Journal List > J Korean Fract Soc > v.24(1) > 1037845

Ahn, Yoon, Kim, Kim, and Kim: Treatment of Distal Clavicle Fracture Using Hook Plate

Abstract

Purpose

To evaluate the result of distal clavicle fracture treated by Hook plate (LCP clavicle hook plate, Synthes®, Paoli, Switzerland).

Materials and Methods

10 patients with distal clavicle fracture treated by Hook plate from April 2008 to March 2010 were analyzed. The average follow-up period was 10 (range 4 to 26) months. The reduction was qualified and evaluated according to the immediate post-operative, final radiographs. We analyze the result by UCLA score and Kona's functional evaluation.

Results

By radiologic evaluation, all cases showed anatomical reduction and solid union. By Kona's functional evaluation, there are 7 cases with excellent results, 3 cases with good results. The UCLA score was average 33.3 (range 29 to 35) points followed by 6 excellent cases, 4 good cases. As complication, 1 case showed post-operative clavicle shaft fracture and 1 case showed acromial osteolysis on X-rays. We found no complications such as skin irritation, infection, loosening of screws, and plate failure.

Conclusion

The Hook plate fixation for distal clavicle fracture is considered effective method for satisfactory reduction and rigid fixation, a lower incidence of nonunion and excellent clinical result.

Figures and Tables

Fig. 1
(A) Preoperative radiograph of the left shoulder of a 55 year old male shows distal clavicle fracture.
(B) This is postoperative radiograph with Hook plate fixation.
(C) At 4 months follow-up, implant is removed without any complication. Bony union is achieved.
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Fig. 2
(A) Preoperative radiograph of the left shoulder of a 80 year old female shows distal clavicle fracture.
(B) This is postoperative radiograph with Hook plate fixation.
(C) At 1 months follow-up, radiograph shows clavicle shaft fracture.
(D) At 6 months follow-up, the union of fracture site was found.
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Fig. 3
(A) Preoperative radiograph of the left shoulder of a 49 year old male shows distal clavicle fracture.
(B) This is postoperative radiograph with Hook plate fixation.
(C) At 4 months follow-up, postoperative radiograph shows osteolysis of acromion by the hook of plate.
jkfs-24-48-g003
Table 1
Ucla end-result scores
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Table 2
Classification of functional result by Kona
jkfs-24-48-i002
Table 3
Summary of cases
jkfs-24-48-i003

References

1. Ballmer FT, Gerber C. Coracoclavicular screw fixation for unstable fractures of the distal clavicle. A report of five cases. J Bone Joint Surg Br. 1991. 73:291–294.
crossref
2. Chun JM, Kim SY, Lee KW, Shin SJ, Kim EG. Modified tenson band fixation for unstable fracture of the distal clavicle. J Korean Orthop Assoc. 2002. 37:416–420.
crossref
3. Craig EV. Rockwood CA, Green DP, Bucholz RW, Heckman JD, editors. Fracture of the clavicle. Fractures in adults. 1996. 4th ed. Philadelphia: Lippincott-Raven;1109–1161.
4. Edwards DJ, Kavanagh TG, Flannery MC. Fractures of the distal clavicle: a case for fixation. Injury. 1992. 23:44–46.
crossref
5. Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986. 68:1136–1144.
crossref
6. Sim E, Schwarz N, Hocker K, Berzlanovich A. Repair of Complete Acromioclavicular Separations Using the Acromioclavicular-Hook Plate. Clin Orthop Relat Res. 1995. 314:134–142.
crossref
7. Eskola A, Vainionpää S, Pätiälä H, Rokkanen P. Outcome of operative treatment in fresh lateral clavicular fracture. Ann Chir Gynaecol. 1987. 76:167–169.
8. Fann CY, Chiu FY, Chuang TY, Chen CM, Chen TH. Transacromial knowles pin in the treatment of Neer type 2 distal clavicle fractures. A prospective evaluation of 32 cases. J Trauma. 2004. 56:1102–1105.
9. Faraj AA, Ketzer B. The use of a hook-plate in the management of acromioclavicular injuries. Report of ten cases. Acta Orthop Belg. 2001. 67:448–451.
10. Flinkkilä T, Ristiniemi J, Hyvönen P, Hämäläinen M. Surgical treatment of unstable fractures of the distal clavicle: a comparative study of Kirschner wire and clavicular hook plate fixation. Acta Orthop Scand. 2002. 73:50–53.
crossref
11. Goldberg JA, Bruce WJ, Sonnabend DH, Walsh WR. Type 2 fractures of the distal clavicle: a new surgical technique. J Shoulder Elbow Surg. 1997. 6:380–382.
crossref
12. Herrmann S, Schmidmaier G, Greiner S. Stabilisation of vertical unstable distal clavicular fractures (Neer 2b) using locking T-plates and suture anchors. Injury. 2009. 40:236–239.
crossref
13. Hessmann M, Kirchner R, Baumgaertel F, Gehling H, Gotzen L. Treatment of unstable distal clavicular fractures with and without lesions of the acromioclavicular joint. Injury. 1996. 27:47–52.
crossref
14. Kang HJ, Park KK, Yoon HK, Song HK, Hahn SB. T plate fixation for unstable fracture of distal clavicle. J Korean Fract Soc. 2006. 19:329–334.
crossref
15. Kao FC, Chao EK, Chen CH, Yu SW, Chen CY, Yen CY. Treatment of distal clavicle fracture using Kirschner wires and tension-band wires. J Trauma. 2001. 51:522–525.
crossref
16. Kiefer H, Claes L, Burri C, Holzwarth J. The stabilizing effect of various implants on the torn acromioclavicular joint. A biomechanical study. Arch Orthop Trauma Surg. 1986. 106:42–46.
crossref
17. Kim JS, Jun JH, Chung YK. Coracoclavicular screw fixation for AC dislocation and unstable distal clavicle fracture. J Korean Shoulder Elbow Soc. 1999. 2:133–137.
18. Kona J, Bosse MJ, Staeheli JW, Rosseau RL. Type II distal clavicle fractures: a retrospective review of surgical treatment. J Orthop Trauma. 1990. 4:115–120.
19. Macdonald PB, Lapointe P. Acromioclavicular and sternoclavicular joint injuries. Orthop Clin North Am. 2008. 39:535–545.
crossref
20. Mall JW, Jacobi CA, Philipp AW, Peter FJ. Surgical treatment of fractures of the distal clavicle with polydioxanone suture tension band wiring: an alternative osteosynthesis. J Orthop Sci. 2002. 7:535–537.
crossref
21. Mizue F, Shirai Y, Ito H. Surgical treatment of comminuted fractures of the distal clavicle using Wolter clavicular plates. J Nihon Med Sch. 2000. 67:32–34.
crossref
22. Muramatsu K, Shigetomi M, Matsunaga T, Murata Y, Taguchi T. Use of the AO hook-plate for treatment of unstable fractures of the distal clavicle. Arch Orthop Trauma Surg. 2007. 127:191–194.
crossref
23. Neer CS 2nd. Nonunion of the clavicle. J Am Med Assoc. 1960. 172:1006–1011.
crossref
24. Neer CS 2nd. Fracture of the distal clavicle with detachment of the coracoclavicular ligaments in adults. J Trauma. 1963. 3:99–110.
crossref
25. Neer CS 2nd. Nonunion of the clavicle. J Am Med Assoc. 1960. 172:1006–1011.
crossref
26. Neviaser RJ. Injuries to the clavicle and acromioclavicular joint. Orthop Clin North Am. 1987. 18:433–438.
crossref
27. Nordqvist A, Petersson C, Redlund-Johnell I. The natural course of lateral clavicle fracture. 15 (11-21) year follow-up of 110 cases. Acta Orthop Scand. 1993. 64:87–91.
crossref
28. Park JH, Rha KW, Suh SW, Kim SK. Operative treatment of type II distal clavicle fractures. J Korean Soc Fract. 1998. 11:683–689.
crossref
29. Regel JP, Pospiech J, Aalders TA, Ruchholtz S. Intraspinal migration of a Kirschner wire 3 months after clavicular fracture fixation. Neurosurg Rev. 2002. 25:110–112.
crossref
30. Salem KH, Schmelz A. Treatment of Tossy III acromioclavicular joint injuries using hook plates and ligament suture. J Orthop Trauma. 2009. 23:565–569.
crossref
31. Tambe AD, Motkur P, Qamar A, Drew S, Turner SM. Fractures of the distal third of the clavicle treated by hook plating. Int Orthop. 2006. 30:7–10.
crossref
32. Wang SJ, Wong CS. Transacromial extra-articular Knowles pin fixation treatment of acute type V acromioclavicular joint injuries. J Trauma. 2008. 65:424–429.
crossref
33. Yamaguchi H, Arakawa H, Kobayashi M. Results of the Bosworth method for unstable fractures of the distal clavicle. Int Orthop. 1998. 22:366–368.
crossref
34. Yum JK, Lee SL, Ra HJ. Mini-T plate fixation for neer type II distal clavicle fracture. J Korean Shoulder Elbow Soc. 2009. 12:1–6.
crossref
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