The Surgical Outcome of Unstable Distal Clavicle Fractures Treated with 2.4 mm Volar Distal Radius Locking Plate

Suk Kyu Choo; Ji Ho Nam; Youngwoo Kim; Hyoung-Keun Oh

doi:10.12671/jkfs.2015.28.1.38

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Choo, Nam, Kim, and Oh: The Surgical Outcome of Unstable Distal Clavicle Fractures Treated with 2.4 mm Volar Distal Radius Locking Plate

Original Article

Journal of the Korean Fracture Society 2015; 28(1): 38-45.

Published online: 20 January 2015

DOI: https://doi.org/10.12671/jkfs.2015.28.1.38

The Surgical Outcome of Unstable Distal Clavicle Fractures Treated with 2.4 mm Volar Distal Radius Locking Plate

Suk Kyu Choo, M.D., Ji Ho Nam, M.D., Youngwoo Kim, M.D., Hyoung-Keun Oh, M.D.

Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.

Address reprint requests to: Hyoung-Keun Oh, M.D. Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang 411-706, Korea. Tel: 82-31-910-7968·Fax: 82-31-910-7967, osd11@paik.ac.kr

Received 15 September 2014 Revised 29 October 2014 Accepted 3 December 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study evaluated the surgical outcomes of unstable distal clavicular fractures treated with a 2.4 mm volar distal radius locking plate.

Materials and Methods

From August 2009 to August 2012, 16 patients with distal clavicle fractures underwent surgical treatment. Mean age was 36 years (18-62 years) and mean follow-up period was 12.9 months (6-32 months). Two cases were Neer type I, six cases IIa, three cases IIb, three cases III, and two cases V. For the radiologic assessment, union time and metal failure were evaluated, and coracoidiologic assessment, union time and metal failure were evaluatethe acromioclavicular joint. The clinical results were evaluated by range of motion, postoperative complication, and University of California at Los Angeles (UCLA) score.

Results

Mean time to fracture union was 7.4 weeks (6-14 weeks) in all cases. No statistical difference in coracoid-clavicle distance was observed between immediate post-operation group and contra-lateral group (p=0.6), but an increase of 2.1 mm was observed in the last follow up group compared with the contra-lateral group (p<0.01). The UCLA scoring system showed excellent results in 15 cases and good results in one case. Acromial-clavicle instability occurred in one case so that metal removal and distal clavicle resection were performed.

Conclusion

A 2.4 mm volar distal radius locking plate can provide rigid fixation through several screw fixation in the short distal fragment and lead to satisfactory clinical outcomes in unstable distal clavicular fractures.

Keywords: Clavicle, Distal clavicle fracture, 2.4 mm volar distal radius locking plate

Figures and Tables

Fig. 1

(A) Precontoured locking plate for distal clavicle (3.5 mm LCP superior clavicle plates; Synthes, Oberdorf, Switzerland). (B) A 2.4 mm volar distal locking plate (2.4 mm LCP Distal Radius System; Synthes) can provide variable options for screw position at the distal clavicle end compared to conventional precontoured locking plate for distal clavicle.

Fig. 2

(A) Original shape of 2.4 mm volar distal radius locking plate. (B) After neutralization of volar angle and making a curved shape from the straight distal end of 2.4 mm volar distal radius locking plate.

Fig. 3

(A) Preoperative clavicle anteroposterior view of a 41-year-old male shows a Neer V unstable distal clavicle fracture. (B) Intraoperative fluoroscopic image. Cerclage wires were used to stabilize the inferior fragment of the distal clavicle, which is the insertion site of the coraco-clavicular ligament. (C) Intraoperative fluoroscopic image. Short distal fragment could be stabilized by 2.4 volar locking plate for distal radius.

Fig. 4

(A) Preoperative clavicle anteroposterior (AP) view of a 46-year-old male shows a Neer V unstable distal clavicle fracture. (B) Immediate postoperative clavicle AP view of tension band wiring addition to plate fixation. (C) Postoperative four months clavicle AP and apical view shows solid union of the fracture site.

Fig. 5

Measurement of Coracoid-clavicle distance. Coracoidclavicle distance (C) was measured by two parallel lines at the inferior border of the distal clavicle (B) and superior margin of the coracoid process (A).

Fig. 6

(A) Preoperative radiograph of a 42-year-old male shows a Near V unstable distal clavicle fracture. (B) At postoperative 5 months, acromio-clavicle joint dislocation developed as a complication. (C) Removal of plate and distal clavicle resection was performed as a salvage operation.

Table 1

Summary of the Patients

UCLA score: University of California at Los Angeles score.

Notes

Financial support: None.

Conflict of interest: None.

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