Posterior Positioning of a Clavicle Hook Plate Is a Risk Factor for Acromial Fractures after Acromioclavicular Joint Dislocation

Tamiya, Hironari; Umemoto, Shusaku; Y, Akimoto; Kyo, Takayuki; Gamo, Kazushige; Kuratsu, Shigeyuki

doi:10.4236/ojo.2019.94010

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…Kim et al 22 used 3DCT to analyze the changing position of the acromioclavicular joint and clavicle after hook plate surgery and reported that a mismatch between the center of rotation of the clavicle and the rotational axis of the hook plate resulted in stress at the undersurface of the acromion. Using plain radiography, Tamiya et al 23 showed that a posterior hook position exacerbated bone erosion and posed a risk of acromion fracture. Using CT, the present study investigated patients after CHP fixation and found that posterior hook placement tended to be associated with deep bone erosion and increased the likelihood of complications (see Figure , Supplemental Digital Contents 4A , http://links.lww.com/JOT/B617).…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Subacromial Bone Erosion and Hook Position of Clavicular Plate in Distal Clavicle Fractures

Shimpuku

Uchiyama

Imai

et al. 2022

Journal of Orthopaedic Trauma

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Section: Discussionmentioning

confidence: 99%

Relationship Between Subacromial Bone Erosion and Hook Position of Clavicular Plate in Distal Clavicle Fractures

Shimpuku

Uchiyama

Imai

et al. 2022

Journal of Orthopaedic Trauma

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“…Pressure is continuously applied to the undersurface of the acromion after the operation to suppress the upward dislocation of the distal end of the clavicle, and this pressure has been shown to cause subacromial osteolysis [2][3][4][6][7][8][9][10]. If the severity of subacromial osteolysis progresses significantly, a serious complication, acromial fracture, occurs [12][13][14]. There is a report recommending the locking plate because the complication rate of the clavicle hook plate is higher than that of the locking plate [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Reduction of subacromial osteolysis by bending the hook arthroscopically in clavicle hook plate fixation for distal clavicle fractures

Okazaki¹,

Shiba²,

Takeuchi³

et al. 2020

Preprint

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Background: Subacromial osteolysis is a serious complication caused by clavicle hook plates. Incongruency between the hook and undersurface of the acromion has been reported as a cause of subacromial osteolysis. The aim of this study was to retrospectively examine the effectiveness of hook bending in reducing subacromial osteolysis. Methods: Twenty-two patients with unstable distal clavicle fractures were treated with clavicle hook plates. There were 19 males and 3 females, with a mean age of 55.0 years. They were followed for a mean period of 9.5 months. The patients were divided into two groups; there were 10 patients whose hook was bent (the bending group) and 12 patients whose hook was not bent (the nonbending group). In the bending group, the hook was bent using a dedicated bender such that the hook and the undersurface of the acromion were parallel, and the direction of the hook was confirmed arthroscopically. At plate removal, arthroscopy was performed in both groups to observe the subacromial bony defect and the rotator cuff injury. Results: One patient in the nonbending group had a fibrous union, but bone union was achieved in all other patients. In the bending group, the angle at which the hook was inclined downward with respect to the distal portion of the plate (hook inclination angle) was 9.3 ± 6.1˚ (range, 2-23˚). The subacromial bony defects were significantly smaller in the bending group (1.7 ± 2.4 mm) than in the nonbending group (4.7 ± 2.3 mm) (P<0.05). Partial-thickness rotator cuff tears localized around the hook were observed arthroscopically in 6 patients in the bending group (60%) and in 7 patients in the nonbending group (58%). Conclusions: When the hook was bent such that it was parallel to the undersurface of the acromion, the degree of subacromial osteolysis was reduced.

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Fixing Cho Type IIC Distal Clavicle Fractures with Hook Plates Leads to a High Incidence of Subacromial Osteolysis: A Retrospective Study and Literature Review

Chen,

Lin

et al. 2024

Clin Orthop Surg

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Background This retrospective study investigates the complications, particularly subacromial osteolysis (SAO), associated with hook plate (HP) fixation, in the treatment of unstable distal clavicle fractures characterized by complete coracoclavicular (CC) ligament rupture. The decision-making process for employing HP in fractures of this nature, such as Neer types IIB and V and Cho classification IIC, involves considerations of distal fragment size and displacement. While HP offers advantages in clinical practice, it is not without complications, with SAO being a notable concern. Factors such as non-anatomic hook tip placement and fracture classification may influence the risk of SAO. Methods The study comprises a retrospective analysis of unstable distal clavicle fractures treated with HP at our institution from 2019 to 2022. Exclusions include non-displaced fractures, those treated with other locking plates, and pathologic fractures. A total of 91 patients with displaced distal clavicle fractures underwent open reduction and internal fixation with HP. Cho classification was employed to differentiate cases with CC ligament rupture. Patient demographics, classifications, postoperative radiographs, distal fragment size, plate position, timing of implant removal, and complications, including SAO, were recorded. Results Among the 91 patients, 32 were classified as Cho IIB, 43 as Cho IIC, and 16 as Cho IID. Ninety-one percent exhibited solid union before implant removal. The prevalence of SAO was 43.8%, 76.7%, and 62.5% in Cho IIB, IIC, and IID, respectively. Univariate analysis revealed a significant difference only in Cho classification ( p = 0.014). Binary logistic regression identified Cho classification type IIC as the sole risk factor for SAO ( p = 0.021; odds ratio, 4.48; 95% confidence interval, 1.56–12.87). Conclusions Cho type IIC fractures, characterized by CC ligament deficiency causing horizontal instability, demonstrated the highest SAO rate. In contrast, Neer type IIB fractures retained the trapezoid ligament, and Neer type V fractures had intact CC ligaments, resulting in lower SAO rates. Biomechanically, combining HPs with CC ligament reconstruction provided better structural stability than using HPs alone in treating Cho type IIC fractures.

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Posterior Positioning of a Clavicle Hook Plate Is a Risk Factor for Acromial Fractures after Acromioclavicular Joint Dislocation

Cited by 3 publications

References 15 publications

Relationship Between Subacromial Bone Erosion and Hook Position of Clavicular Plate in Distal Clavicle Fractures

Relationship Between Subacromial Bone Erosion and Hook Position of Clavicular Plate in Distal Clavicle Fractures

Reduction of subacromial osteolysis by bending the hook arthroscopically in clavicle hook plate fixation for distal clavicle fractures

Fixing Cho Type IIC Distal Clavicle Fractures with Hook Plates Leads to a High Incidence of Subacromial Osteolysis: A Retrospective Study and Literature Review

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