Archives of Orthopaedic and Trauma Surgery

, Volume 132, Issue 10, pp 1415–1421 | Cite as

Treatment of Neer type II fractures of the lateral clavicle using distal radius locking plates combined with TightRope augmentation of the coraco-clavicular ligaments

Orthopaedic Surgery



Neer type II lateral clavicle fractures are inherently unstable and debate continues regarding optimal treatment. The purpose of this study was to review the outcome of Neer type II lateral clavicle fractures treated using a novel technique, which incorporates a superiorly placed distal radius locking plate combined with TightRope™ fixation to augment the coraco-clavicular ligaments.


Between 2007 and 2010, a total of 31 Neer type II fractures were managed operatively at our institution. Clinical outcomes were assessed using the SPADI, DASH, Constant, and Taft scores. Subjects were evaluated at 6 weeks, 3, 6 months, and 1 year. For the latest follow-up (mean 38.7 months), all patients were telephoned by an independent research associate and interviewed to establish SPADI and DASH scores. Radiological union was evaluated using standard views including an antero-posterior view, an angled (Zanca) view, and a trans-scapular view.


Bony union was achieved at a mean follow-up of 6.3 ± 4.1 weeks. At the 1-year follow-up, the AC joint remained reduced radiologically in all cases. At 1 year, the mean Constant score was 95.6 ± 4.82, the DASH score was 3.45 ± 3.02, and the SPADI score was 2.58 + 1.94. At the latest follow-up, at a mean of 38.7 + 14.8 months, the DASH score was 0.6 ± 2.1 and the SPADI score was 0.6 ± 2.


Surgical fixation of Neer type II lateral clavicle fractures using a 2.4-mm distal radius locking plate in combination with TightRope™ suture augmentation results in a predictable outcome, preserving excellent shoulder function while maintaining a low complication rate.


Lateral clavicle fracture Neer type II Distal radius plate fixation TightRope™ 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Neer CS (1984) Fractures and dislocations of the shoulder. In: Rockwood Jr. CA, Green DP (eds) Fractures in adults, Philadelphia: J. B. Lippincott, Philadelphia, pp 711–712. ISBN: 0397506236Google Scholar
  2. 2.
    Anderson K (2003) Evaluation and treatment of distal clavicle fractures. Clin Sports Med 22:319–326PubMedCrossRefGoogle Scholar
  3. 3.
    Cheng ZJ, Hyun-Kim K, Byoung-Hyun M (2006) Surgical treatment for distal clavicle fracture associated with coracoclavicular ligament rupture using a cannulated screw fixation technique. J Trauma 60:1358–1361CrossRefGoogle Scholar
  4. 4.
    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 7:365–372PubMedCrossRefGoogle Scholar
  5. 5.
    Edwards DJ, Kavanagh TG, Flannery MC (1992) Fractures of the distal clavicle: a case for fixation. Injury 23:44–46PubMedCrossRefGoogle Scholar
  6. 6.
    Shin SJ, Roh KJ, Kim JO, Sohn HS (2009) Treatment of unstable distal clavicle fractures using two suture anchors and suture tension bands. Injury 40:1308–1312PubMedCrossRefGoogle Scholar
  7. 7.
    Herrmann S, Schmidmaier S, Greiner S (2008) Stabilisation of vertical unstable distal clavicular fractures (Neer 2b) using locking T-plates and suture anchors. Injury 40:236–239CrossRefGoogle Scholar
  8. 8.
    Kalamares M, Cutbush K, Robinson M (2008) A method for internal fixation of unstable distal clavicle fractures: early observations using a new technique. J Should Elb Surg 17:60–62CrossRefGoogle Scholar
  9. 9.
    Wang SJ, Wong CS (2008) Extra-articular Knowles pin fixation for unstable distal clavicle fractures. J Trauma 64:1522–1527PubMedCrossRefGoogle Scholar
  10. 10.
    Yoo JH, Chang JD, Seo YS, Shin JH (2008) Stable fixation of distal clavicle fracture with comminuted superior cortex using oblique T-plate and cerclage wiring. Injury 40:455–457PubMedCrossRefGoogle Scholar
  11. 11.
    Webber MCB, Haines JF (2000) The treatment of lateral clavicle fractures. Injury 31:175–179PubMedCrossRefGoogle Scholar
  12. 12.
    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 127:25–28PubMedCrossRefGoogle Scholar
  13. 13.
    Lee YS, Lau MJ, Tseng YC, Chen WC, Kao HY, Wei JD (2009) Comparison of hook plate versus tension band wire in the treatment of unstable fractures of the distal clavicle. Int Orthop (SICOT) 33:1401–1405CrossRefGoogle Scholar
  14. 14.
    Mall JW, Jacobi CA, Philipp AW, Peter FJ (2002) Surgical treatment of fractures of the distal clavicle with polydioxane suture tension band wiring: an alternative osteosynthesis. J Orthop Sci 7:535–537PubMedCrossRefGoogle Scholar
  15. 15.
    Flinkkilä T, Ristiniemi J, Hyvönen P, Hammleinen 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 73:50–53PubMedCrossRefGoogle Scholar
  16. 16.
    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 Scand 77:644–649CrossRefGoogle Scholar
  17. 17.
    Jou IM, Chiang EP, Lin CJ, Cheng LL, Wang PH, Su WR (2011) Treatment of unstable distal clavicle fractures with Knowles pin. J Should Elb Surg 20:414–419CrossRefGoogle Scholar
  18. 18.
    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] 22:811–816Google Scholar
  19. 19.
    Kaipel M, Majewski M, Regazzoni P (2010) Double-plate fixation in lateral clavicle fractures—a new strategy. J Trauma 69:896–900PubMedCrossRefGoogle Scholar
  20. 20.
    Checchia SL, Doneux PS, Miyasaki AN, Fregoneze M, Silva LA (2008) Treatment of distal clavicle fractures using an arthroscopic technique. J Should Elb Surg 17:395–398CrossRefGoogle Scholar
  21. 21.
    Nourissat G, Kakuda C, Dumontier C, Sautet A, Dourssounia L (2007) Arthroscopic stabilization of Neer type 2 fractures of the distal part of the clavicle. Arthroscopy 23:674e1–674e4Google Scholar
  22. 22.
    Pujol N, Philippeau JM, Richou J, Lespangnol F, Graveleau, Hardy P (2008) Arthroscopic treatment of distal clavicle fractures: a technical note. Knee Surg Sports Traumatol Arthrosc 16:884–886PubMedCrossRefGoogle Scholar
  23. 23.
    Clark RL, Milgram JW, Yawn DH (1974) Fatal aortic perforation and cardiac tamponade due to a Kirschner wire migrating from the right sternoclavicular joint. South Med J 67:316–318PubMedCrossRefGoogle Scholar
  24. 24.
    Yu C, Sun YH, Zhao CQ, Shi DW, Wang Y (2009) Treatment of distal clavicle fracture with distal radius volar locking compression plate. Chin J Traumatol 12:299–301PubMedGoogle Scholar
  25. 25.
    Constant MR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orth Relat Res 214:160–164Google Scholar
  26. 26.
    Gummesson C, Atroshi I, Ekdahl C (2003) The Disabilities of the Arm, Shoulder and Hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord 16:11CrossRefGoogle Scholar
  27. 27.
    Hill CL, Lester S, Taylor AW, Shanahan ME, Gill TK (2011) Factor structure and validity of the shoulder pain and disability index in a population-based study of people with shoulder symptoms. BMC Musculoskelet Disord 12:8PubMedCrossRefGoogle Scholar
  28. 28.
    Taft TN, Wilson FC, Oglesby JW (1987) Dislocation of the acromioclavicular joint. J Bone Joint Am 69A:1045–1051Google Scholar
  29. 29.
    Bossart PJ, Jouce SM, Manaster BJ, Packer SM (1988) Lack of efficacy of “weighted” radiographs in diagnosing acute coracoclavicular separation. Ann Emerg Med 17:20–24PubMedCrossRefGoogle Scholar
  30. 30.
    Yap JJ, Curl LA, Kvitne RS, McFarland EG (1999) The value of weighted views of the acromioclavicular joint. Results of a survey. Am J Sports Med 27:806–809PubMedGoogle Scholar
  31. 31.
    Mazzocca AD, Spang JT, Rodrigues RR, Rios CG, Romeo AA, Arciero RA (2008) Biomechanical and radiographic analysis of partial coracoclavicular ligament injuries. Am J Sports Med 36:1397–1402PubMedCrossRefGoogle Scholar
  32. 32.
    Neer CS (1968) Fractures of the distal third of the clavicle. Clin Orth Relat Res 1968(58):43–50Google Scholar
  33. 33.
    Renger RJ, Roukema GR, Reurings JC, Raams PM, Font J, Verleisdonk EJ (2009) The clavicle hook plate for Neer type II lateral fractures. J Orthop Trauma 23:570–574PubMedCrossRefGoogle Scholar
  34. 34.
    Kona J, Bosse MJ, Staheli JW (1990) Rosseau RL (1990) Type II distal clavicle fractures: a retrospective review of surgical treatment. J Orthop Trauma 4:115–120PubMedCrossRefGoogle Scholar
  35. 35.
    Motamedi AR, Blevins FT, Willis MC, McNally TP, Shahinpoor M (2000) Biomechanics of the coracoclavicular ligament complex and augmentations used in its repair and reconstruction. Am J Sports Med 28:380–384PubMedGoogle Scholar
  36. 36.
    Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB (2008) The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study. Am J Sports Med 36:2398–2406PubMedCrossRefGoogle Scholar
  37. 37.
    Jackson WFM, Bayne G, Gregg-Smith SJ (2006) Fractures of the lateral third of the clavicle: an anatomic approach to treatment. J Trauma 61:222–225PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryRockhampton HospitalRockhamptonAustralia
  2. 2.Musculoskeletal Research UnitCQ UniversityRockhamptonAustralia
  3. 3.Department of Orthopaedic SurgeryRoyal Brisbane HospitalHerstonAustralia
  4. 4.Division of SurgeryUniversity of Queensland Medical SchoolHerstonAustralia

Personalised recommendations