Elsevier

JSES Reviews, Reports, and Techniques

Available online 12 August 2021
JSES Reviews, Reports, and Techniques

Coracoclavicular fixation techniques for Neer IIb and ‘extra-lateral’ fractures of the distal clavicle: A systematic review

https://doi.org/10.1016/j.xrrt.2021.06.007Get rights and content
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Abstract

Background

Unstable ‘extra-lateral’ fractures of the distal clavicle (lateral to the coracoclavicular ligaments) are not distinguished in the Neer classification system and are commonly included with Neer IIb fractures. In the literature, there is no optimal surgical technique for managing unstable fractures of the distal clavicle, nonetheless for unique ‘extra-lateral’ patterns. The aim of this study is to evaluate the effectiveness and safety of existing coracoclavicular fixation techniques for managing unstable Neer IIb and extra-lateral (IIc) fractures of the distal clavicle.

Methods

We performed a systematic search of the literature to capture all studies evaluating the safety and effectiveness of existing coracoclavicular loop techniques for unstable Neer IIb and extra-lateral (IIc) fractures of the distal clavicle. We searched the PubMed (Medline and PubMed Central), Scopus, Web of Science, Google Scholar, and Cochrane Central Register of Controlled Trials electronic databases to retrieve studies published between January 2000 and November 2020. Our study was guided by a prospectively developed protocol and reported in accordance with the latest PRISMA guidelines.

Results

Our database search yielded a total of 564 records, out of which 21 were deemed appropriate for inclusion in our qualitative synthesis. The total number of reported IIb/c fractures managed with a coracoclavicular stabilization technique in all studies was 421. In total, 139 (33%) patients received arthroscopic assisted treatment, and 282 (67%) patients were managed with open coracoclavicular stabilization. The reported clinical results were very good to excellent in most studies, whereas the overall major and minor complication rate was 2.6% and 12.8%, respectively. Major complications were more frequent in arthroscopic assisted techniques (4.3%) compared to open (1.8%).

Conclusion

The present systematic review of coracoclavicular stabilization techniques for unstable Neer IIb and extra-lateral fractures of the distal clavicle demonstrates promising clinical outcomes, including effectiveness and safety. We support the previously proposed modification of the Neer classification to include this unique type of unstable extra-lateral fracture (type IIc) to allow for targeted surgical management.

Keywords

unstable extra-lateral distal clavicle fractures
Neer type IIb
Neer type IIc
coracoclavicular fixation

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Disclaimers:

Funding: No funding was disclosed by the author(s).

Conflicts of interest: The authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all individual participants included in the study.

Institutional review board approval was not required for this review.

Level of Evidence: IV

Declaration of interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.