Biomechanical analysis of clavicle hook plate implantation with different hook angles in the acromioclavicular joint

Hung, Li-Kun; Su, Kuo‐Chih; Lu, Wen-Hsien; Lee, Cheng-Hung

doi:10.1007/s00264-016-3384-z

Cited by 44 publications

(44 citation statements)

References 16 publications

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“…Hung et al also used FEA to investigate the impacts of different hook angles. They found that a larger hook angle of implant exerted a larger load on the acromion because the larger hook angle made the contact position between the hook plate and acromion more proximal [24]. This theory seemed to contradict the phenomenon we encountered.…”

Section: Type Selection Of Clavicular Hook Platementioning

confidence: 62%

Persistent pain of distal clavicle fractures with a large lateral angle acromion treated with a clavicle hook plate: Report on 9 cases

Wu¹,

Xu²,

Xu³

et al. 2019

Preprint

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Background: The clavicular hook plate was a popular surgical treatment for distal clavicle fractures. The relationship among characteristics of the hook plate, acromioclavicular joint morphology and clinical outcome has remained poorly understood. We reviewed the clinical records of patients who had distal clavicle fractures with large lateral angle of acromion treated using a clavicle hook plate and evaluated the feasibility of this technique.Methods: Between 2010 and 2017, 9 patients (4 male and 5 female; mean age, 43 years) who had distal clavicle fractures with a large lateral angle of acromion were treated by clavicle hook plate at our institute. Follow-up ranged from 18 to 28 months (mean, 23 months). We examined clinical characteristics, MRI findings, treatments, and outcomes.Results: All patients complained of implant-related symptoms postoperatively. Clinical subacromial impingement was observed in all of them. Two patients had relief after removing the device. The symptoms in the remaining seven patients did not subside after removal of plate. Rotator cuff lesions were found in these cases, five of whom received rotator cuff repair and achieved remission of their symptoms.Conclusion: Distal clavicle–acromion coronal angle is an important factor for postoperative efficacy of the hook plate. The selection of a hook plate that makes the contact position between the hook and acromion more proximal may be helpful. Early limited mobility and removal of the implant may improve the prognosis and reduce the rate of impingement and rotator cuff lesions.Study Design: Restropective Review, Level of evidence, 4.

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Section: Type Selection Of Clavicular Hook Platementioning

confidence: 62%

Persistent pain of distal clavicle fractures with a large lateral angle acromion treated with a clavicle hook plate: Report on 9 cases

Wu¹,

Xu²,

Xu³

et al. 2019

Preprint

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“…Subacromial osteolysis and rotator cuff injury caused by the hook are serious complications caused by clavicle hook plates, and there are many reports of these complications [1][2][3][4][5][6][7][8][9][10][11]. An inappropriate hook depth and incongruency between the hook and undersurface of the acromion have been reported as causes of subacromial osteolysis [20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Reduction of subacromial osteolysis by bending the hook arthroscopically in clavicle hook plate fixation for distal clavicle fractures

Okazaki¹,

Shiba²,

Takeuchi³

et al. 2020

Preprint

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Background: Subacromial osteolysis is a serious complication caused by clavicle hook plates. Incongruency between the hook and undersurface of the acromion has been reported as a cause of subacromial osteolysis. The aim of this study was to retrospectively examine the effectiveness of hook bending in reducing subacromial osteolysis. Methods: Twenty-two patients with unstable distal clavicle fractures were treated with clavicle hook plates. There were 19 males and 3 females, with a mean age of 55.0 years. They were followed for a mean period of 9.5 months. The patients were divided into two groups; there were 10 patients whose hook was bent (the bending group) and 12 patients whose hook was not bent (the nonbending group). In the bending group, the hook was bent using a dedicated bender such that the hook and the undersurface of the acromion were parallel, and the direction of the hook was confirmed arthroscopically. At plate removal, arthroscopy was performed in both groups to observe the subacromial bony defect and the rotator cuff injury. Results: One patient in the nonbending group had a fibrous union, but bone union was achieved in all other patients. In the bending group, the angle at which the hook was inclined downward with respect to the distal portion of the plate (hook inclination angle) was 9.3 ± 6.1˚ (range, 2-23˚). The subacromial bony defects were significantly smaller in the bending group (1.7 ± 2.4 mm) than in the nonbending group (4.7 ± 2.3 mm) (P<0.05). Partial-thickness rotator cuff tears localized around the hook were observed arthroscopically in 6 patients in the bending group (60%) and in 7 patients in the nonbending group (58%). Conclusions: When the hook was bent such that it was parallel to the undersurface of the acromion, the degree of subacromial osteolysis was reduced.

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“…Virtual implantation analysis for measuring the loading force on the acromion and clavicle has been conducted. Hung et al [11]. Demonstrated that a larger hook angle produces more force on the acromion.…”

Section: Discussionmentioning

confidence: 99%

Posterior Positioning of a Clavicle Hook Plate Is a Risk Factor for Acromial Fractures after Acromioclavicular Joint Dislocation

Tamiya¹,

Umemoto²,

Y³

et al. 2019

OJO

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Purpose: Acromioclavicular (AC) joint dislocation is commonly treated using a clavicle hook plate (HP). However, previous reports have indicated that acromial fractures may occur after HP fixation. The purpose of this study was to identify risk factors for acromial fractures. Methods: A retrospective study was conducted on 39 patients with AC joint dislocation who were treated using clavicle HP fixation in our hospital between 2006 and 2017. Related parameters, including Rockwood classification, hook angle, the degree of reduction, the coverage of the hook under the acromion, and the anteroposterior position of the hook under the acromion, were evaluated to identify risk factors for acromial fractures. Results: The mean age of the participants was 51.7 (range 19-81) years; 34 were men and 5 were women. Injury occurred on the right side in 18 patients and on the left side in 21. Injuries were categorized as follows: 24 were Rockwood type III, one was type IV, and 14 were type V. Four of the 39 patients (10%) experienced acromial fractures. Statistical analyses indicated that the degree of reduction at the final follow-up was moderately correlated with the Constant score. Posterior positioning of the hook was the only identified risk factor for acromial fractures. Hook angle and the degree of reduction at the time of surgery were not significantly associated with acromial fractures. Conclusions: Postoperative shoulder function was associated with the degree of reduction at the final follow-up, suggesting that anatomical reduction is recommended for AC joint dislocation. Posterior positioning of the hook is a risk factor for acromial fractures; however, clavicle HP fixation provides a positive outcome for AC joint dislocation. Therefore, careful positioning of the hook is required for preventing acromial fractures.

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Biomechanical analysis of clavicle hook plate implantation with different hook angles in the acromioclavicular joint

Abstract: A clavicle hook plate with different hook angles may induce different biomechanical behaviors in the clavicle and acromion. Orthopedic surgeons must select a suitable clavicle hook plate based on the anatomical structure of each patient.

Cited by 44 publications

References 16 publications

Persistent pain of distal clavicle fractures with a large lateral angle acromion treated with a clavicle hook plate: Report on 9 cases

Persistent pain of distal clavicle fractures with a large lateral angle acromion treated with a clavicle hook plate: Report on 9 cases

Reduction of subacromial osteolysis by bending the hook arthroscopically in clavicle hook plate fixation for distal clavicle fractures

Posterior Positioning of a Clavicle Hook Plate Is a Risk Factor for Acromial Fractures after Acromioclavicular Joint Dislocation

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