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Open coraco-clavicular ligament reconstruction (CCLR) in treatment of displaced distal clavicle fractures has low complication rate and excellent union rate: a systematic review

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

A Correction to this article was published on 06 February 2023

This article has been updated

Abstract

Background

It is well established that non-operative treatment of displaced distal clavicle fractures (DDCF) leads to a high non-union rate. A number of open surgical treatments in the past have shown good to excellent outcomes including shoulder function and union rate. Despite this there is no consensus on the outcome of open coraco-clavicular ligament reconstruction (CCLR). The aim of this systematic review was to assess the union rate, complications and shoulder function of open CCLR techniques in the treatment of DDCF.

Patients and methods

A review of the online databases MEDLINE and Embase was conducted on 1 January 2021 according to PRISMA guidelines. The review was registered prospectively in the PROSPERO database. Clinical studies reporting union rate, complications and shoulder function were included. The studies were appraised using the Methodological Index for Non-Randomized Studies (MINORS) tool.

Results

The search strategy identified 18 studies eligible for inclusion with a total of 330 patients. These included 12 retrospective case series and 5 nonrandomized retrospective comparative studies and one RCT. All but one study reported on shoulder function, while all the studies reported on union rate and complications. The overall shoulder function was good to excellent using Constant–Murley score. The overall union rate was 97.6% and complication rate was 7.6%.

Conclusion

Open CCLR for displaced distal clavicle fractures that have a disruption of CC ligament, is a reliable treatment with excellent union rate and good to excellent shoulder functional scores.

Level of evidence

IV; Systematic review.

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Funding

The authors did not receive any funding for this study.

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Authors and Affiliations

  1. Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, WR5 1DD, UK

    Shahbaz S. Malik

  2. King’s College Hospital NHS Foundation Trust, London, UK

    Sheraz Malik

  3. The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK

    Muaaz Tahir

  4. University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

    Robert W. Jordan

  5. St Luke’s Hospital, Bielsko-Biała, Poland

    Hubert Laprus

  6. Orthopaedic Research Foundation of Western Australia, Perth, Australia

    Peter D’Alessandro

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  1. Shahbaz S. Malik
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Correspondence to Shahbaz S. Malik.

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Malik, S.S., Malik, S., Tahir, M. et al. Open coraco-clavicular ligament reconstruction (CCLR) in treatment of displaced distal clavicle fractures has low complication rate and excellent union rate: a systematic review. Arch Orthop Trauma Surg 143, 1459–1477 (2023). https://doi.org/10.1007/s00402-022-04384-7

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