Hook plate fixation of acute displaced lateral clavicle fractures: mid-term results and a brief literature overview

Abstract

BackgroundThe clavicle hook plate achieves like most other operative techniques, a high percentage of union and a low percentage of complications however concerns about long term complications still exist, particularly the involvement of the acromioclavicular joint.MethodsTo evaluate the results and long term effects in use of this plate we performed a retrospective analysis with a mean follow up of 65 months (5.4 years) of 28 consecutive patients with acute displaced lateral clavicle fractures, treated with the clavicle hook plate.ResultsShort term functional results in all patients were good to excellent. All but one patient had a united fracture (96%). Nine patients (32%) developed impingement symptoms and in 7 patients (25%) subacromial osteolysis was found. These findings resolved after plate removal. Twenty-four patients were re-evaluated at a mean follow-up period of 5.4 years. The Constant-Murley score was 97 and the DASH score was 3.5. Four patients (14%) developed acromioclavicular joint arthrosis of which one was symptomatic. Three patients (11%) had extra articular ossifications of which one was symptomatic. There was no relation between the impingement symptoms, subacromial osteolysis and development of acromioclavicular joint arthrosis or extra articular ossifications.ConclusionsThe clavicle hook plate is a good primary treatment option for the acute displaced lateral clavicle fracture with few complications. At mid term the results are excellent and no long term complications can be addressed to the use of the plate.

Comparison of the efficacy of a distal clavicular locking plate versus a clavicular hook plate in the treatment of unstable distal clavicle fractures and a systematic literature review

“…Complications reported with this design have also been relatively frequent, including implant failure and metaphyseal fracture, impingement, rotator cuff tears or even hook migration and acromial fracture as the implant penetrates the subacromial space and require plate removal. It is therefore important to exercise caution when using hook plate [6][7][8][9][10][11][12][13]. In a recent study, Tan et al [26] reported 74 % of patients in the hook plate group had mild to severe shoulder pain.…”

“…Since not all studies reported the functional outcome scores of the distal clavicle fractures and they used different functional evaluation instruments, it was difficult to analyse and compare the function between the different treatment modalities. Consequently, we reviewed and compared the functional outcome scores evaluated by Constant score between the hook plate group (nine studies) [6,7,[9][10][11][12][13]31, present study] and the locking plate group (eight studies) [14][15][16][17][18][19][20]30, present study] in distal clavicle fractures. The mean Constant scores were 91.9 and 93.6 in the hook plate and locking plate groups, respectively.…”

“…Today, there is a wide variety of surgical techniques for the treatment for these fractures. If surgery of distal clavicle fractures is indicated, many implants or surgical methods are available, including Kirschner wires [3], coracoclavicular screw fixation [4,5], hook plate fixation [6][7][8][9][10][11][12][13], or locking plate fixation [14][15][16][17][18][19][20]. Although there are many types of operative procedures, no procedures are considered to be the gold standard treatment.…”

Treatment of unstable distal third clavicular fracture with locked distal radius plate

“…However, later reports showed increased incidence of complications such as subacromial impingement, rotator cuff ruptures, acromion fractures, acromial osteolysis and pain. 10 The technique presented in this study provides rigid fixation of the distal clavicle fracture itself and does not limit the Fig. 1 e a) Preoperative X-ray.…”

“…Several authors 1,7,8 reported high rates of nonunion or delayed union (67e75%) in Neer type II distal clavicle fractures with conservative treatment. Many surgical methods have been introduced for distal clavicle fractures, including, transacromial Knowles pins, 9 hook-plate fixation, 5,10 and coracoclavicular stabilization with suture loops, 11 or screws. 12 Techniques using internal fixation that includes rigid coracoclavicular or acromioclavicular fixation have the disadvantage of interfering with the normal rotational movement of the clavicle in relation to the coracoid and acromion.…”