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All arthroscopic coracoclavicular button fixation is efficient for Neer type II distal clavicle fractures

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Neer type II distal clavicle fractures are associated with a high rate of non-union or malunion due to impaired coracoclavicular ligament stability. The purpose of this study was to assess the clinical and radiological outcomes of arthroscopically assisted indirect osteosynthesis for type II distal clavicle fractures using a cortical suture button device.

Methods

Seventeen patients Neer type II fractures of the distal clavicle were treated surgically using cortical suture button fixation between 2012 and 2017. The clinical and radiological results were assessed using the American Shoulder and Elbow Surgeons Shoulder Score (ASES), Constant-Murley score and visual analogue scale (VAS) score.

Results

Anatomic reduction and bone healing were achieved in all patients at the final follow-up. The median age of the patients was 31 years (range 19–57). The mean follow-up was 25.9 months (range 14–64). The average delay before surgery was 2 days (range 1–4). At the final follow-up, the mean ASES, Constant-Murley score and VAS score were 92.6 ± 3.2 (range 84.9–96.6), 96.2 ± 2.4 (range 92–100) and 0.47 ± 0.51 (range 0–1), respectively. All patients were able to resume work as well as sport activities. The postoperative complications included two coracoid process fractures, and none of the patients required additional surgery related to the index procedure.

Conclusion

All arthroscopic coracoclavicular button fixation of Neer type II distal clavicle fractures would provide sufficient stability and union with satisfactory radiological and clinical outcomes. This arthroscopic fixation technique would be more efficient than other osteosynthesis methods because it is a minimally invasive surgery with a low complication rate.

Level of evidence

III.

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Abbreviations

AC:

Acromioclavicular

CC:

Coracoclavicular

K-wires:

Kirschner wires

CB:

Coracoclavicular button

ROM:

Range of motion

ASES:

The American Shoulder and Elbow Surgeons Shoulder Score

VAS:

Visual analogue scale

CT:

Computed tomography

MRI:

Magnetic resonance imaging

References

  1. Baumgarten KM (2008) Arthroscopic fixation of a type II-variant, unstable distal clavicle fracture. Orthopedics 31(12):1236–1238

    Google Scholar 

  2. Blake MH, Lu MT, Shulman BS, Glaser DL, Huffman GR (2017) Arthroscopic cortical button stabilization of isolated acute Neer type II fractures of the distal clavicle. Orthopedics 40(6):e1050–e1054

    Article  Google Scholar 

  3. Goldberg JA, Bruce WJ, Sonnabend DH, Walsh WR (1997) Type 2 fractures of the distal clavicle: a new surgical technique. J Shoulder Elbow Surg 6(4):380–382

    Article  CAS  Google Scholar 

  4. Hsu KH, Tzeng YH, Chang MC, Chiang CC (2018) Comparing the coracoclavicular loop technique with a hook plate for the treatment of distal clavicle fractures. J Shoulder Elbow Surg 27(2):224–230

    Article  Google Scholar 

  5. Klein SM, Badman BL, Keating CJ, Devinney DS, Frankle MA, Mighell MA (2010) Results of surgical treatment for unstable distal clavicular fractures. J Shoulder Elbow Surg 19(7):1049–1055

    Article  Google Scholar 

  6. Lin HH, Wang CS, Chen CF, Chiang CC, Huang CK, Chen WM et al (2013) Treatment of displaced distal clavicle fractures with a single cortical screw. Orthopedics 36(3):199–202

    Article  Google Scholar 

  7. Lopiz Y, Checa P, Garcia-Fernandez C, Valle J, Vega ML, Marco F (2019) Complications with the clavicle hook plate after fixation of Neer type II clavicle fractures. Int Orthop 43(7):1701–1708

    Article  Google Scholar 

  8. Loriaut P, Moreau PE, Dallaudiere B, Pelissier A, Vu HD, Massin P et al (2015) Outcome of arthroscopic treatment for displaced lateral clavicle fractures using a double button device. Knee Surg Sports Traumatol Arthrosc 23(5):1429–1433

    Article  Google Scholar 

  9. Millett PJ, Hurst JM, Horan MP, Hawkins RJ (2011) Complications of clavicle fractures treated with intramedullary fixation. J Shoulder Elbow Surg 20(1):86–91

    Article  Google Scholar 

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

    PubMed  Google Scholar 

  11. Nordqvist A, Petersson C (1994) The incidence of fractures of the clavicle. Clin Orthop Relat Res 300:127–132

    Google Scholar 

  12. 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 (e1–4)

    Article  Google Scholar 

  13. Oh JH, Kim SH, Lee JH, Shin SH, Gong HS (2011) Treatment of distal clavicle fracture: a systematic review of treatment modalities in 425 fractures. Arch Orthop Trauma Surg 131(4):525–533

    Article  Google Scholar 

  14. Postacchini F, Gumina S, De Santis P, Albo F (2002) Epidemiology of clavicle fractures. J Shoulder Elbow Surg 11(5):452–456

    Article  Google Scholar 

  15. Renfree KJ, Riley MK, Wheeler D, Hentz JG, Wright TW (2003) Ligamentous anatomy of the distal clavicle. J Shoulder Elbow Surg 12(4):355–359

    Article  Google Scholar 

  16. Rijal L, Sagar G, Joshi A, Joshi KN (2012) Modified tension band for displaced type 2 lateral end clavicle fractures. Int Orthop 36(7):1417–1422

    Article  Google Scholar 

  17. Robinson CM, Cairns DA (2004) Primary nonoperative treatment of displaced lateral fractures of the clavicle. J Bone Joint Surg Am 86(4):778–782

    Article  Google Scholar 

  18. Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE (2004) Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am 86(7):1359–1365

    Article  Google Scholar 

  19. Rokito AS, Zuckerman JD, Shaari JM, Eisenberg DP, Cuomo F, Gallagher MA (2002) A comparison of nonoperative and operative treatment of type II distal clavicle fractures. Bull Hosp Jt Dis 61(1–2):32–39

    PubMed  Google Scholar 

  20. Sautet P, Galland A, Airaudi S, Argenson JN, Gravier R (2018) Arthroscopy-assisted fixation of fracture of the distal part of the clavicle by subcoracoid suture and clavicle button. Orthop Traumatol Surg Res 104(8):1237–1240

    Article  Google Scholar 

  21. Scadden JE, Richards R (2005) Intramedullary fixation of Neer type 2 fractures of the distal clavicle with an AO/ASIF screw. Injury 36(10):1172–1175

    Article  CAS  Google Scholar 

  22. Stegeman SA, Nacak H, Huvenaars KH, Stijnen T, Krijnen P, Schipper IB (2013) Surgical treatment of Neer type-II fractures of the distal clavicle: a meta-analysis. Acta Orthop 84(2):184–190

    Article  Google Scholar 

  23. van der Meijden OA, Gaskill TR, Millett PJ (2012) Treatment of clavicle fractures: current concepts review. J Shoulder Elbow Surg 21(3):423–429

    Article  Google Scholar 

  24. Yagnik GP, Brady PC, Zimmerman JP, Jordan CJ, Porter DA (2019) A biomechanical comparison of new techniques for distal clavicular fracture repair versus locked plating. J Shoulder Elbow Surg 28(5):982–988

    Article  Google Scholar 

  25. Zheng YR, Lu YC, Liu CT (2019) Treatment of unstable distal-third clavicule fractures using minimal invasive closed-loop double endobutton technique. J Orthop Surg Res 14(1):37

    Article  Google Scholar 

  26. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD (2005) Evidence-Based Orthopaedic Trauma Working G. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma 19(7):504–507

    Article  Google Scholar 

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Correspondence to Tunay Erden.

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Kapicioglu, M., Erden, T., Bilgin, E. et al. All arthroscopic coracoclavicular button fixation is efficient for Neer type II distal clavicle fractures. Knee Surg Sports Traumatol Arthrosc 29, 2064–2069 (2021). https://doi.org/10.1007/s00167-020-06048-8

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