Complications of Hook-Plate Fixation for Distal Clavicle Fractures

Su-Han An; Hyung-Chun Kim; Kwang-Yeol Kim; Ji-Hoon Lee; Seung-Hyun Yoon

doi:10.12671/jkfs.2012.25.1.38

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An, Kim, Kim, Lee, and Yoon: Complications of Hook-Plate Fixation for Distal Clavicle Fractures

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2012; 25(1): 38-45.

Published online: 31 January 2012

DOI: https://doi.org/10.12671/jkfs.2012.25.1.38

Complications of Hook-Plate Fixation for Distal Clavicle Fractures

Su-Han An, M.D., Hyung-Chun Kim, M.D., Kwang-Yeol Kim, M.D., Ji-Hoon Lee, M.D., Seung-Hyun Yoon, M.D.

Department of Orthopedic Surgery, Wallace Memorial Baptist Hospital, Busan, Korea.

Address reprint requests to: Hyung-Chun Kim, M.D. Department of Orthopedic Surgery, Wallace Memorial Baptist Hospital, 374-75, Namsan-dong, Heumjung-gu, Busan 609-728, Korea. Tel: 82-51-580-1422, Fax: 82-51-583-2568, dizziku@naver.com

Received 13 December 2011 Accepted 16 December 2011

Abstract

Purpose

To report on the complications of hook-plate fixation for distal clavicle fractures.

Materials and Methods

Eighteen patients who underwent surgery for distal clavicle fracture with a hook-plate from April 2008 to April 2011 were enrolled with a minimum of 4 months follow-up. The reduction was qualified and evaluated according to the radiologic findings. We analyzed the results by UCLA score, Kona's functional evaluation, and VAS pain score.

Results

By radiologic evaluation, 17 of 18 cases showed anatomical reduction and solid unions. Although satisfactory results were found in the clinical study as shown by the UCLA score, Kona's functional evaluation, and VAS pain score, complications arose in 7 cases, including osteolysis of the acromion in 2 cases, nonunion in 1 case, periprosthetic fracture in 2 cases, subacromial pain in 1 case, and skin irritation in 1 case. 2 cases of all required reoperation.

Conclusion

To reduce the complications of the hook-plate, a precise surgical technique and the choice of an appropriate size for the hook-plate are needed. We suggest that early removal of the plate is necessary to decrease the risk of subacromial impingement and erosion in hook-plate fixation.

Keywords: Clavicle, Distal clavicle fracture, Hook plate, Complication

Figures and Tables

Fig. 1

Radiograhs of 52-year-old male.

(A) Postoperative radiograph of the right shoulder shows Neer type II distal clavicle fracture.

(B) At 2 months follow-up, the radiograph shows osteo-lysis of acromion by the Hook plate.

(C) At 4 month follow-up, Hook plate was removed.

Fig. 2

The hook of Hook plate can be bent to fit the clavicle anatomy. Bending is required to fit the curve of the acromoclavicular joint, that maximized the area of contact surface with hook of the Hook plate.

Fig. 3

Radiographs of 45-year-old female.

(A) Preoperative radiograph shows left distal clavicle fracture.

(B) Postoperative radiograph. The fracture was reduced and fixed with Hook plate. But the locking screw was being fracture site.

(C) At. POD 7 months follow-up, the radiographs shows proximal screw loosening & plate migration, but seen no bony union.

(D) At POD 10 months Hook plate was removed, internal fixation and bone graft was done.

(E) At POD 14 month follow-up, the union of fracture was deteched, eventually.

Fig. 4

Radiographs of 62-year-old female.

(A) Preoperative radiograph of the left shoulder shows neer type II distal clavicle fracture.

(B) Postoperative radiograph. Satisfactory reduction and Hook plate fixation were seen.

(C) At POD 4 weeks follow-up, postoperative radiograph shows clavicle shaft fracture.

(D) At 6 months follow-up, bony union was achieved without any complications.

Table 1

Summary of complications

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