Precontoured superior locked plating of distal clavicle fractures: a new strategy

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.

Fig. 1

This depicts an illustration of a Neer Type IIb distal clavicle fracture showing a torn conoid ligament with an intact trapezoid ligament.

Fig. 2A–B

(A) This is a preoperative AP radiograph of Patient 7. (B) This is a postoperative AP radiograph of the same patient treated with superior locked plating and vertical suture sling from coracoid anchors.

Fig. 3A–B

(A) This is a preoperative AP radiograph of Patient 20. (B) This is a postoperative AP radiograph of the same patient treated with superior locked plating supplemented with a coracoclavicular screw.