Abstract
The aim of this prospective study was to assess the clinical outcomes of an unstable fracture of the lateral end of the clavicle treated with an arthroscopic-assisted locking compressive plate (LCP) clavicular hook plate. Twenty-three patients underwent arthroscopic assisted LCP clavicular hook plate fixation for these fractures. All patients achieved clinical and radiological union over a mean of 4.2 months (range, 3.4–5 months). Four patients (17%) showed some degree of acromial osteolysis. Three patients (13%) showed radiological signs of arthrosis of the acromioclavicular joint. In one patient, a second fracture (stress) was observed between the medial two screws of the plate without an additional injury. Five patients (22%) showed subacromial bursitis on dynamic ultrasonography. The mean Constant and Murley score was 91 points (range, 81–98). The average level of pain in the shoulder at rest and on abduction was 1 (range, 0–2) and 2.4 (range, 0–4), respectively. Based on our experience, arthroscopic-assisted LCP hook plate fixation for the treatment of unstable fractures of the lateral end of the clavicle is not without complications. However, it is an acceptable alternative method that is easy to apply with good results. Furthermore, it prevents rotator cuff impingement, allows early mobilisation and maintains the acromioclavicular joint biomechanics.
Similar content being viewed by others
References
Ballmer FT, Gerber C (1991) Coracoclavicular screw fixation for unstable fractures of the distal clavicle. A report of five cases. J Bone Jt Surg Br 73(2):291–294
Charity RM, Haidar SG, Ghosh S, Tillu AB (2006) Fixation failure of the clavicular hook plate: a report of three cases. J Orthop Surg (Hong Kong) 14(3):333–335
Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164
Craig EV (1990) Fractures of the clavicle. In: Rockwood CA Jr, Green DP III (eds) The shoulder. W.B. Saunders, Philadelphia, pp 367–412
Eberle C, Fodor P, Metzger U (1992) Hook plate (so-called Balser plate) or tension banding with the Bosworth screw in complete acromioclavicular dislocation and clavicular fracture. Z Unfallchir Versicherungsmed 85(3):134–139
Edwards DJ, Kavanagh TG, Flannery MC (1992) Fractures of the distal clavicle: a case for fixation. Injury 23(1):44–46
Eskola A, Vainionpää S, Pätiälä H, Rokkanen P (1987) Outcome of operative treatment in fresh lateral clavicular fracture. Ann Chir Gynaecol 76(3):167–169
Fann CY, Chiu FY, Chuang TY, Chen CM, Chen TH (2004) Transacromial Knowles pin in the treatment of Neer type 2 distal clavicle fractures. A prospective evaluation of 32 cases. J Trauma 56(5):1102–1106
Faraj AA, Ketzer B (2001) The use of the hook-plate in the management of acromioclavicular injuries. Report of ten cases. Acta Orthop Belg 67(5):448–451
Flinkkilä T, Ristiniemi J, Hyvönen P, Flinkkilä HM (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):50–53
Fung M, Kato S, Barrance PJ, Elias J, McFarland EG, Nobuhara K, Chao EY (2001) Scapular and clavicular kinematics during humeral elevation: a study with cadavers. J Shoulder Elbow Surg 10(3):278–285
Hackenbruch W, Regazzoni P, Schwyzer K (1994) Surgical treatment of lateral clavicular fracture with the “clavicular hooked plate”. Z Unfallchir Versicherungsmed 87(3):145–152
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(4):419–423
Hessmann M, Kirchner R, Baumgaertel F, Gehling H, Gotzen L (1996) Treatment of unstable distal clavicular fractures with and without lesions of the acromioclavicular joint. Injury 27(1):47–52
Jupiter JB, Leffert RD (1987) Non-union of the clavicle. Associated complications and surgical management. J Bone Jt Surg Am 69(5):753–760
Kashii M, Inui H, Yamamoto K (2006) Surgical treatment of distal clavicle fractures using the clavicular hook plate. Clin Orthop Relat Res 447:158–164
Kona J, Bosse MJ, Staeheli JW, Rosseau RL (1990) Type II distal clavicle fractures: a retrospective review of surgical treatment. J Orthop Trauma 4(2):115–120
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(5):1401–1405
Lyons FA, Rockwood CA Jr (1990) Migration of pins used in operations on the shoulder. J Bone Jt Surg Am 72(8):1262–1267
Meda PV, Machani B, Sinopidis C, Braithwaite I, Brownson P, Frostick SP (2006) Clavicular hook plate for lateral end fractures: a prospective study. Injury 37:277–283
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):191–194
Neer CS 2nd (1968) Fractures of the distal third of the clavicle. Clin Orthop Relat Res 58:43–50
Neviaser RJ (1987) Injuries to the clavicle and acromioclavicular joint. Orthop Clin North Am 18(3):433–438
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):87–91
Schmittinger K, Sikorski A (1983) Experiences with the Balser plate in dislocations of the acromioclavicular joint and lateral fractures of the clavicle. Aktuelle Traumatol 13(5):190–193
Yamaguchi H, Arakawa H, Kobayashi M (1998) Results of Bosworth method for unstable fractures of the distal clavicle. Int Orthop 22(6):366–368
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lee, K.W., Lee, S.K., Kim, K.J. et al. Arthroscopic-assisted Locking Compression Plate clavicular hook fixation for unstable fractures of the lateral end of the clavicle: a prospective study. International Orthopaedics (SICOT) 34, 839–845 (2010). https://doi.org/10.1007/s00264-009-0925-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-009-0925-8