Modified tension band for displaced type 2 lateral end clavicle fractures

Abstract

Purpose Displaced type 2 lateral end clavicle fractures have a tendency to delayed union or non-union. Various methods of stabilisation of the displaced lateral end fractures are described. The increasing use of implants to fix such fractures also necessitates extensive dissection for implant retrieval. Adequate reduction and minimal tissue trauma during implant placement and removal would be ideal modalities for fixation of such fractures. Methods All displaced type 2 lateral end clavicle fractures fulfilling our inclusion criteria were reduced with a small anterosuperior incision. Anteroposterior drill holes were made in both the fragments and a nonabsorabable polyester suture was passed through. The fracture was reduced and fixed with transacromial smooth Kirshner wires. The suture was tied with the knot superiorly in a figure-eight manner. The arm was supported in an arm pouch for six weeks. The Kirshner wire was routinely removed after six weeks in an out-patient department. Clinico-radiological outcome was studied at six weeks, and monthly intervals thereafter until union. Results All 16 fractures united. The mean average age of patients was 36.25 years with a SD of 11.35. There was no loss of reduction even after removal of Kirshner wires at six weeks. The mean average time of union was 10.75 weeks with a SD of 3.92. All patients regained near normal range of motion, and the mean average constant score at the end of one year was 98.37 with a SD of 2.87. All patients returned to preinjury level by the one-year follow-up. The range of motion remained the same in those who were followed up in successive years. Skin impingement with bent Kirshner wires were noted in four cases. Kirshner wires backed out in one case before six weeks but there was no loss of reduction. Infection and Kirshner wire breakage were not noted in our series. Conclusion The clinico-radiological outcomes with our modified tension band fixation for displaced type 2 lateral end clavicle fractures were encouraging and comparable with earlier studies.

Anatomical Locking Plate with Additional K-wire Fixation for Distal Clavicle Fracture

“…Therefore, the K-wire needs to be removed before active mobilization. For maintaining the reduction after removal of K-wire, Rijal et al 14) suggested additional figure-eight tension band techniques.…”

“…Several authors therefore suggested modified combined techniques, such as tension band with transacromial K-wire, and CC ligament suture augmentation with locking plate, with satisfactory clinical results. [14][15][16] However, the optimal treatment for type II fracture is still controversial.…”

Locking plates for displaced fractures of the lateral end of clavicle: Potential pitfalls

“…[11] Though it was a relatively small cohort study, good outcome and minimal complications were reported for this technique, which requires minimal incision and dissection and provides stable fixation of the fracture. [11] Another method of fixation is open reduction and endobutton fixation.…”

“…[11] Though it was a relatively small cohort study, good outcome and minimal complications were reported for this technique, which requires minimal incision and dissection and provides stable fixation of the fracture. [11] Another method of fixation is open reduction and endobutton fixation. [12] This technique allows reduction and internal fixation of the fracture using sutures that pass through an endobutton placed in the clavicle and coracoid process and has shown good short and medium term outcomes.…”

Open reduction and fixation of displaced lateral clavicle fractures using the Minimally Invasive Acromioclavicular Joint Reconstruction (MINAR®) technique: a case series review

“…lateral end of clavicle modified tension banding techniques with transacromial Kirschner wires or suture anchors. 13,14 . hook plates, which are not only very reliable for union, but also can have complications, including rotator cuff tear, 15 impingement pain 16 and need for removal.…”