Coracoclavicular ligament augmentation at clavicle distal-third fracture treatment
DOI:
https://doi.org/10.15587/2519-4798.2021.229927Keywords:
distal clavicle, coracoclavicular, ligament, plate, fracture, type 2, surgery, anatomic healing, early motionAbstract
The aim: type 2B clavicle fractures with conoid ligament rupture are considered unstable. Although surgical treatment is recommended as the standard treatment modality for type 2B fractures, there is no consensus about the type of operative treatment. We aimed to evaluate results of surgical treatment with an anatomical distal clavicle plate using CC ligament augmentation.
Materials and methods: 15 patients that diagnosed with distal clavicle fractures, who underwent surgery for unstable type 2 fractures. The average patient age was 38 years (range 24–52 years). All patients were male; the right clavicle was injured in 10 patients whereas the left clavicle was injured in 5 cases. Surgical treatment was done with a distal clavicle anatomic locked plate augmentation (ZipTight™) at all cases. The mean follow-up period was 24 months (range, 12–40 months).
Results: bony union was achieved at a mean follow-up of 8 weeks (range 6-10 weeks). The mean Constant score was 97 (range, 92–100). There were no complications or no need to second operation. All patients achieved satisfactory full range of shoulder motion. Hardware removal was performed for prominence in one case after the union was completed.
Conclusion: the augmented technique reported here, provides early motion, increased stability and anatomic healing compared to other conventional options. We recommend augmentative CC ligament repair techniques over the distal locking anatomic plate for type 2 fractures
References
- Ballmer, F., Gerber, C. (1991). Coracoclavicular screw fixation for unstable fractures of the distal clavicle. A report of five cases. The Journal of Bone and Joint Surgery. British Volume, 73-B (2), 291–294. doi: http://doi.org/10.1302/0301-620x.73b2.2005158
- Neer, C. S. (1968). 5 Fractures of the Distal Third of the Clavicle. Clinical Orthopaedics and Related Research, 58, 43–50. doi: http://doi.org/10.1097/00003086-196805000-00007
- Wu, C.-C. (2012). Tension Band Wiring versus Knowles Pinning for Non-Union of Type-2 Distal Clavicle Fractures. Journal of Orthopaedic Surgery, 20 (3), 297–301. doi: http://doi.org/10.1177/230949901202000306
- Riiser, M. O., Molund, M. (2021). Long-term Functional Outcomes and Complications in Operative Versus Nonoperative Treatment for Displaced Midshaft Clavicle Fractures in Adolescents: A Retrospective Comparative Study. Journal of Pediatric Orthopaedics, 41 (5), 279–283. doi: http://doi.org/10.1097/bpo.0000000000001768
- Andersen, J. R., Willis, M. P., Nelson, R., Mighell, M. A. (2011). Precontoured Superior Locked Plating of Distal Clavicle Fractures: A New Strategy. Clinical Orthopaedics & Related Research, 469 (12), 3344–3350. doi: http://doi.org/10.1007/s11999-011-2009-5
- Hohmann, E., Hansen, T., Tetsworth, K. (2012). Treatment of Neer type II fractures of the lateral clavicle using distal radius locking plates combined with TightRope augmentation of the coraco-clavicular ligaments. Archives of Orthopaedic and Trauma Surgery, 132 (10), 1415–1421. doi: http://doi.org/10.1007/s00402-012-1570-z
- Liu, Q., Miao, J., Lin, B., Lian, K. (2012). Surgical Treatment for Unstable Distal Clavicle Fracture with Micromovable and Anatomical Acromioclavicular Plate. International Journal of Medical Sciences, 9 (4), 301–305. doi: http://doi.org/10.7150/ijms.4425
- Shin, S.-J., Roh, K. J., Kim, J. O., Sohn, H.-S. (2009). Treatment of unstable distal clavicle fractures using two suture anchors and suture tension bands. Injury, 40 (12), 1308–1312. doi: http://doi.org/10.1016/j.injury.2009.03.013
- Soliman, O., Koptan, W., Zarad, A. (2013). Under-coracoid-around-clavicle (UCAC) loop in type II distal clavicle fractures. The Bone & Joint Journal, 95-B (7), 983–987. doi: http://doi.org/10.1302/0301-620x.95b7.31316
- Rieser, G. R., Edwards, K., Gould, G. C., Markert, R. J., Goswami, T., Rubino, L. J. (2013). Distal-third clavicle fracture fixation: a biomechanical evaluation of fixation. Journal of Shoulder and Elbow Surgery, 22 (6), 848–855. doi: http://doi.org/10.1016/j.jse.2012.08.022
- Venjakob, A. J., Salzmann, G. M., Gabel, F., Buchmann, S., Walz, L., Spang, J. T. et. al. (2013). Arthroscopically Assisted 2-Bundle Anatomic Reduction of Acute Acromioclavicular Joint Separations. The American Journal of Sports Medicine, 41 (3), 615–621. doi: http://doi.org/10.1177/0363546512473438
- Constant, C. R., G. Murley, A. H. (1987). A Clinical Method of Functional Assessment of the Shoulder. Clinical Orthopaedics and Related Research, 214, 160–164. doi: http://doi.org/10.1097/00003086-198701000-00023
- Stegeman, S. A., Nacak, H., Huvenaars, K. H., Stijnen, T., Krijnen, P., Schipper, I. B. (2013). Surgical treatment of Neer type-II fractures of the distal clavicle. Acta Orthopaedica, 84 (2), 184–190. doi: http://doi.org/10.3109/17453674.2013.786637
- Wang, S.-J., Wong, C.-S. (2008). Extra-Articular Knowles Pin Fixation for Unstable Distal Clavicle Fractures. Journal of Trauma: Injury, Infection & Critical Care, 64 (6), 1522–1527. doi: http://doi.org/10.1097/ta.0b013e3180593646
- Klein, S. M., Badman, B. L., Keating, C. J., Devinney, D. S., Frankle, M. A., Mighell, M. A. (2010). Results of surgical treatment for unstable distal clavicular fractures. Journal of Shoulder and Elbow Surgery, 19 (7), 1049–1055. doi: http://doi.org/10.1016/j.jse.2009.11.056
- Sajid, S., Fawdington, R., Sinha, M. (2012). Locking plates for displaced fractures of the lateral end of clavicle: Potential pitfalls. International Journal of Shoulder Surgery, 6 (4), 126. doi: http://doi.org/10.4103/0973-6042.106226
- Bhatia, D., Page, R. (2012). Surgical treatment of lateral clavicle fractures associated with complete coracoclavicular ligament disruption: Clinico-radiological outcomes of acromioclavicular joint sparing and spanning implants. International Journal of Shoulder Surgery, 6 (4), 116. doi: http://doi.org/10.4103/0973-6042.106224
- Zhang, F., Fu, Q., Li, Y., Lu, N., Chen, A., Zhao, L. (2021). Locking plate combined with titanium cable for Neer type II distal clavicle fractures. BMC Musculoskeletal Disorders, 22 (1). doi: http://doi.org/10.1186/s12891-021-04137-4
- Schliemann, B., Roßlenbroich, S. B., Schneider, K. N., Petersen, W., Raschke, M. J., Weimann, A. (2013). Surgical treatment of vertically unstable lateral clavicle fractures (Neer 2b) with locked plate fixation and coracoclavicular ligament reconstruction. Archives of Orthopaedic and Trauma Surgery, 133 (7), 935–939. doi: http://doi.org/10.1007/s00402-013-1737-2
- Neviaser, R. J. (1987). Injuries to the Clavicle and Acromioclavicular Joint. Orthopedic Clinics of North America, 18 (3), 433–438. doi: http://doi.org/10.1016/s0030-5898(20)30373-4
- Madsen, W., Yaseen, Z., LaFrance, R., Chen, T., Awad, H., Maloney, M., Voloshin, I. (2013). Addition of a Suture Anchor for Coracoclavicular Fixation to a Superior Locking Plate Improves Stability of Type IIB Distal Clavicle Fractures. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 29 (6), 998–1004. doi: http://doi.org/10.1016/j.arthro.2013.02.024
- Salazar, B. P., Chen, M. J., Bishop, J. A., Gardner, M. J. (2020). Outcomes after locking plate fixation of distal clavicle fractures with and without coracoclavicular ligament augmentation. European Journal of Orthopaedic Surgery & Traumatology, 31 (3), 473–479. doi: http://doi.org/10.1007/s00590-020-02797-x
- Dey Hazra, R.-O., Blach, R. M., Ellwein, A., Lill, H., Warnhoff, M., Jensen, G. (2021). Additional coracoclavicular augmentation reduces revision rates in the treatment of lateral clavicle fractures as compared to angle-stable plate osteosynthesis alone. Archives of Orthopaedic and Trauma Surgery. doi: http://doi.org/10.1007/s00402-021-03893-1
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