Ahmadreza MIRBOLOOK, Mirmostafa SADAT, Mohammadreza GOLBAKHSH, Mohammad Sadegh MOUSAVI, Amirmohammad GHOLIZADEH, Sepehr SAGHARI

Distal clavicular fracture treatment with suture anchor method

Objective: The aim of this study was to evaluate the results of the suture anchor fixation in the treatment of distal clavicle fractures.Methods: This cross series study included 43 patients (27 males, 12 females; mean age: 40.1±10.18 years) with type II unstable distal clavicle fractures. The fractures were fixed by 2 pins and 1 suture anchor. All patients were followed at postoperative months 3, 6, and 12 and underwent clinical and radiographic evaluation after 1 year, ongoing at 6-month intervals thereafter. Demographic data were recorded on the first postoperative day. At third and 12th month follow-up, Constant-Murley Shoulder Outcome Score (CMS) was used to assess performance of the acromioclavicular joint, and Visual Analog Scale questionnaire was used to assess patient satisfaction.Results: Based on CMS scores 1 year after surgery, 37 patients were in excellent condition, and 2 patients were in good condition. Mean surgical case duration was 43.25±4.01 min. These results indicate that there was no significant association between CMS scores and surgical case duration. Mean time to union in our patients was 4.46±0.96 months.Conclusion: We were able to observe optimal results in our patients by using closed reduction and suture anchors without opening the fracture site, thus allowing physiological processes in union without complications of complete union, while also preventing additional costs such as removing the device.

___

Ballmer FT, Gerber C. Coracoclavicular screw fixation for unstable fractures of the distal clavicle. A report of five cases. J Bone Joint Surg Br 1991;73:291-4.

Bezer M, Aydin N, Guven O. The treatment of distal clav- icle fractures with coracoclavicular ligament disruption: a report of 10 cases. J Orthop Trauma 2005;19:524-8.

Brouwer KM, Wright TC, Ring DC. Failure of superior locking clavicle plate by axial pull-out of the lateral screws: a report of four cases. J Shoulder Elbow Surg 2009;18:22-5.

Charity RM, Haidar SG, Ghosh S, Tillu AB. Fixation fail- ure of the clavicular hook plate: a report of three cases. J Orthop Surg (Hong Kong) 2006;14:333-5.

Harris RI, Wallace AL, Harper GD, Goldberg JA, Sonna- bend DH, Walsh WR. Structural properties of the intact and the reconstructed coracoclavicular ligament complex. Am J Sports Med 2000;28:103-8.

Edwards DJ, Kavanagh TG, Flannery MC. Fractures of the distal clavicle: a case for fixation. Injury 1992;23:44-6.

Flinkkilä T, Ristiniemi J, Hyvönen P, Hämäläinen M. Sur- gical treatment of unstable fractures of the distal clavicle: a comparative study of Kirschner wire and clavicular hook plate fixation. Acta Orthop Scand 2002;73:50-3.

Harris TG, Lynch SA. Acromioclavicular joint separa- tions: update, diagnosis, classification, and treatment. Cur- rent Opinion in Orthopaedics 2003;14:255-61.

Flinkkilä T, Ristiniemi J, Lakovaara M, Hyvönen P, Leppilahti J. Hook-plate fixation of unstable lateral clavicle fractures: a report on 63 patients. Acta Orthop 2006;77:644-9.

Goldberg JA, Bruce WJ, Sonnabend DH, Walsh WR. Type 2 fractures of the distal clavicle: a new surgical tech- nique. J Shoulder Elbow Surg 1997;6:380-2.

Hackenbruch W, Regazzoni P, Schwyzer K. Surgical treatment of lateral clavicular fracture with the "clavicular hooked plate". [Article in German] Z Unfallchir Versicher- ungsmed 1994;87:145-52.

Oh JH, Kim SH, Lee JH, Shin SH, Gong HS. Treatment of distal clavicle fracture: a systematic review of treatment modalities in 425 fractures. Arch Orthop Trauma Surg 2011;131:525-33.

Klein SM, Badman BL, Keating CJ, Devinney DS, Frankle MA, Mighell MA. Results of surgical treatment for un- stable distal clavicular fractures. J Shoulder Elbow Surg 2010;19:1049-55.

Robinson CM, Cairns DA. Primary nonoperative treat- ment of displaced lateral fractures of the clavicle. J Bone Joint Surg Am 2004;86-A:778-82.

Rokito AS, Zuckerman JD, Shaari JM, Eisenberg DP, Cuomo F, Gallagher MA. A comparison of nonoperative and operative treatment of type II distal clavicle fractures. Bull Hosp Jt Dis 2002-2003;61:32-9.

Scadden JE, Richards R. Intramedullary fixation of Neer type 2 fractures of the distal clavicle with an AO/ASIF screw. Injury 2005;36:1172-5.

Wang SJ, Wong CS. Extra-articular knowles pin fixa- tion for unstable distal clavicle fractures. J Trauma 2008;64:1522-7.

Mizue F, Shirai Y, Ito H. Surgical treatment of commi- nuted fractures of the distal clavicle using Wolter clavicular plates. J Nippon Med Sch 2000;67:32-4.

Chiang CL, Yang SW, Tsai MY, Kuen-Huang Chen C. Ac- romion osteolysis and fracture after hook plate fixation for acromioclavicular joint dislocation: a case report. J Shoul- der Elbow Surg 2010;19:13-5.

Chen CH, Chen WJ, Shih CH. Surgical treatment for dis- tal clavicle fracture with coracoclavicular ligament disrup- tion. J Trauma 2002;52:72-8.

Seyhan M, Kocaoglu B, Kiyak G, Gereli A, Turkmen M. Anatomic locking plate and coracoclavicular stabilization with suture endo-button technique is superior in the treat- ment of Neer Type II distal clavicle fractures. Eur J Orthop Surg Traumatol 2015;25:827-32.