Skip to main content
SpringerLink
Log in

Surgical treatment of vertically unstable lateral clavicle fractures (Neer 2b) with locked plate fixation and coracoclavicular ligament reconstruction

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

Abstract

Introduction

The present study evaluates the outcome of patients treated with a combination of locked plate fixation and minimal-invasive coracoclavicular (CC) ligament reconstruction for unstable lateral clavicle fractures type IIb according to Neer.

Patients and methods

Fourteen patients with an unstable lateral clavicle fracture were treated with a combination of locked plate fixation and a minimal-invasive CC ligament reconstruction. At a mean follow-up of 38 months, patients were re-evaluated using the Constant-Murley score, the Acromioclavicular (AC) joint instability score and the TAFT score. Furthermore, anterior–posterior (ap) stress radiographs and axillary views were performed in order to detect any recurrent instability.

Results

Bony union was achieved in all cases within 6–10 weeks. The mean Constant-Murley score of the affected shoulder was 93.5 points compared to 97.2 of the contralateral unaffected shoulder. The mean Taft score was 11.2 points and the mean AC joint instability score was 92 points in comparison to 96 points on the unaffected side. The mean CC distance at the time of the injury was 21 mm compared to 8.5 mm after surgery and 12 mm a the final follow-up examination. The CC distance did not differ between the postoperative X-rays and those at the time of follow-up (p = 0.068). Three plates had to be removed because of implant irritation.

Conclusion

A combination of locked plate fixation and CC ligament augmentation in a minimal-invasive manner can be regarded as suitable for the treatment of vertically unstable lateral clavicle fractures and is associated with excellent clinical and radiological outcomes and a low complication rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Edwards DJ, Kavanagh TG, Flannery MC (1992) Fractures of the distal clavicle: a case for fixation. Injury 23(1):44–46. doi:0020-1383(92)90125-C

    Article  PubMed  CAS  Google Scholar 

  2. van der Meijden OA, Gaskill TR, Millett PJ (2012) Treatment of clavicle fractures: current concepts review. J Should Elb Surg 21(3):423–429. doi:10.1016/j.jse.2011.08.053

    Article  Google Scholar 

  3. Neer CS 2nd (1968) Fractures of the distal third of the clavicle. Clin Orthop Relat Res 58:43–50

    PubMed  Google Scholar 

  4. Eskola A, Vainionpaa S, Myllynen P, Patiala H, Rokkanen P (1986) Outcome of clavicular fracture in 89 patients. Arch Orthop Trauma Surg 105(6):337–338

    Article  PubMed  CAS  Google Scholar 

  5. Robinson CM (1998) Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br 80(3):476–484

    Article  PubMed  CAS  Google Scholar 

  6. 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(1):25–28. doi:10.1007/s00402-006-0197-3

    Article  PubMed  CAS  Google Scholar 

  7. Kalamaras 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(1):60–62. doi:10.1016/j.jse.2007.04.012

    Article  Google Scholar 

  8. Nourissat G, Kakuda C, Dumontier C, Sautet A, Doursounian L (2007) Arthroscopic stabilization of Neer type 2 fracture of the distal part of the clavicle. Arthroscopy 23 (6):674 e671-674. doi:10.1016/j.arthro.2006.08.028

  9. 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 Jt Surg Br 92(6):811–816. doi:10.1302/0301-620X.92B6.23558

    CAS  Google Scholar 

  10. Neer CS 2nd (1963) Fracture of the distal clavicle with detachment of the coracoclavicular ligaments in adults. J Trauma 3:99–110

    Article  PubMed  Google Scholar 

  11. Andersen JR, Willis MP, Nelson R, Mighell MA (2011) Precontoured superior locked plating of distal clavicle fractures: a new strategy. Clin Orthop Relat Res 469(12):3344–3350. doi:10.1007/s11999-011-2009-5

    Article  PubMed  Google Scholar 

  12. 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. doi:0020138395001565

    Article  PubMed  CAS  Google Scholar 

  13. Jou IM, Chiang EP, Lin CJ, Lin CL, Wang PH, Su WR (2011) Treatment of unstable distal clavicle fractures with Knowles pin. J Should Elb Surg 20(3):414–419. doi:10.1016/j.jse.2010.08.009

    Article  Google Scholar 

  14. 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. doi:10.1097/01.blo.0000203469.66055.6a

    Article  PubMed  Google Scholar 

  15. 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(3):277–283. doi:10.1016/j.injury.2005.10.017

    Article  PubMed  Google Scholar 

  16. Tambe AD, Motkur P, Qamar A, Drew S, Turner SM (2006) Fractures of the distal third of the clavicle treated by hook plating. Int Orthop 30(1):7–10. doi:10.1007/s00264-005-0019-1

    Article  PubMed  CAS  Google Scholar 

  17. Yang SW, Lin LC, Chang SJ, Kuo SM, Hwang LC (2011) Treatment of acute unstable distal clavicle fractures with single coracoclavicular suture fixation. Orthopedics 34(6):172. doi:10.3928/01477447-20110427-10

    PubMed  Google Scholar 

  18. Carofino BC, Mazzocca AD (2010) The anatomic coracoclavicular ligament reconstruction: surgical technique and indications. J Should Elb Surg 19(2 Suppl):37–46. doi:10.1016/j.jse.2010.01.004

    Article  Google Scholar 

  19. Flinkkila T, Ristiniemi J, Hyvonen P, Hamalainen 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(1):50–53. doi:10.1080/000164702317281404

    Article  PubMed  Google Scholar 

  20. Lyons FA, Rockwood CA Jr (1990) Migration of pins used in operations on the shoulder. J Bone Jt Surg Am 72(8):1262–1267

    CAS  Google Scholar 

  21. Herrmann S, Schmidmaier G, Greiner S (2009) Stabilisation of vertical unstable distal clavicular fractures (Neer 2b) using locking T-plates and suture anchors. Injury 40(3):236–239. doi:10.1016/j.injury.2008.07.021

    Article  PubMed  CAS  Google Scholar 

  22. Martetschlager F, Kraus TM, Schiele CS, Sandmann G, Siebenlist S, Braun KF, Stockle U, Freude T, Neumaier M (2012) Treatment for unstable distal clavicle fractures (Neer 2) with locking T-plate and additional PDS cerclage. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-012-2089-0

    Google Scholar 

  23. Largo RD, Rudin MA, Hotz TK, Valderrabano V, Kach KK (2011) Anatomic reconstruction of unstable lateral clavicular fractures. J Trauma 71(5):1348–1351. doi:10.1097/TA.0b013e3182095dd1

    Article  PubMed  Google Scholar 

  24. Petersen W, Wellmann M, Rosslenbroich S, Zantop T (2010) Minimally Invasive Acromioclavicular Joint Reconstruction (MINAR). Oper Orthop Traumatol 22(1):52–61. doi:10.1007/s00064-010-3004-4

    Article  PubMed  Google Scholar 

  25. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    PubMed  Google Scholar 

  26. Scheibel M, Droschel S, Gerhardt C, Kraus N (2011) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med 39(7):1507–1516. doi:10.1177/0363546511399379

    Article  PubMed  Google Scholar 

  27. Taft TN, Wilson FC, Oglesby JW (1987) Dislocation of the acromioclavicular joint. An end-result study. J Bone Jt Surg Am 69(7):1045–1051

    CAS  Google Scholar 

  28. Boehm D (2002) Scores. In: Gohlke F, Hedtmann A (eds) Schulter: das Standardwerk für Klinik und Praxis. Thieme, Stuttgart-New York, pp 98–104

    Google Scholar 

  29. Klein SM, Badman BL, Keating CJ, Devinney DS, Frankle MA, Mighell MA (2010) Results of surgical treatment for unstable distal clavicular fractures. J Should Elb Surg 19(7):1049–1055. doi:10.1016/j.jse.2009.11.056

    Article  Google Scholar 

  30. Hellmich A, Sievers U (1988) Surgical management of acromioclavicular joint separation with transcutaneous Kirschner wire fixation. Results of follow-up in 45 patients. Aktuelle Traumatol 18(1):9–13

    PubMed  CAS  Google Scholar 

  31. Moneim MS, Balduini FC (1982) Coracoid fracture as a complication of surgical treatment by coracoclavicular tape fixation. A case report. Clin Orthop Relat Res 168:133–135

    PubMed  Google Scholar 

  32. Guttmann D, Paksima NE, Zuckerman JD (2000) Complications of treatment of complete acromioclavicular joint dislocations. Instr Course Lect 49:407–413

    PubMed  CAS  Google Scholar 

  33. 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(9):884–886. doi:10.1007/s00167-008-0578-y

    Article  PubMed  Google Scholar 

  34. 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):399–403. doi:10.1007/s00402-011-1455-6

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Susanne Amler and Birgit Drews for their help in the preparation of the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany

    Benedikt Schliemann, Steffen B. Roßlenbroich, Kristian N. Schneider, Michael J. Raschke & Andre Weimann

  2. Department of Orthopaedics and Trauma Surgery, Martin-Luther Hospital, Caspar-Theyß-Straße 27-31, 14193, Berlin, Germany

    Wolf Petersen

Authors
  1. Benedikt Schliemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steffen B. Roßlenbroich
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kristian N. Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wolf Petersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael J. Raschke
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andre Weimann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benedikt Schliemann.

Additional information

B. Schliemann and S. B. Roßlenbroich contributed equally to this study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schliemann, B., Roßlenbroich, S.B., Schneider, K.N. et al. Surgical treatment of vertically unstable lateral clavicle fractures (Neer 2b) with locked plate fixation and coracoclavicular ligament reconstruction. Arch Orthop Trauma Surg 133, 935–939 (2013). https://doi.org/10.1007/s00402-013-1737-2

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-013-1737-2

Keywords

Search

Navigation