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Management of unstable distal third clavicle fractures: clinical and radiological outcomes of the arthroscopy-assisted conoid ligament reconstruction and fracture cerclage with sutures

  • Original Article • SHOULDER - ARTHROSCOPY
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

Surgical treatment is indicated for the management of Neer type IIB fractures of the distal third of the clavicle. The aim of this study was to assess the clinical and radiological outcomes, in cases of unstable distal third clavicle fractures managed by means of an arthroscopy-assisted conoid ligament reconstruction and fracture cerclage with sutures.

Methods

Nine patients with unstable distal third clavicle fractures (Neer type IIB) managed arthroscopically by means of a conoid ligament reconstruction and fracture cerclage with sutures, between 2008 and 2012, were included. The QoL was evaluated at the last follow-up visit, by means of the Health Survey questionnaire (SF36), the visual analogue scale (VAS) for pain, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the constant score, and a Global Satisfaction scale (from 0 to 10). The mean time from fracture fixation until radiological union, the development of hardware loosening, nonunion, infections, and hardware skin discomfort were evaluated.

Results

The mean age was 36 [21–48] years old. The mean [range] time from surgery until the last follow-up visit was 49 [46–52] months. Values of the questionnaires assessed at the last follow-up visit were: (1) physical SF36 score (50.72 ± 6.88); (2) mental SF36 score (50.92 ± 11.65); (3) VAS for pain (1.86 ± 1.35); (4) DASH questionnaire (11.97 ± 7.03); (5) constant score (89.67 ± 8.55), and (6) Global Satisfaction (8.17 ± 0.98). The mean time elapsed from fracture fixation to radiological union was 8.41 ± 3.26 months. Hardware loosening was observed in none of the patients. Nonunion was observed in 11.11% (1/9) of the patients. Hardware skin discomfort was observed in 11.11% (1/9) of the patients.

Conclusion

Patients with unstable distal third clavicle fractures managed by means of an arthroscopy-assisted conoid ligament reconstruction and fracture cerclage with sutures may have good clinical and radiological outcomes, with no need for a second surgical procedure to remove any metal hardware.

Level of evidence

Therapeutic; case series, Level IV.

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Authors and Affiliations

  1. Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Street Sant Quintí 89, 08026, Barcelona, Spain

    Luis Natera Cisneros & Juan Sarasquete Reiriz

  2. Hospital Quirón Teknon, Street Vilana 12, 08022, Barcelona, Spain

    Juan Sarasquete Reiriz

Authors
  1. Luis Natera Cisneros
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  2. Juan Sarasquete Reiriz
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Correspondence to Luis Natera Cisneros.

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None of the authors have any conflict of interest related to this study.

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Research involving human participants.

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All patients signed an informed consent prior to be included in the study.

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Dr. Juan Sarasquete receives royalties from Biomet Sports Medicine.

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Cisneros, L.N., Reiriz, J.S. Management of unstable distal third clavicle fractures: clinical and radiological outcomes of the arthroscopy-assisted conoid ligament reconstruction and fracture cerclage with sutures. Eur J Orthop Surg Traumatol 27, 373–380 (2017). https://doi.org/10.1007/s00590-017-1925-9

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  • DOI: https://doi.org/10.1007/s00590-017-1925-9

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