Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Coracoclavicular Ligament Suture Augmentation with Anatomical Locking Plate Fixation for Distal Clavicle Fracture

  • Lim, Tae Kang (Department of Orthopaedic Surgery, Eulji Hospital, Eulji University School of Medicine) ;
  • Shon, Min Soo (Department of Orthopaedic Surgery, National Medical Center) ;
  • Ryu, Hyung Gon (Department of Orthopaedic Surgery, Seoul Medical Center) ;
  • Seo, Jae Sung (Department of Orthopaedic Surgery, Seoul Medical Center) ;
  • Park, Jae Hyun (Department of Orthopaedic Surgery, Eulji Hospital, Eulji University School of Medicine) ;
  • Ko, Young (College of Nursing, Gachon University) ;
  • Koh, Kyoung-Hwan (Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital)
  • Received : 2014.08.09
  • Accepted : 2014.10.17
  • Published : 2014.12.30
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Abstract

Background: For Neer type IIB fracture of distal clavicle with coracoclavicular ligament injury, various surgical treatments have been used in literatures. However, there was no consensus on the optimal treatment. The aim of this study is to report the clinical and radiological results of open reduction and internal fixation of unstable distal clavicle fracture and suture augmentation of disrupted coracoclavicular ligament. Methods: A prospective study was performed in 23 patients with Neer type IIB distal clavicle fracture in Seoul Medical Center, Eulji Hospital, and National Medical Center. Firstly, suture anchors are inserted in the base of coracoid process and preliminary reduction was achieved by tie-off of three suture limbs around the clavicle. Then, the final fixation was completed with anatomical locking plate. Bony union and the distance between coracoclavicular ligaments were evaluated. Clinical results and complications including stiffness and secondary procedures were evaluated. Results: Bony union was achieved in all cases except one (22 of 23). At mean 14.9 months, no significant difference in the mean coracoclavicular distance was observed compared to uninjured shoulder ($8.2{\pm}7.9mm$ versus $7.3{\pm}3.4mm$, p=0.14). Pain visual analogue scale, American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were 0.5, 83.4, 78.5, and 6.2, respectively. Revision surgery was performed in one case of nonunion. Four patients who complained of skin irritation underwent implant removal. Conclusions: In cases of an unstable distal clavicle fracture with coracoclavicular ligament disruption, satisfactory clinical results were obtained by locking plate fixation and coracoclavicular ligament suture augmentation concurrently.

Keywords

References

  1. Flinkkila T, Heikkila A, Sirnio K, Pakarinen H. TightRope versus clavicular hook plate fixation for unstable distal clavicular fractures. Eur J Orthop Surg Traumatol. 2014 [Epub ahead of print].
  2. Lee SK, Park JS, Choy WS. Locking compression plate distal ulna hook plate as alternative fixation for fifth metatarsal base fracture. J Foot Ankle Surg. 2014;53(5):522-8. https://doi.org/10.1053/j.jfas.2014.02.021
  3. Oh JH, Kim SH, Lee JH, Shin SH, Gong HS. Treatment of distal clavicle fracture: a systematic review of treatment modalities in 425 fractures. Arch Orthop Trauma Surg. 2011;131(4):525-33. https://doi.org/10.1007/s00402-010-1196-y
  4. Nunez FA Jr, Li Z, Campbell D, Nunez FA Sr. Distal ulna hook plate: angular stable implant for fixation of distal ulna. J Wrist Surg. 2013;2(1):87-92. https://doi.org/10.1055/s-0032-1333427
  5. Neer CS 2nd. Fracture of the distal clavicle with detachment of the coracoclavicular ligaments in adults. J Trauma. 1963;3:99-110. https://doi.org/10.1097/00005373-196303000-00001
  6. Flinkkila T, Ristiniemi J, Lakovaara M, Hyvonen P, Leppilahti J. Hook-plate fixation of unstable lateral clavicle fractures: a report on 63 patients. Acta Orthop. 2006;77(4):644-9. https://doi.org/10.1080/17453670610012737
  7. Fazal MA, Saksena J, Haddad FS. Temporary coracoclavicular screw fixation for displaced distal clavicle fractures. J Orthop Surg (Hong Kong). 2007;15(1):9-11. https://doi.org/10.1177/230949900701500103
  8. Badhe SP, Lawrence TM, Clark DI. Tension band suturing for the treatment of displaced type 2 lateral end clavicle fractures. Arch Orthop Trauma Surg. 2007;127(1):25-8.
  9. Nourissat G, Kakuda C, Dumontier C, Sautet A, Doursounian L. Arthroscopic stabilization of Neer type 2 fracture of the distal part of the clavicle. Arthroscopy. 2007;23(6):674.e1-4. https://doi.org/10.1016/j.arthro.2006.08.028
  10. Kashii M, Inui H, Yamamoto K. Surgical treatment of distal clavicle fractures using the clavicular hook plate. Clin Orthop Relat Res. 2006;447:158-64. https://doi.org/10.1097/01.blo.0000203469.66055.6a
  11. Lee SK, Park JS, Choy WS. LCP distal ulna hook plate as alternative fixation for fifth metatarsal base fracture. Eur J Orthop Surg Traumatol. 2013;23(6):705-13. https://doi.org/10.1007/s00590-012-1061-5
  12. An WJ, Sun JB, Ye P, Guo WW. Comparative study on the treatment of acromioclavicular joint dislocation: coracoclavicular ligament reconstruction combined with hook plate fixation or suture-anchor fixation. Zhonghua Wai Ke Za Zhi. 2013;51(4):349-53.
  13. Herrmann S, Schmidmaier G, Greiner S. Stabilisation of vertical unstable distal clavicular fractures (Neer 2b) using locking T-plates and suture anchors. Injury. 2009;40(3):236-9. https://doi.org/10.1016/j.injury.2008.07.021
  14. Haidar SG, Krishnan KM, Deshmukh SC. Hook plate fixation for type II fractures of the lateral end of the clavicle. J Shoulder Elbow Surg. 2006;15(4):419-23. https://doi.org/10.1016/j.jse.2005.11.012
  15. Yoo JH, Chang JD, Seo YJ, Shin JH. Stable fixation of distal clavicle fracture with comminuted superior cortex using oblique T-plate and cerclage wiring. Injury. 2009;40(4):455-7. https://doi.org/10.1016/j.injury.2008.05.028
  16. Kalamaras M, Cutbush K, Robinson M. A method for internal fixation of unstable distal clavicle fractures: early observations using a new technique. J Shoulder Elbow Surg. 2008;17(1):60-2. https://doi.org/10.1016/j.jse.2007.04.012
  17. Ye JK, Yu BJ, Ye FS, Hong JY, Wang W, Tong PJ. Case-control study on therapeutic effects between modified Weaver-Dunn surgery and clavicular hook plate fixation in the treatment of acromioclavicular joint dislocation. Zhongguo Gu Shang. 2014;27(1):4-8.
  18. Kaku N, Hara K, Tabata T, Tsumura H. Influence of the volume of bone defect, bone grafting methods, and hook fixation on stress on the Kerboull-type plate and screw in total hip arthroplasty: three-dimensional finite element analysis. Eur J Orthop Surg Traumatol. 2014 [Epub ahead of print].
  19. Gu X, Cheng B, Sun J, Tao K. Arthroscopic evaluation for omalgia patients undergoing the clavicular hook plate fixation of distal clavicle fractures. J Orthop Surg Res. 2014;9:46. https://doi.org/10.1186/1749-799X-9-46
  20. Chen CY, Yang SW, Lin KY, et al. Comparison of single coracoclavicular suture fixation and hook plate for the treatment of acute unstable distal clavicle fractures. J Orthop Surg Res. 2014;9:42. https://doi.org/10.1186/1749-799X-9-42
  21. Webber MC, Haines JF. The treatment of lateral clavicle fractures. Injury. 2000;31(3):175-9. https://doi.org/10.1016/S0020-1383(99)00276-4
  22. Madsen W, Yaseen Z, LaFrance R, et al. Addition of a suture anchor for coracoclavicular fixation to a superior locking plate improves stability of type IIB distal clavicle fractures. Arthroscopy. 2013;29(6):998-1004. https://doi.org/10.1016/j.arthro.2013.02.024

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