Arthroscopic Cortical Button Stabilization of Isolated Acute Neer Type II Fractures of the Distal Clavicle

Blake, Matthew H.; Lu, Michael T.; Shulman, Brandon S.; Glaser, David L.; Huffman, G. Russell

doi:10.3928/01477447-20170925-06

Cited by 22 publications

(27 citation statements)

References 21 publications

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“…The 15 included articles consisted of 8 retrospective cases series reporting on a single fixation technique, 7,13 –17,27,32 5 prospective case series that reported on a single fixation technique, 4,12,19,24,31 and 2 retrospective comparative studies. 9,34 All but 1 study 14 provided data on union rates and functional outcome scores, and this study was excluded when deriving a mean.…”

Section: Resultsmentioning

confidence: 99%

“…4,13,19 Most authors reported that union was achieved at the end of the follow-up period, while some described the date of earliest radiographic union. 4,9,12,13,24,31 Bony union was reported in 208 of the 221 (94.1%) fractures. Of the 13 reported nonunions, only 4 (30.8%) were symptomatic and required revision surgery.…”

Section: Resultsmentioning

confidence: 99%

“…In addition to the Constant score, 4 studies each utilized the University of California Los Angeles Shoulder Score, 7,14,31,32 and the SSV. 9,12,13,27 The visual analog scale for pain score, 13,14,34 the American Shoulder and Elbow Surgeons Subjective Shoulder Scale 4,14,17 and the DASH score 4,9,13 were used in 3 papers each. The Simple Shoulder Test was used in 2 papers, 19,34 and the Penn Shoulder Score 4 and the QuickDASH 17 were each used in 1 study.…”

Section: Resultsmentioning

confidence: 99%

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Outcomes of Arthroscopic Fixation of Unstable Distal Clavicle Fractures: A Systematic Review

Yagnik¹,

Seiler²,

Vargas³

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Surgical management of unstable distal clavicle fractures (DCFs) remains controversial. Traditional open techniques result in acceptable union rates but are fraught with complications. In response to these limitations, arthroscopic techniques have been developed; however, clinical outcome data are limited. Purpose: The primary purpose was to systematically evaluate the clinical and radiographic outcomes of arthroscopic fixation of unstable DCFs. The secondary purpose was to characterize the overall complication rate, focusing on major complications and subsequent reoperations. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included a search of the PubMed, Web of Science, Cochrane Register of Controlled Trials, EMBASE, and Scopus databases. English-language studies between 2008 and 2019 that reported on outcomes of patients with DCFs who underwent operative fixation using an arthroscopic or arthroscopically assisted surgical technique were included. Data consisted of patient characteristics, fracture type, surgical technique, concomitant injuries, union rates, functional outcomes, and complications. Results: A total of 15 studies consisting of 226 DCFs treated using an arthroscopically based technique were included in the systematic review. The majority of fractures were classified as Neer type II. Most (97%) of the fractures underwent arthroscopic fixation using a cortical button coracoclavicular stabilization surgical technique. Bony union was reported in 94.1% of the fractures. Good to excellent outcomes were recorded in most patients at the final follow-up. The Constant-Murley score was the most widely used functional outcome score; the pooled mean Constant score was 93.06 (95% CI, 91.48-94.64). Complications were reported in 14 of the 15 studies, and the overall complication rate was 27.4%. However, only 12% of these were considered major complications, and only 6% required a reoperation for hardware-related complications. Conclusion: Arthroscopic fixation of DCFs resulted in good functional outcomes with union rates comparable to those of traditional open techniques. While the overall complication profile was similar to that of other described techniques, there was a much lower incidence of major complications, including hardware-related complications and reoperations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Outcomes of Arthroscopic Fixation of Unstable Distal Clavicle Fractures: A Systematic Review

Yagnik¹,

Seiler²,

Vargas³

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…The authors did report 2 cases of asymptomatic nonunion and 1 fixation failure requiring revision with plate osteosynthesis. Most recently, Blake et al 5 performed arthroscopic cortical button fixation on 17 patients with Neer type II distal clavicle fractures using a TightRope device. Despite excellent functional outcomes, the authors did report a 17.5% nonunion rate and a hardware-related complication requiring implant removal.…”

Section: Discussionmentioning

confidence: 99%

Distal Clavicle Fracture Repair: Clinical Outcomes of a Surgical Technique Utilizing a Combination of Cortical Button Fixation and Coracoclavicular Ligament Reconstruction

Yagnik

Jordan

Narvel

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: When treated conservatively, unstable distal clavicle fractures demonstrate a high symptomatic nonunion rate. While a variety of surgical techniques have been described, many of these techniques are associated with high failure rates and hardware-related complications. The surgical technique used in this study has shown promising biomechanical results; however, long-term clinical results have not yet been described. Purpose: To assess the clinical and radiological outcomes of a surgical technique for fixing displaced distal clavicle fractures using a combination of cortical button fixation and coracoclavicular (CC) ligament reconstruction. Study Design: Case series; Level of evidence, 4. Methods: We conducted a retrospective review of 22 consecutive patients with displaced, unstable Neer type II or V distal clavicle fractures who underwent this surgical technique from 2012 to 2019. Primary outcome variables were radiographic union, patient satisfaction, and postoperative shoulder function. Preoperative and postoperative University of California, Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) scores were compared. Secondary outcome variables included intraoperative complications, postoperative complications, time to radiographic union, and preoperative and postoperative CC distance. Quality of life was assessed using preoperative and postoperative 36-Item Short Form Health Survey (SF-36) scores. Results: Nearly all (21/22) patients were available for a final review; 1 patient was lost to follow-up at 2 weeks. All 21 patients achieved radiographic union by 4 months (mean, 60.38 days; range, 41-84 days; 95% CI, 53.80-66.96 days). All patients were satisfied with the surgical procedure and their functional outcome. The mean UCLA score improved from 5.36 (95% CI, 4.14-6.60) preoperatively to 32.52 (95% CI, 30.56-34.48) postoperatively (mean difference, 27.14; P < .001). The mean ASES score improved from 16.23 (95% CI, 9.79-22.67) preoperatively to 88.11 (95% CI, 81.82-94.40) postoperatively (mean difference, 71.91; P < .001). Statistically significant improvements in SF-36 scores were seen in the physical functioning, role limitations due to physical health, pain, social functioning, and emotional well-being categories. There were 3 postoperative complications, including 1 patient with a minor complication secondary to hardware irritation, 1 patient with adhesive capsulitis, and 1 patient with wound dehiscence requiring wound closure. Conclusion: We describe a surgical technique for fixing displaced distal clavicle fractures using a combination of cortical button fixation and CC ligament reconstruction that resulted in a 100% union rate and excellent clinical outcomes with acceptable complications.

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“…Its biomechanical excellence has been proven by recent articles, and several actual clinical cases with favorable outcomes have also been reported 2345). Moreover, the indication for this technique is expanding because the technique can be used for not only the AC joint dislocation, but also acute distal clavicle fractures with CC ligament disruption 6). However, it is technically demanding, and the process of creating an anatomically accurate bone tunnel through the distal clavicle and small coracoid process can be difficult.…”

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confidence: 99%

Intraoperative and Postoperative Complications after Arthroscopic Coracoclavicular Stabilization

Lim

2019

Clin Orthop Surg

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Background Arthroscopic stabilization of torn coracoclavicular (CC) ligaments gained popularity recently. However, loss of reduction after the operation and complications unique to this technique involving tunnel placement through the distal clavicle and coracoid process are concerns. The purpose of this study was to report intraoperative and early postoperative complications associated with this procedure. Methods This study retrospectively evaluated 18 consecutive patients who had undergone arthroscopic stabilization for torn CC ligaments between 2014 and 2015. The indications for surgery were acute or chronic acromioclavicular dislocation and acute fracture of the distal clavicle, associated with CC ligament disruption. Clinical outcomes were evaluated with the American Shoulder and Elbow Surgeons (ASES) and the University of California, Los Angeles (UCLA) scores. Intra- and postoperative complications and reoperations were investigated. Results There were six female and 12 male patients with a mean age of 47 years (range, 22 to 86 years). At a mean follow-up of 17 ± 10 months (range, 10 to 28 months), the mean ASES score was 88.8 ± 19.9 and the mean UCLA score was 30.9 ± 5.2. Intraoperatively, seven complications developed: breach of lateral cortex of the coracoid process in five patients, medial cortex of the coracoid process in one, and anterior cortex of the clavicle in one. Postoperative complications developed in eight patients: four ossifications of the CC interspace, four tunnel widening of the clavicle, one bony erosion on the clavicle, and one superficial infection. A loss of reduction was found in six patients. Reoperation was performed in three patients for loss of reduction in two and superficial infection in the other. Conclusions Arthroscopic CC stabilization resulted in high rates of intraoperative and early postoperative complications. Most of them were related to the surgical technique involving bone tunnel placement in the coracoid process and the clavicle.

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Arthroscopic Cortical Button Stabilization of Isolated Acute Neer Type II Fractures of the Distal Clavicle

Cited by 22 publications

References 21 publications

Outcomes of Arthroscopic Fixation of Unstable Distal Clavicle Fractures: A Systematic Review

Outcomes of Arthroscopic Fixation of Unstable Distal Clavicle Fractures: A Systematic Review

Distal Clavicle Fracture Repair: Clinical Outcomes of a Surgical Technique Utilizing a Combination of Cortical Button Fixation and Coracoclavicular Ligament Reconstruction

Intraoperative and Postoperative Complications after Arthroscopic Coracoclavicular Stabilization

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