Treatment of unstable distal clavicle fractures using two suture anchors and suture tension bands

Shin, Sang Jin; Roh, Kwon Jae; Kim, Jong Oh; Sohn, Hoon Sang

doi:10.1016/j.injury.2009.03.013

Cited by 70 publications

(62 citation statements)

References 24 publications

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“…The rotational movement that occurs at the acromioclavicular joint is transferred to the fracture site, making the lateral end mobile, resulting in nonunion. Consequently, various surgical modalities have been advocated with various techniques of fixation with better outcomes [7][8][9][10][11][12][13][14][15][16][17][18]. Gaining control over such rotational movement with some sort of semi rigid to rigid fixation would prevent nonunion.…”

Section: Discussionmentioning

confidence: 99%

“…However, a few series of coracoclavicular screws [7][8][9], tension bands [10][11][12], Kirshner wires [1,13], hook plates [14,15] and contoured locked and non locked plates [16][17][18] have been published with encouraging results in all series. Feared complications of open reduction and internal fixation (ORIF) include fixation failure, pin migration, refracture, malunion and extensive tissue dissection during hardware removal [12,19]. Levy [20] described a minimally invasive suture fixation with good outcome, which obviates the need for implant removal.…”

Section: Introductionmentioning

confidence: 99%

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Modified tension band for displaced type 2 lateral end clavicle fractures

Rijal

Sagar

Joshi³

et al. 2012

International Orthopaedics (SICOT)

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Modified tension band for displaced type 2 lateral end clavicle fractures

Rijal

Sagar

Joshi³

et al. 2012

International Orthopaedics (SICOT)

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“…4,5 Although some nonunions may be asymptomatic, surgical treatment is recommended. 2,[6][7][8][9] Supplementation with cancellous bone grafting to provide stability and initiate osteogenesis is suggested. [10][11][12] Tension band wiring (TBW) and intramedullary Knowles pinning have high success rates in treating fresh type-2 distal clavicle fractures.…”

Section: Introductionmentioning

confidence: 99%

Tension Band Wiring versus Knowles Pinning for Non-Union of Type-2 Distal Clavicle Fractures

2012

J Orthop Surg (Hong Kong)

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purpose. To compare tension band wiring (TBW) with Knowles pinning for non-union of type-2 distal clavicle fractures. Methods. 22 men and 6 women aged 23 to 62 (mean, 39) years underwent TBW (n=17) or Knowles pinning (n=11) for non-union of type-2 distal clavicle fractures. Both techniques were supplemented with autogenic cancellous bone grafting. Functional outcome of the shoulder was evaluated using the Constant scoring system (maximum score, 100). Excellent (≥90) and good (≥80) scores were defined as satisfactory. results. Of the 28 patients, 25 were followed up for a mean of 2.6 (range, 1.1-4.2) years, whereas 3 were lost to follow-up. The median times to union were not significantly different between the TBW (n=15) and Knowles pinning (n=10) groups (4.0 vs. 4.3 months, p=0.94). Five non-unions treated with TBW had migration of the Kirschner wires, which was resolved by further restriction of shoulder motion. There were no other complications such as deep Tension band wiring versus Knowles pinning for non-union of type-2 distal clavicle fractures Chi-Chuan WuDepartment of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan Address correspondence and reprint requests to: Dr Chi-Chuan Wu, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Hsin St. 333, Kweishan, Taoyuan, Taiwan. E-mail: ccwu@mail.cgu.edu.tw Journal of Orthopaedic Surgery 2012;20(3):297-301 infection, non-unions, or malunions. All 25 patients achieved satisfactory full range of shoulder motion with minimal pain. conclusion. Both techniques achieved high rates of satisfactory outcome. TBW may result in Kirschner wire migration but is preferred for cases with a small distal fragment.

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“…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.…”

Section: Discussionmentioning

confidence: 68%

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

Khan

Yoo

Kim³

et al. 2016

Clinics in Shoulder and Elbow

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Background: The purpose of our study was to evaluate the accuracy of reduction based on postoperative computed tomography (CT) images after arthroscopic stabilization using tightrope system for unstable distal clavicle fracture. Methods: Twelve patients with distal clavicle fracture combined with coracoclavicular (CC) ligament injury (type II, V) who received arthroscopically assisted fixation using a flip button device were evaluated for accuracy of reduction using 3-dimensional postoperative CT scan by measuring the degree of distal clavicular angulation and clavicular shortening. Results: Immediate postoperative plain radiograph confirmed restoration of the CC distance (CCD) in 10 patients. At final follow-up, the CCD remained reduced anatomically on plain radiographs in these patients. All patients showed excessive posterior angulation and shortening compared to the opposite side. The average Constant score recovered to 94.8 at final follow-up. Conclusions: Indirect reduction and arthroscopic subacromial approach with flip button fixation of unstable distal clavicle fractures demonstrated favorable clinical results despite unavoidable posterior angulation of distal clavicle and shortening the total length of clavicle.

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Treatment of unstable distal clavicle fractures using two suture anchors and suture tension bands

Cited by 70 publications

References 24 publications

Modified tension band for displaced type 2 lateral end clavicle fractures

Modified tension band for displaced type 2 lateral end clavicle fractures

Tension Band Wiring versus Knowles Pinning for Non-Union of Type-2 Distal Clavicle Fractures

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

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