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

Kenyon, Peter; Morgan, Barnes; Webb, Mark; Ebreo, Darren; Wheelton, Andrew; Ravenscroft, Matt

doi:10.1177/1758573214536535

Cited by 5 publications

(2 citation statements)

References 24 publications

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“…Li et al used titanium cable in a minimally invasive technique 10 . Kenyon et al used an orthocord suture and two flip tacks to reconstruct the coracoclavicular ligaments via a minimally invasive approach 11 . Both groups reported favorable outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…For hook plate, which used to be widely accepted as a proper implant hardware for dislocation of acromioclavicular joint and distal clavicle fracture, may bring some annoying complications, such as rotator cuff injury, acromioclavicular joint osteoarthritis, acromial fracture and hook cutout, and clavicle fracture at the medial end of the plate, which usually required a secondary surgery to remove the implanted hardware within a short period or even a secondary revision operation [4][5][6][7][8][9] . While titanium alloy cable or orthocord suture might cure most of the fractures, they could leave some deformities and complications due to not anatomically reducing the fracture and the long-term cutting effect of the materials 10,11 . For distal clavicular plate alone, patients might face the potential risks of the screw detachment and plate back-out, which can lead to loss of reduction, malunion or non-union, etc., which can eventually result in the failure of the treatment.…”

Section: Introductionmentioning

confidence: 99%

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Precontoured Locking Compression Plate with Titanium Alloy Cable System: In Treatment of Neer Type IIb Distal Clavicle Fracture

Xie

Song

Zhou³

et al. 2021

Orthopaedic Surgery

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Objective To describe a new method which involves anatomical distal clavicle plate fixation and titanium alloy cable system‐augmented coracoclavicular ligament reconstruction to manage Neer type IIb distal clavicle fracture. Methods Between January 2013 and June 2018, 28 patients with acute Neer type IIb lateral clavicle fracture were treated by a new method – precontoured locking compressive distal clavicular plate fixation of the fracture combined with titanium alloy cable system‐augmented reconstruction of the coracoclavicular ligament. There were 11 females and 17 males treated in this way. There were 15 cases of the right side and 13 of the left. The mean age of the patients was 48.5 years (range, 18–78 years). The mean time from injury to surgery was 3.9 days (range, 1–7 days). After completing the preoperative examinations and evaluations, surgeries were performed for all these patients, anatomical distal clavicle plates were used for fractures, and titanium alloy cables were implanted for the augmented reconstruction of coracoclavicular ligaments. Postoperative protocols, including arm sling management and rehabilitative activities, were unified and recommended to all the patients. These patients were followed up for at least 1 year. The mean duration of postoperative follow‐up was 23.3 months (range, 12–52 months). At the last follow‐up, the coracoclavicular distances were recorded and shoulder functional outcomes were assessed by the Constant scores and the Fudan University Shoulder Scores (FUSSs) questionnaires. Results Radiographic bony unions were achieved in all patients within 20 weeks. Functional and radiographic outcomes were retrospectively evaluated. The mean coracoclavicular distance was 9.61 ± 0.61 mm on the injured side vs 9.62 ± 0.57 mm on the contralateral uninjured side. The mean Constant score and mean FUSS were 90.1 ± 6.6 (range, 68–98) and 86.1 ± 7.2 (range, 64–95) respectively, which indicating good restoration of function and high level of satisfaction for both the patients and their physical therapists. There were a few major complications, including one delayed healing of the skin, one severe shoulder stiffness, three incidences of moderate shoulder stiffness, and five incidences of symptomatic hardware. There is no deep infections, neurovascular injuried, delayed union or nonunion, peri‐implant fracture, loss of reduction, implant malposition or failure, or other severe complications. Conclusion This combined method for the treatment of Neer type IIb distal clavicle fracture could yield high bony union rate, good functional outcome, and low complication rate. Further prospective randomized controlled studies are needed to confirm the benefits of this method of treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Precontoured Locking Compression Plate with Titanium Alloy Cable System: In Treatment of Neer Type IIb Distal Clavicle Fracture

Xie

Song

Zhou³

et al. 2021

Orthopaedic Surgery

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Tendon graft through the coracoid tunnel versus under the coracoid for coracoclavicular/acromioclavicular reconstruction shows no difference in radiographic or patient-reported outcomes

Ranne,

Kainonen,

Kanto

et al. 2024

Arch Orthop Trauma Surg

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Introduction The purpose of this prospective study was to report the outcomes of two different methods in CC and AC reconstruction for the treatment of AC separation using a tendon graft and knot-hiding titanium clavicular implant. Materials and methods Twenty-seven patients with Rockwood grade III and V acromioclavicular (AC) separations were randomized into two groups. The primary outcome was whether taking the tendon graft through the coracoid risked a fracture. The following were secondary outcomes: follow-up of clavicular wound healing and Nottingham Clavicle score, Constant score, and Simple Shoulder Test results obtained preoperatively and 24 months postoperatively. The anteroposterior radiographic change between the clavicular and coracoid cortexes and the clavicular tunnel diameter was measured postoperatively and 24 months postoperatively. General patient satisfaction with the outcome (poor, fair, good, or excellent) was assessed 2 years postoperatively. Results No coracoid fractures were detected. No issues in clavicular wound healing were detected. The mean Nottingham Clavicle score increased from a preoperative mean of 42.42 ± 13.42 to 95.31 ± 14.20 (P < 0.00). The Constant score increased from a preoperative mean of 50.81 ± 17.77 to 96.42 ± 11.51 (P < 0.001). The Simple Shoulder Test score increased from a preoperative mean of 7.50 ± 2.45 to 11.77 ± 1.18 (P < 0.001). The changes were significant. The coracoclavicular distance increased from 11.88 ± 4.00 to 14.19 ± 4.71 mm (P = 0.001), which was significant. The clavicular drill hole diameter increased from 5.5 to a mean of 8.00 ± 0.75 mm. General patient satisfaction was excellent. Conclusions There were no significant differences between the two groups. There were no implant related complications in the clavicular wound healing. The results support the notion that good results are achieved by reconstructing both the CC and AC ligaments with a tendon graft. Study registration This clinical trial was registered on Clinicaltrials.gov.

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Outcome following management of unstable lateral end clavicle fractures with locking plate and coracoid anchor augmentation

et al. 2021

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Background Management of complex lateral end clavicle fractures with coraco-clavicular ligament disruption can be challenging. Methods We prospectively analysed 19 (17 M:2F) patients from January 2014 to June 2016. Six patients had intra-articular fractures (Edinburgh-3B2) and the remaining were extra-articular (3B1). All patients had open reduction internal fixation with lateral end locking plate augmented with a coracoid anchor. All patients were evaluated at the final follow-up by American Shoulder and Elbow Surgeon score (ASES), Disabilities of the Arm, Shoulder and Hand (DASH), Oxford Shoulder Score (OSS), return to work, sports and radiographs. Results At a mean follow-up of 54 months (range 37–64), 19 patients were available for analysis. Mean age of patients was 34 years (range 24–65). At final follow-up DASH score was 1.66 (range 0–5); ASES score was 98.14 (93.3–100) and OSS was 46.6 (42–48). There was no difference in the functional outcome between 3B1 and 3B2 fractures (DASH – p(0.51); ASES – p(0.44); OSS – p(0.69)). All patients returned to preinjury level of function, sports and work. Five patients needed implant removal and three developed capsulitis that resolved with conservative treatment. Conclusion Locking plate fixation, augmented with coracoid anchor is an effective option in the management of these complex injuries. The need for implant removal is reduced (26%) and there is no difference in the functional outcome between 3B1 and 3B2 fractures.

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

Abstract: The MINAR is reproducible and safe when treating lateral end of clavicle fractures. We consider that, over the short- to mid-term, it achieves results equivalent to those for other implants.

Cited by 5 publications

References 24 publications

Precontoured Locking Compression Plate with Titanium Alloy Cable System: In Treatment of Neer Type IIb Distal Clavicle Fracture

Precontoured Locking Compression Plate with Titanium Alloy Cable System: In Treatment of Neer Type IIb Distal Clavicle Fracture

Tendon graft through the coracoid tunnel versus under the coracoid for coracoclavicular/acromioclavicular reconstruction shows no difference in radiographic or patient-reported outcomes

Outcome following management of unstable lateral end clavicle fractures with locking plate and coracoid anchor augmentation

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