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Purpose:The purpose of this study is to compare the clinical and radiological outcomes of two surgical treatments, transacromial pin fixation and hook plate fixation, for unstable distal clavicle fractures. Materials and Methods: Twenty four patients with Neer type II distal clavicle fractures who underwent surgery with transacromial pin fixation (Group I: 12 patients) and hook plate fixation (Group II: 12 patients) were included. Reduction and union were evaluated using plain radiographs. Functional evaluation was performed according to UCLA score and Constant-Murley score at last follow-up. Results: All 24 cases showed bone union. Complete union took an average of 10 weeks for group I and 11.7 weeks for group II. Average UCLA score was 33 (group I) and 32.8 (group II). Average Constant score was 88.5 (group I) and 88.8 (group II). No significant difference for each variable was observed between the two groups. Conclusion: For the surgical treatment of Neer type II distal clavicle fractures, transacromial pin fixation and hook plate fixation are both useful methods.

Pulmonary embolism is a serious complication, which is well known in patients undergoing total hip or total knee arthroplasty or lower extremity fracture surgery. But, there are few literatures concerning pulmonary embolism after upper extremity surgery. Pulmonary embolism after minor upper extremity fracture surgery is extremely rare. We report a case of 66-year-old female patient that developed pulmonary embolism after percutaneous cannulated screw fixation for a greater tubercle fracture of the proximal humerus with literature review. Deep vein thrombosis (DVT) and pulmonary embolism is a commonly recognized complication after lower extremity arthoplasty. It is rare after upper extremity surgery. The majority of reported cases of pulmonary embolism after upper extremity surgery have occurred in patients after shoulder arthroplasty, [1][2][3][4] shoulder arthroscopic surgery, 2,5-7) but their incidence rates are very low. Rarely, single cases of pulmonary embolism after open glenohumeral joint debridement, subacromial decompression of the shoulder, and surgical treatment of ulnar pseudoarthrosis have been reported. Pulmonary embolism after surgery for a proximal humerus fracture has been also reported, but these procedures involved hemiarthroplasty or open reduction-internal fixation. 1,2) Pulmonary embolism after minor upper extremity fracture surgery is extremely rare. We experienced a case of a 66-year-old female patient that developed pulmonary embolism after percutaneous cannulated screw fixation for a greater tubercle fracture of the right proximal humerus. However, little information is available in the literature concerning pulmonary embolism after upper extremity surgery. 2,4,8) Here, we report a case of pulmonary embolism after percutaneous cannulated screw fixation for a greater tubercle fracture of the proximal humerus with literature review. Case ReportA case of 66-year-old female without any explicit risk factor presented at our out-patient department after slip down during which her right shoulder struck the ground complaining of pain in right shoulder joint. She did not have any history of medical disease or a family history of DVT or pulmonary embolism. Her surgical history included kyphoplasty for an osteoporotic compression fracture of the T12 spine with an uneventful outcome 3 years previously. Physical examination showed no external wound but severe tenderness over the greater tubercle of right proximal humerus. She was unable to elevate the right arm actively to an overhead position, but motor, sensory and vascular examinations of upper extremity were normal. Right shoulder radiographs revealed no definite fracture line but coronal magnetic resonance imaging revealed a diffuse high signal change in the greater tubercle of the right proximal humerus on T2W image and a lower signal change on T1W image, suggesting non-displaced fracture of the greater tubercle of the proximal humerus. The arm was protected with c-type sling.One week later, the right shoulder pain had not resolved and a follo...

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