» Anterior glenohumeral instability is a complex problem that requires careful attention to osseous and soft-tissue lesions in order to treat it effectively.» The arthroscopic soft-tissue Bankart repair is considered first-line treatment for patients with anterior glenohumeral instability. However, recent long-term outcome studies have shown surprisingly high failure rates, specifically in the setting of anterior glenoid bone loss.» The definition of “critical” glenoid bone loss that cannot be overcome by a soft-tissue procedure alone continues to evolve and may in fact be lower than the previously published total of 20%.» Arthroscopic reconstruction of the anterior glenoid margin can be performed with either autograft or allograft. The arthroscopic Latarjet procedure has emerged as a reliable and effective technique for autograft augmentation, while the distal aspect of the tibia appears to be a promising source of allograft.

We hope to expand the use of this versatile flap to extranasal locations. It can produce the equivalent excellent functional and esthetic results compared with its more common nasal application.

Objectives: To assess both clinical and radiological long-term outcomes after hook plate osteosynthesis for Neer type II lateral clavicle fractures. Design: Retrospective case series. Setting: Level-1 trauma center. Patients/Participants: Patients who underwent open reduction internal fixation with a hook plate for displaced fractures of the lateral third of the clavicle (Neer type II) at a single trauma hospital were identified. Intervention: Lateral clavicle open reduction internal fixation with a hook plate. Main Outcome Measures: At the first of 2 long-term follow-up appointments, bilateral magnetic resonance imaging (MRI) scans and strength measurements were performed, Constant-Murley score, subjective shoulder value (SSV), and Oxford shoulder score (OSS) of both shoulders were obtained. At the second follow-up, specific acromioclavicular (AC) score, SSV, and OSS were obtained.Results: Twenty-one patients (mean age, 29.5 6 9.7 years) could be included who were available for at least 1 of 2 follow-ups after 7.4 years (62.3) and 13.9 years (62.2). Bony union was achieved in all patients (100%) at an average of 3.4 months (61.4). The hook plate was removed at an average of 5.5 months (63.3) after initial surgery in all patients. No significant side-to-side differences were found in OSS, Constant-Murley score, SSV, and specific AC score and for strength testing and MRI scans.Conclusions: Long-term outcome after hook plate fixation of Neer type II lateral clavicle fractures demonstrated good clinical results and shoulder strength without higher radiographic rates of AC joint osteoarthritis, subacromial impingement, or rotator cuff lesions. That may be related to a standardized early plate removal after bony fracture union.

Long-term results indicate that the combined use of synthetic graft in Impaction Bone grafting is an effective substitute.