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Precontoured Superior Locked Plating of Distal Clavicle Fractures: A New Strategy

  • Symposium: Fractures of the Shoulder Girdle
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The ideal management of fractures of the distal third of the clavicle remains a topic of debate. Locked plating is a new treatment method but is not yet widely studied.

Questions/purposes

We therefore determined union rates, function, and complications treated with locked plating.

Patients and Methods

We retrospectively reviewed 20 patients with Neer Type II distal clavicle fractures. All patients were treated with superior locked plating augmented with suture cerclage or screw fixation into the coracoid when there were concerns with screw purchase in the lateral fragment. Union was assessed radiographically and function was reported in terms of American Shoulder and Elbow Surgeons (ASES) scores and motion. Sixteen of 20 patients were followed for a minimum of 1 year; four of the patients with less than 1 year followup were included only for reporting of complications. The 16 patients were followed a minimum of 12 months (average, 30.7 months; range, 13–87 months).

Results

Union occurred in 15 of 16 (94%) patients. Average forward elevation and external rotation were 165.6° (range, 115°–180°) and 58.8° (range, 20°–90°), respectively. The average ASES score at the most recent followup was 79.0 (range, 33.3–100). Complications occurred in two patients. One patient developed an infected nonunion and a second patient sustained a peri-implant fracture.

Conclusions

Acute unstable distal clavicle fractures can be treated with superior locking plates with union rates, ASES scores, and ROM that are comparable to similar studies in the literature. The treatment method described allows supplemental fixation such as suture augmentation or a coracoclavicular screw.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Jordan Brooks, BS, Christopher David Williams, BS, and Mark Frankle, MD, for their hard work in collecting data and evaluating radiographs.

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Authors and Affiliations

  1. Florida Orthopaedic Institute, 13020 Telecom Parkway N, Temple Terrace, FL, 33637, USA

    Jaron R. Andersen MD, Ryan Nelson DO & Mark A. Mighell MD

  2. Tennessee Orthopaedic Alliance, Nashville, TN, USA

    Matt P. Willis MD

Authors
  1. Jaron R. Andersen MD
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  2. Matt P. Willis MD
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  3. Ryan Nelson DO
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  4. Mark A. Mighell MD
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Corresponding author

Correspondence to Mark A. Mighell MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

This work was performed at Florida Orthopaedic Institute, Temple Terrance, FL, USA.

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Andersen, J.R., Willis, M.P., Nelson, R. et al. Precontoured Superior Locked Plating of Distal Clavicle Fractures: A New Strategy. Clin Orthop Relat Res 469, 3344–3350 (2011). https://doi.org/10.1007/s11999-011-2009-5

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  • DOI: https://doi.org/10.1007/s11999-011-2009-5

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