
    Pandya NV, Hosalkar HS, Babatunde OM, Huffman GF (2009) Distal third clavicular fracture fixation: a new arthroscopically-assisted technique. Curr Orthop Practice 20:454–457. doi: 10.1097/BCO.0b013e31819d5e90 CrossRefGoogle Scholar
  20. 20.
    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 16:884–886. doi: 10.1007/s00167-008-0578-y CrossRefPubMedGoogle Scholar
  21. 21.
    Pujol N, Desmoineaux P, Boisrenoult P, Beaufils P (2013) Arthroscopic treatment of comminuted distal clavicle fractures (Latarjet Fractures) using 2 double-button devices. Arthrosc Tech 2:e61–e63. doi: 10.1016/j.eats.2012.11.001 CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    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 22:848–855. doi: 10.1016/j.jse.2012.08.022 CrossRefPubMedGoogle Scholar
  23. 23.
    Stegeman SA, Nacak H, Huvenaars KH, Stijnen T, Krijnen P, Schipper IB (2013) Surgical treatment of Neer type-II fractures of the distal clavicle: a meta-analysis. Acta Orthop 84:184–190. doi: 10.3109/17453674.2013.786637 CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Takase K, Kono R, Yamamoto K (2012) Arthroscopic stabilization for Neer 2 fracture of the distal clavicle. Arch Orthop Trauma Surg 132:399–403. doi: 10.1007/s00402-011-1455-6 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • Tapio Flinkkilä
    • 1
    Email author
  • Akseli Heikkilä
    • 1
  • Kai Sirniö
    • 1
  • Harri Pakarinen
    • 1
  1. 1.Division of Orthopedic and Trauma Surgery, Department of SurgeryOulu University HospitalOuluFinland

Personalised recommendations