Outcomes of arthroscopic assisted fixation of distal clavicle fractures using an adjustable button

Abstract

Background: Distal clavicle fractures, particularly unstable Neer type II fractures, pose a challenge due to high nonunion rates. Arthroscopic-assisted techniques for coracoclavicular (CC) stabilization, such as the adjustable button fixation, have been used for their minimal invasiveness and effectiveness.

Methods: This retrospective study analyzed 24 patients with Neer type II distal clavicle fractures treated with arthroscopically assisted adjustable button fixation. Patients were evaluated using the Constant-Murley and the American Shoulder and Elbow Surgeons scoring systems, with a minimum follow-up of 18 months. Outcomes assessed included CC distance, return to sports, complications, and reoperations.

Results: The majority of injuries were due to sports (58%), with a mean age of 25.7 years. The average operation time was 85.3 minutes, and the average follow-up was 38.7 months. The preoperative CC distance was reduced from 19.3 mm to 10.6 mm postoperatively. Complications were minimal, with 1 instance of superficial infection treated with antibiotics and 1 case of button displacement that was treated conservatively. The median American Shoulder and Elbow Surgeons score was 89.0, and the Constant-Murley score averaged 91.8. A total of 87.5% of patients returned to sports, with 66.7% returning to their previous level of activity. Age was negatively correlated with the return to sports and preinjury activity levels.

Conclusion: Arthroscopic-assisted fixation of distal clavicle fractures using the adjustable button technique demonstrated good functional and radiological outcomes, with a high rate of return to sports and minimal postoperative complications. This method may be considered an effective option for the treatment of Neer type II distal clavicle fractures.

Keywords: Acromioclavicular joint; Adjustable button; Arthroscopic; Distal clavicle fracture; Fixation; Neer Classification; Operative treatment.

Figure 1

Patient in beach chair position in the operating theater, with the affected extremity draped free and the c-arm angled at 45°.

Figure 2

Removing the anterior joint capsule (rotator interval).

Figure 3

(A) Preparation of the undersurface of the coracoid base. (B) View of the coracoid base after preparation.

Figure 4

(A) Passing the guide drill through the coracoid. (B) The endobutton lying on the undersurface of the coracoid.

Figure 5

(A) Intraoperative fluoroscopy showing the drill going through four cortices. (B) Fluoroscopic image showing the button in place with the fracture reduced.

Figure 6

Intraoperative photograph showing the button lying on top of the reduced fracture.

Figure 7

(A) Preoperative plain radiograph of a distal clavicle fracture. (B) The same patient 1-year after surgery showing fracture union.

Figure 8

(A) Plain radiographs of another case showing off-center endobutton placement with good reduction. (B) A follow-up radiograph at 1 year showing fracture and endobutton displacement with subsequent fracture consolidation.