Dual mini-fragment plate fixation for Neer type-II and -V distal clavicle fractures

Abstract

Contemporary methods for open reduction and internal fixation of displaced distal clavicle fractures have excellent rates of union and high rates of reoperation for symptomatic implant removal. The authors describe their preferred surgical technique and case series of patients with Neer Type-II and -V distal clavicle fractures treated with lower profile dual mini-fragment plates using interdigitating screws placed into the distal segment to enhance fixation.

Keywords: distal clavicle; dual mini-fragment plating; implant prominence.

Figure 1

(A) Injury radiographs, (B) intraoperative fluoroscopy, and (C) final postoperative radiographs demonstrating healing of a Neer type-V distal clavicle fracture fixed with dual mini-fragment plates. Multiple lag screws were placed into the inferior fragment attached to the coracoclavicular ligaments. Note the interdigitating screws placed through orthogonal plates to enhance fixation in the distal segment.

Figure 2

(A) Injury radiographs of another Neer type-V distal clavicle fracture. (B) An intraoperative photograph showing definitive fixation with a Y-shaped mini-fragment plate on the superior distal clavicle surface, and a straight mini-fragment plate contoured to the anterior distal clavicle surface. (C, D) Final fluoroscopic images demonstrating anatomic reduction and the dual mini-fragment plated construct with interdigitating locking screws in the distal fragment. A single lag screw prior to plate application was placed into the inferior fragment attached to the coracoclavicular ligaments.