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. 2022 Nov 21;10(11):23259671221137337.
doi: 10.1177/23259671221137337. eCollection 2022 Nov.

Comparative Evaluation of Arthroscopically Assisted Coracoclavicular Fixation Versus Hook Plate Fixation for Unstable Distal Clavicle Fractures: A Minimum 2-Year Follow-up Study

Fahmy Samir Fahmy  1 , Mohammed ElAttar  1 , Mohamed Abulsoud  2 , Ahmed Saied Mohammed  2 , Mohamed Elhalawany  2
Affiliations

Comparative Evaluation of Arthroscopically Assisted Coracoclavicular Fixation Versus Hook Plate Fixation for Unstable Distal Clavicle Fractures: A Minimum 2-Year Follow-up Study

Fahmy Samir Fahmy et al. Orthop J Sports Med. .

Abstract

Background: Neer type 2 distal clavicular fractures are associated with poor outcomes after nonoperative management. Surgical management is preferred, and various fixation methods have been studied.

Purpose: To assess the clinical and radiological outcomes in patients with unstable distal-end clavicular fractures that were treated with hook plate (HP) or arthroscopically assisted coracoclavicular (AAC) fixation.

Study design: Cohort study; Level of evidence, 3.

Methods: We retrospectively compared the clinical and radiological results of HP versus AAC fixation in patients who had unstable lateral-end clavicular fractures and at least 2 years of follow-up. The recorded postoperative Constant score, American Shoulder and Elbow Surgeons score, and shoulder forward flexion were compared between treatment groups using the independent t test. Fracture union was evaluated on routine shoulder radiographs.

Results: This study included 34 patients (17 with HP fixation, 17 with AAC fixation) with a mean ± SD age of 36.4 ± 8.3 years for the HP group and 37.2 ± 6.9 years for the AAC group. The mean follow-up period was 30.8 ± 2.8 months for the HP group and 28.8 ± 3.01 months for the AAC group. No statistically significant difference between groups was observed regarding postoperative Constant score (89.7 vs 92.5; P = .07), American Shoulder and Elbow Surgeons score (88.2 vs 91.1; P = .12), or mean time to union (10.1 vs 9.3 weeks; P = .16). Postoperative shoulder forward flexion was better in the AAC group (168.2° ± 4.3°) versus the HP group (161.9° ± 6.6°; P = .002), and the complication rate was lower in the AAC group (5.8% vs 41.1%; P = .03).

Conclusion: Both the AAC and HP fixation methods were effective in the surgical fixation of unstable Neer type 2 lateral-third clavicle fractures, with successful functional and radiological outcomes. However, AAC fixation provided an earlier return to work with fewer complications.

Keywords: arthroscopically assisted fixation; lateral-end fracture clavicle; unstable.

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Conflict of interest statement

The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
The base of the coracoid process, C, was cleared of soft tissue using a radiofrequency probe.
Figure 2.
Figure 2.
(A) Introduction of C-arm device through the anterior portal. (B) The guide system was centered below the base of the coracoid process, and (C) the guide wire exited the undersurface of the coracoid process.
Figure 3.
Figure 3.
The cortical button was retrieved to settle underneath the coracoid.
Figure 4.
Figure 4.
(A) Preoperative anteroposterior view radiograph of a 28-year-old man who had an unstable distal-third clavicle fracture that was fixed using a hook plate. (B) The patient achieved full radiographic union at 4 months postoperatively.
Figure 5.
Figure 5.
(A) Preoperative anteroposterior view radiograph shows a Neer type 2 lateral-third clavicle fracture. (B) The fracture was indirectly reduced and fixed using arthroscopically assisted double-button cortical fixation with (C) complete radiographic union achieved at 3 months postoperatively.
See this image and copyright information in PMC

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