Comparison of Locking Plate Osteosynthesis versus Coracoclavicular Stabilization for Neer Type IIB Lateral Clavicle Fractures

Abstract

Background The best option for the treatment of Neer type IIB lateral clavicle fractures remains controversial. The aim of this study was to compare outcomes and complications between pre-contoured locking plate osteosynthesis (PLPO) and coracoclavicular stabilization (CCS) using a TightRope for the treatment of type IIB fractures. Methods Forty-six consecutive type IIB fractures were treated with PLPO (17 cases) or CCS (29 cases). The mean follow-up period was 33.7 months (range, 12–144 months). Radiographic outcomes were evaluated using serial plain radiographs. Clinical outcomes were evaluated using the University of California, Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV). Results Of the 46 cases, complete bony union within 6 months after surgery was achieved in 42 cases (91.3%). The union rate was 100% (17/17) in the PLPO group and 86.2% (25/29) in the CCS group, showing a statistically significant difference ( p = 0.043). No significant differences in terms of UCLA score (32.8 vs. 32.1), ASES score (93.2 vs. 90.8), or SSV (89.1% vs. 90.3%) were observed between the PLPO and CCS groups. The complication rates were 17.6% (3/17; 2 cases of screw breakage and 1 case of stiffness) in the PLPO group and 37.9% (11/29; 4 cases of nonunion, 3 cases of stiffness, 2 cases of skin irritation, 1 case of superficial infection, and 1 case of coracoid button migration) in the CCS group, showing no statistically significant difference ( p > 0.05). Four cases with nonunion after CCS did not require reoperation because they had good to excellent clinical outcomes without radiographic progression. Conclusions Although a higher nonunion rate was observed in the CCS group compared with the PLPO group, satisfactory clinical outcomes were obtained for both groups. Both techniques can be regarded as useful options for the treatment of Neer type IIB lateral clavicle fractures.

Hook plate fixation of Neer type II distal clavicle fractures results in satisfactory patient-reported outcomes but complications and revisions are high

“…In the systematic reviews performed by Panagopoulos et al and Uittenbogaard et al, the authors summarize that the surgical treatment of Neer type II fractures has a high complication rate in general, but the use of hook plates leads to poorer clinical outcomes compared to other modes of xation [1,2]. In the present study, a mean SSV of 91.0 was achieved, which is comparable to the literature [22][23][24], and does not fully agree with the poor results of Uittenbogaard and Panagopoulos [1][2]. Interestingly, the mean CS of 80.9 is below of what is described in the literature for locking plate xation, AC Joint trans xation, tension band wiring and hook plate xation as well [2].…”

Hook plate fixation of Neer type II distal clavicle fractures results in satisfactory patient-reported outcomes but complications and revisions are high

“…In the systematic reviews performed by Panagopoulos et al and Uittenbogaard et al, the authors summarize that the surgical treatment of Neer type II fractures has a high complication rate in general, but the use of hook plates leads to poorer clinical outcomes compared to other modes of fixation [ 1 , 2 ]. In the present study, a mean SSV of 91.0 was achieved, which is comparable to the literature [ 22 – 24 ], and does not fully agree with the poor results of Uittenbogaard and Panagopoulos [ 1 , 2 ]. Interestingly, the mean CS of 80.9 is below of what is described in the literature for locking plate fixation, AC Joint transfixation, tension band wiring and hook plate fixation as well [ 2 ].…”

Comments on the Article “Comparison of Locking Plate Osteosynthesis versus Coracoclavicular Stabilization for Neer Type IIB Lateral Clavicle Fractures”: To the Editor

“…We read with interest the recent article, “Comparison of locking plate osteosynthesis versus coracoclavicular stabilization for Neer Type IIB lateral clavicle fractures,” by Kim et al 1) They compared outcomes and complications between pre-contoured locking plate osteosynthesis and coracoclavicular stabilization using a TightRope for the treatment of type IIB fractures. We really appreciate the work done by the authors.…”

“…The authors in this study obtained satisfactory radiologic and clinical outcomes with an acceptable complication rate after TightRope fixation for Neer type IIB fractures. 1) Unlike the firm fixation of locking plate osteosynthesis, the TightRope device provides flexible coracoclavicular stabilization. The clavicular button frequently tends to migrate through the clavicle and may cause loss of reduction and bone fragment displacement.…”