Surgical treatment of Neer type-II fractures of the distal clavicle

Abstract

Background and purpose Type-II distal clavicle fractures according to the Neer classification are generally operated because of the high non-union rate after non-operative treatment. Several surgical techniques have been developed in order to reduce the non-union rate and improve functional outcome. This meta-analysis overviews the available surgical techniques for type-II distal clavicular fractures.Methods We searched the literature systematically. No comparative studies were found. 21 studies (8 prospective and 13 retrospective cohort studies) were selected for the meta-analysis. Data were pooled for 5 surgical outcome measures: function, time to union, time to implant removal, major complications, and minor complications.Results The 21 studies selected included 350 patients with a distal clavicular fracture. Union was achieved in 98% of the patients. Functional outcome was similar between the treatment modalities. Hook-plate fixation was associated with an 11-fold increased risk of major complications compared to intramedullary fixation and a 24-fold increased risk compared to suture anchoring.Interpretation If surgical treatment of a distal clavicle fracture is considered, a fixation procedure with a low risk of complications and a high union rate such as plate fixation or intramedullary fixation should be used. The hook-plate fixation had an increased risk of implant-related complications.

The Interrater and Intrarater Agreement of a Modified Neer Classification System and Associated Treatment Choice for Lateral Clavicle Fractures

“…1,4 Conversely, modified Neer type II and V fractures are unstable and suggest operative treatment because of the high nonunion rate and poor functional outcomes after nonoperative treatment. 4,11,13 In the present study, the inter-and intrarater agreement of treatment choice was regarded as moderate (k = 0.465 and 0.555, respectively). Although experienced shoulder specialists showed substantial intrarater agreement of treatment choice (k = 0.705), the interrater agreement of treatment choice was not nearly as high (k = 0.434).…”

Open Reduction Internal Fixation of Distal Clavicle Fracture With Supplementary Button Coracoclavicular Fixation

“…thus limiting its natural micromotion. [4][5][6][7][8] Currently, there is no consensus regarding the most reliable surgical treatment for the treatment of these injuries.…”

“…1,[4][5][6] With modern operative techniques, the healing rates are improved; however, multiple surgical techniques exist (K-wire fixation, clavicular hook-plate fixation, modified tension-band fixation, Bosworth-type screw fixation), each associated with its own set of complications either as a result of the fixation itself or due to spanning the AC joint and Fig 2. (A) A pectoralis button is screwed onto the cannulated insertion device.…”

Kombinierte AC-Gelenk-Luxation und laterale Klavikulafraktur

“…der Therapie glenohumeraler Begleitpathologien [1]. Die Versorgung mit einer Hakenplatte hat aus unserer Sicht die Nachteile einer möglichen Schädigung der Rotatorenmanschette und der Notwendigkeit einer Implantatentfernung [13]. Für eine winkelstabile Plattenosteosynthese…”