Journal List > J Korean Fract Soc > v.26(1) > 1037914

Kwon, Lee, Moon, Shin, and Woo: Coracoclavicular Screw Fixation and Tension Band Wiring in Treatment of Distal Clavicle Fracture



The purpose of this study was to analyze the effectiveness of coracoclavicular screw fixation with tension band wiring in the treatment of displaced distal clavicle fractures.

Materials and Methods

From October 2006 to December 2010, 18 patients with Neer type 2 displaced distal clavicle fracture were surgically treated. Fixation was performed, using coracoclavicular screw with tension band wiring. Radiographic and clinical evaluation was performed and the University of California at Los Angeles (UCLA) shoulder rating scale was employed for the assessment of shoulder joint function.


Osseous union was achieved approximately 9.5 weeks (8-11 weeks) in all patients. After the union, the screw and wire were removed under local anesthesia. All patients returned to the normal shoulder range of motion. Loosening of the screw was seen in two patients and breakage was seen in one patient. However, we could not observe the delayed union and complications, such as infection and refracture. All but one patient showed excellent results according to the UCLA shoulder score at one year after the operation.


Coracoclavicular screw fixation with tension band wiring in the treatment of displaced distal clavicle fractures is a clinically useful technique with good result and less complication.

Figures and Tables

Fig. 1
(A) After two K-wire inserted to the coracoid process, drill hole was made between them.
(B) Coracoclavicular screw is fixed with a tension band wiring.
(C) Superior view: We use interosseous augmentation sutures through drill holes in the distal clavicle tip and coracuclavicular screw head. The use of wire sutures separately in a figure-eight pattern.
Fig. 2
(A) Initial radiograph showed a left type II fracture of the distal clavicle and significant displacement of the fracture.
(B) This radiograph showed that the fracture was reduced anatomically immediately after surgery.
(C) Radiograph 2 months after surgery showing that the fracture line was not clear and the alignment was well maintained.
(D) Radiograph showed that the fracture was united 6 months after surgery and after the implant had been removed.
Fig. 3
(A) Initial radiograph showed a right type II fracture of the distal clavicle and significant displacement of the fracture.
(B) This radiograph showed that the fracture was reduced anatomically immediately after surgery.
(C) Radiograph 6 weeks after surgery showing the breakage of screw, which caused minimal displacement at the fracture site.
(D) Radiograph showed that the fracture was united 11 weeks after surgery and after the implant had been removed in spite of the broken screw.
Fig. 4
Tension band was tied in a figure-eight manner, keeping the knot superiorly. The figure-eight wire loop acts as a tension band. Tension band converts tensile force into compression force at the opposite cortex.
Table 1
Patient Demographic Data

UCLA: University of California at Los Angeles, ROM: Range of motion, Fl: Flexion, Ex: Extension, Abd: Abduction, Add: Adduction, IR: Internal rotation, ER: External rotation, F: Female, M: Male.


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