Outcome of arthroscopic treatment for displaced lateral clavicle fractures using a double button device

Abstract

Purpose The purpose of this study was to assess the clinical and radiological outcomes of an arthroscopically assisted fixation of type IIB fractures using a double button device. Methods Twenty‐one patients with a type IIB displaced fracture of the clavicle who received an arthroscopically assisted fixation using a double button device were enrolled from 2009 to 2011. Clinical assessment included the patient's demographics, cause of injury, delay before surgery, time for surgery, time before resuming work and sports, the Shoulder and Hand (QuickDASH) score, the Constant–Murley score and the visual pain analogue scale (VAS). Radiological examination consisted of anteroposterior and axillary radiographs. Results The median age of patients was 33 years (range 18–67). Mean follow‐up was 35 ± 8.9 months (range 24–51 months). The average delay before surgery was 3 days (range 1–7). At final follow‐up, the mean QuickDASH score, Constant score and VAS were respectively 3.2 ± 6 (range 0–25), 94.8 ± 9.9 (range 62–100) and 0.5 ± 1.2 (range 0–4). Seventeen (81 %) patients were able to resume work, including heavy manual labour, and to resume their sport activities as well. Postoperative complications included one transient adhesive capsulitis, a symptomatic acromioclavicular joint osteoarthritis and an implant failure with nonunion. Bony union was achieved in all other patients. Conclusion This study has demonstrated that the arthroscopic treatment using a double button device was effective at providing a satisfactory functional outcome, minimizing the risk of complications and presenting low implant failure and low nonunion rates in patients with Neer type IIB fractures of the distal clavicle. Such results lead us to consider this minimally invasive technique as a first‐choice treatment. Level of evidence IV.

Arthroscopic Stabilization for Displaced Lateral Clavicular Fractures: Can It Restore Anatomy?

“…Numerous complications in relation to arthroscopic fixation have been mentioned in the literature, including implant failure with nonunion, transient adhesive capsulitis, symptomatic AC joint arthritis, coracoid fracture, and clavicular erosion. 12,13,16,21) However, we did not encounter any of them except instability and over reduction. Even though Loriaut et al 13) and Motta et al 14) reported satisfactory radiologic outcomes after arthroscopic stabilization based on plane radiographs, malreduction/posterior angulation, an occult complication and its effect on clinical outcome has never been mentioned previously as it is not evident on routine Xrays.…”

“…12,13,16,21) However, we did not encounter any of them except instability and over reduction. Even though Loriaut et al 13) and Motta et al 14) reported satisfactory radiologic outcomes after arthroscopic stabilization based on plane radiographs, malreduction/posterior angulation, an occult complication and its effect on clinical outcome has never been mentioned previously as it is not evident on routine Xrays. Rieser et al, 22) in a biomechanical evaluation, showed that combination of a locking plate and tightrope was superior to either method alone as a result of greater construct strength and stiffness.…”

“…One patient had developed stiffness of the shoulder probably due to use of a rotator interval approach. Loriaut et al 13) recently reported satisfactory functional outcome in 21 patients with type 2B displaced fracture of the clavicle who received an arthroscopically assisted fixation using a double button device through a rotator interval approach. Although the importance of an arthroscopic approach was highlighted, all of them opened the rotator interval for preparing the coracoid base.…”

“…[7][8][9][10] Attention has recently shifted towards minimally invasive surgery and arthroscopic fixation of these unstable fractures. [11][12][13][14][15][16] Midterm results of arthroscopic flip button fixation showing favorable results in distal clavicle fractures have recently been published. 13,14) Arthroscopic fixation has many advantages; however, postoperative X-rays can be deceiving in that it cannot identify occult mal-reduction evident on 3-dimensional computed tomography (3D CT), which might affect the long term results of this novel technique.…”

“…[11][12][13][14][15][16] Midterm results of arthroscopic flip button fixation showing favorable results in distal clavicle fractures have recently been published. 13,14) Arthroscopic fixation has many advantages; however, postoperative X-rays can be deceiving in that it cannot identify occult mal-reduction evident on 3-dimensional computed tomography (3D CT), which might affect the long term results of this novel technique. The purpose of our study was to evaluate the accuracy of reduction based on postoperative CT images after arthroscopic stabilization using a tightrope system for unstable distal clavicle fracture.…”