Neer type II (Edinburgh type 3B) fractures of the lateral clavicle are unstable fractures. The optimal management of these fractures remains controversial with many surgical techniques described in the literature. Our study reports the long-term results of a modified suture (1.5-mm polydioxanone cord) and sling technique for these fractures to avoid complications associated with current techniques in the literature. Over a 5-year period, 23 patients who were (12 males, 11 females; 14 left, 9 right) with a mean age of 42 years were treated with this technique. At last follow-up, the mean Oxford score was 45.1 (range 36–48); the mean SPADI score was 7.4 (range 0–32.3); and the mean Constant score was 91.5 (range 71–100). There were one non-union and no malunion. All patients in our series, except one, returned to their pre-injury activity level. This modified suture fixation technique is safe, technically simple to perform and cheap. It achieves excellent rates of fracture union without the complications associated with other fixation methods in the literature.
Suture and sling Polydioxanone Lateral clavicle fracture Neer type 2 Edinburgh type 3B
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We would like to acknowledge the technical help given by the Medical Illustration Department at Morriston Hospital in producing the surgical animation.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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Allman FL Jr (1967) Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am 49(4):774–784PubMedGoogle Scholar
Nordqvist A, Petersson C (1994) The incidence of fractures of the clavicle. Clin Orthop Relat Res 300:127–132PubMedGoogle Scholar
Robinson CM (1998) Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br 80(3):476–484CrossRefPubMedGoogle Scholar
Robinson CM et al (2004) Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am 86-A(7):1359–1365PubMedGoogle Scholar
Neer CS 2nd (1968) Fractures of the distal third of the clavicle. Clin Orthop Relat Res 58:43–50PubMedGoogle Scholar
Nordqvist A, Petersson C, Redlund-Johnell I (1993) The natural course of lateral clavicle fracture. 15 (11–21) year follow-up of 110 cases. Acta Orthop Scand 64(1):87–91CrossRefPubMedGoogle Scholar
Edwards DJ, Kavanagh TG, Flannery MC (1992) Fractures of the distal clavicle: a case for fixation. Injury 23(1):44–46CrossRefPubMedGoogle Scholar
Robinson CM, Cairns DA (2004) Primary nonoperative treatment of displaced lateral fractures of the clavicle. J Bone Joint Surg Am 86-A(4):778–782PubMedGoogle Scholar
Flinkkila T et al (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):50–53CrossRefPubMedGoogle Scholar
Fann CY et al (2004) Transacromial Knowles pin in the treatment of Neer type 2 distal clavicle fracturesA prospective evaluation of 32 cases. J Trauma 56(5):1102–1105 (discussion 1105–1106)CrossRefPubMedGoogle Scholar
Scadden JE, Richards R (2005) Intramedullary fixation of Neer type 2 fractures of the distal clavicle with an AO/ASIF screw. Injury 36(10):1172–1175CrossRefPubMedGoogle Scholar
Kashii M, Inui H, Yamamoto K (2006) Surgical treatment of distal clavicle fractures using the clavicular hook plate. Clin Orthop Relat Res 447:158–164CrossRefPubMedGoogle Scholar
Muramatsu K et al (2007) Use of the AO hook-plate for treatment of unstable fractures of the distal clavicle. Arch Orthop Trauma Surg 127(3):191–194CrossRefPubMedGoogle Scholar
Klein SM et al (2010) Results of surgical treatment for unstable distal clavicular fractures. J Shoulder Elbow Surg 19(7):1049–1055CrossRefPubMedGoogle Scholar
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
Nourissat G et al (2007) Arthroscopic stabilization of Neer type 2 fracture of the distal part of the clavicle. Arthroscopy 23(6):674.e1–674.e4CrossRefGoogle Scholar
Robinson CM et al (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):811–816CrossRefPubMedGoogle Scholar
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):399–403CrossRefPubMedGoogle Scholar
Goldberg JA et al (1997) Type 2 fractures of the distal clavicle: a new surgical technique. J Shoulder Elbow Surg 6(4):380–382CrossRefPubMedGoogle Scholar