Treatment of unstable distal-third clavicule fractures using minimal invasive closed-loop double endobutton technique

Abstract

Background: Clavicle fractures are common clinical problems, accounting for approximately 10% of all fractures. Neer's type II fractures disrupt the integrity of the coracoclavicular ligament and, therefore, are inherently unstable, requiring an extended period time to achieve bone union and being associated with a high rate of non- or malunion. Restoration of the stability of the distal clavicle is an important factor to decrease the rate of non- or malunion. As such, the aim of our study was to describe our technique of indirect osteosynthesis, using a minimally invasive closed-loop double endobutton (TightRope) technique for fixation of unstable (Neer's type II) distal clavicle factures, and to evaluate the short-term clinical outcomes.

Methods: Fifteen patients with a Neer's type II fracture of the distal clavicle were treated surgically using the TightRope fixation, between January 2016 and December 2017. Clinical and radiological results were assessed using the American Shoulder and Elbow Surgeons Shoulder Score (ASES) and the Constant score.

Results: Definitive fracture healing was achieved in most of the patients. No major complication was identified over a mean follow-up of 9 months, and none of the patients required additional surgery related to the index procedure. At the last follow-up, all patients had recovered functional range of motion of the shoulder, with high Constant and ASES scores, and low pain score.

Conclusion: The use of TightRope fixation provided sufficient stability to reduce the medially displaced fragment of the Neer's type II fracture, with satisfactory radiological and clinical outcomes achieved over a mean follow-up of 9 months. Future studies on the long-term outcomes are needed.

Keywords: Clinical outcomes; Coracoclavicular stabilization; Fracture; Lateral clavicle; Minimally invasive; Radiologic outcomes; Range of motion suture button; TightRope.

Fig. 1

A 32-year-old male with a left distal clavicle fracture (Neer type IIA). During the steps of bone tunnel creation, we changed the trajectory of drilling through the clavicle and coracoid process (a). The endobutton is shown migrating through the inferior surface of the coracoid process due to an occult fracture of the base of the coracoid (b). Posterior-anterior plain radiograph obtained 2 weeks after surgery (c)