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

Abstract

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.

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

“…In response to these complications, newer arthroscopic techniques have been described that incorporate lowerprofile hardware and CC stabilization in an attempt to treat these fractures with less overall morbidity. 23,[35][36][37] There are several advantages to these techniques when compared with plating. The main advantage is that they can be used in most DCF patterns, including fractures with small or comminuted lateral fragments.…”

Stand-alone coracoclavicular suture repair achieves very good results in unstable distal clavicle fractures at a minimum follow-up of 1 year

“…3,5 In addition, up to 29% of patients report local irritation by prominent implants, or suture material sometimes also requiring secondary surgerydeven with arthroscopic techniques. 17,20 It appears that a solid, reproducible fixation method for this fracture entity has not yet been found. This article presents a new surgical technique using a combined coracoclavicular and, for Neer type V fractures, interfragmentary stand-alone cow-hitch suture repair of acute distal clavicle fractures with coracoclavicular instability.…”

A Modified Single-Endobutton Technique Combined with Nice Knot for Treatment of Rockwood Type III Acromioclavicular Joint Dislocation

“…Clavicle hook plate provides mechanical stability in the longitudinal and horizontal directions. However, there is a high incidence of complications, including postoperative shoulder pain, limited shoulder movement, foreign body sensation, rotator cuff injury, acromion impingement syndrome, osteolysis of the acromion, distal clavicle fracture and plate fracture [29][30][31][32][33][34]. In addition, the patient will need to remove the internal xation device a second time.…”