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Abstract
Hook plate fixation is a treatment method for the displaced distal clavicle fracture with favorable results regarding bone union and shoulder function, however possible complications include impingement syndromes, subacrormial erosions, acromial fractures, and periprosthetic fractures. In this report, we observed 3 cases of periprosthetic fracture after hook plate fixation. All cases of periprosthetic fractures were initiated at the medial end screw holes. The causes of these periprosthetic fractures appeared to be the off centered fixation of medial end screws near the anterior or posterior cortex which were specific during operations with hook plates with more than 6 holes and the increased stress on the medial end screw by over-reduced or inferiorly reduced position of the distal end of the clavicle by the hook plate.
Figures and Tables
Fig. 1
(A) Neer type IIa distal clavicle fracture. (B) Open reduction and internal fixation with clavicular hook plate. (C) Medial end of the clavicular hook plate had migrated superiorly and medial end screw lost the fixation to inferior cortex (white arrow). (D) Axial cut of 2-dimensional computed tomography. The medial end fracture at the medial screw of the hook plate was observed (white arrow). (E) Open reduction and internal fixation with clavicular anatomical plate for newly onset fracture after removal of the hook plate.
Fig. 2
(A) Neer type IIa distal clavicle fracture. (B) Open reduction and internal fixation with clavicular hook plate. (C) Fracture at the medial screw of the hook plate was observed and medial end screw lost the fixation to inferior cortex (white arrow). (D) Axial cut of 2-dimensional computed tomography (CT) showed the fracture line communicating the medial two holes of the hook plate (2 white arrows). (E) Clinical photo corresponded to the CT findings (2 white arrows). (F) Open reduction and internal fixation with clavicular plate with cerclage wiring with No. 2 fiber wire between coracoid process and clavicular shaft.
Fig. 3
(A) Neer type IIb distal clavicle fracture. (B) Open reduction and internal fixation with clavicular hook plate. (C) Medial end of the plate had migrated superiorly (white arrow). (D) Axial cut of 2-dimensional computed tomography of the medial end fracture. The fracture started from inferior portion of medial end screw to the unused drill hole which was located anterolaterally to the medial end screw (2 white arrows). (E) Open reduction and internal fixation with clavicular anatomical plate and reconstruction plate as well as K-wires was performed for the revision surgery.
Fig. 4
(A) A 4-hole clavicular hook plate was applied and all holes were in appropriate position on the clavicle. (B) A 5-hole clavicular hook plate was applied and all holes were in appropriate position on the clavicle. (C, D) A 6-hole clavicular hook plate was applied and the most medial hole was slightly off centered and anteriorly positioned to the clavicle (C: from cranial to caudal view, D: from caudal to cranial view). (E, F) A 7-hole clavicular hook plate was applied and the most medial hole was definitely off centered and anteriorly positioned to the clavicle (E: from cranial to caudal view, F: from caudal to cranial view).
References
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