Journal List > Arch Hand Microsurg > v.22(4) > 1106601

Choi, Song, Kim, Kim, and Byun: Comparison of Locking Compression Plate Superior Anterior Clavicle Plate with Suture Augmentation and Hook Plate for Treatment of Distal Clavicle Fractures



The purpose of this study was to compare the results (or effectiveness) of anterior superior locking compression plate (LCP) with suture augmentation and hook plate in treatment of Neer type II distal clavicle fracture.


From April 2009 to October 2015, 34 patients with distal clavicle fracture of Neer type II were surgically treated. Eleven patients were operated with LCP-suture augmentation (group I) and 23 patients underwent by hook plate (group II). Radiographic evaluation and functional evaluation using Korean Shoulder Society (KSS) scoring system were performed.


Radiographic unions were achieved in all cases and mean radiographic union period was not different either as 4.1 months (range 3-14 months), 5.0 months (range 3-14 months) in group I and 3.7 months (range 3-11 months) in group II. However, KSS score was 87.6 (range 82-92) in group I, and was 63.4 (range 32-86) in group II (p<0.05). One case of osteolysis and no case of frozen shoulder were found in group I while 6 cases of osteolysis and 3 cases of frozen shoulder were found in group II.


LCP-suture augmentation is considered a more effective method, compared to hook plate osteosynthesis for distal clavicle fracture of Neer type II, producing better clinical outcomes and lower incidence of complications.

Figures and Tables

Fig. 1

(A) Intraoperative photograph of the left shoulder of a 38-year-old male shows left distal clavicle fracture. After the exposure of fracture fragment, displacement of major fragment is observed. (B) An additional mersilene tape is applied to fix plate and bony fragments with reduction. (C) Reduction is identified by intraoperative C-arm intensifier (D) The fracture is reducted and fixated with a plate, screw and additional 2 mersilene tapes and an Ethibond binding.

Fig. 2

(A) Preoperative radiograph of the left shoulder of a 38-year-old male shows left distal clavicle fracture. (B) This is postoperative radiograph with locking compression plate superior clavicle plate. (C) At 3 months follow-up, bony union is achieved.

Fig. 3

(A) Postoperative radiograph of the left shoulder of a 35-year-old male shows right distal clavicle fracture. (B) At 6 months follow-up, the radiograph shows osteolysis of acromion by the Hook plate. (C) At 8 months follow-up, Hook plate was removed.

Table 1

Demographic data


Values are presented as median (range) or number only.

Group I: operated with locking compression plate-suture augmentation, Group II: underwent by hook plate.

*By Pearson chi-square test. Classification of Craig.9.

Table 2

Comparison of clinical outcome between two group


Values are presented as median (range).

Group I: operated with LCP-suture augmentation, Group II: underwent by hook plate, KSS: Korean Shoulder Society.

*By independent t-test.

Table 3

Summary of complication


Group I: operated with LCP-suture augmentation, Group II: underwent by hook plate, KSS: Korean Shoulder Society.

*Classification of Craig9.


CONFLICTS OF INTEREST The authors have nothing to disclose.


1. Heppenstall RB. Fractures and dislocations of the distal clavicle. Orthop Clin North Am. 1975; 6:477–486.
2. Deafenbaugh MK, Dugdale TW, Staeheli JW, Nielsen R. Nonoperative treatment of Neer type II distal clavicle fractures: a prospective study. Contemp Orthop. 1990; 20:405–413.
3. Kang CH, Jung JH, Ye HU, Cho CH. Associated factors of nonunion following conservative management of distal clavicle fractures. J Korean Orthop Assoc. 2015; 50:137–142.
4. Neer CS 2nd. Fractures of the distal third of the clavicle. Clin Orthop Relat Res. 1968; 58:43–50.
5. Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2004; 86:1359–1365.
6. NEER CS 2nd. Nonunion of the clavicle. J Am Med Assoc. 1960; 172:1006–1011.
7. 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.
8. Edwards DJ, Kavanagh TG, Flannery MC. Fractures of the distal clavicle: a case for fixation. Injury. 1992; 23:44–46.
9. Craig EV. Fracture of the clavicle. In : Rockwood CA, Green DP, Bucholz RW, Heckman JD, editors. Rockwood and Green's fractures in adults. 4th ed. Philadelphia: Lippincott-Raven;1996. p. 1109–1161.
10. Habernek H, Weinstabl R, Schmid L, Fialka C. A crook plate for treatment of acromioclavicular joint separation: indication, technique, and results after one year. J Trauma. 1993; 35:893–901.
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.
12. 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.
13. 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.
14. 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.
15. Robinson CM, Cairns DA. Primary nonoperative treatment of displaced lateral fractures of the clavicle. J Bone Joint Surg Am. 2004; 86-A:778–782.
16. 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.
17. Ahn SH, Yoon HJ, Kim KY, Kim HC, Kim IY. Treatment of distal clavicle fracture using hook plate. J Korean Fract Soc. 2011; 24:48–54.
18. Lee CW, Kim HC, Roh JY, Park YS. 3.5 mm T-shaped LCP (Locking Compression Plate) fixation for unstable distal clavicular fractures. J Korean Shoulder Elbow Surg. 2008; 11:41–45.
19. Kim KY, Kim JY, Lee WB, Jung MG, Yoo JH, Kim JH. Periprosthetic fracture after hook plate fixation in neer type II distal clavicle fracture: a report of 3 cases. J Korean Fract Soc. 2016; 29:55–60.
20. Salem KH, Schmelz A. Treatment of tossy III acromioclavicular joint injuries using hook plates and ligament suture. J Orthop Trauma. 2009; 23:565–569.
21. Charity RM, Haidar SG, Ghosh S, Tillu AB. Fixation failure of the clavicular hook plate: a report of three cases. J Orthop Surg (Hong Kong). 2006; 14:333–335.
22. Eskola A, Vainionpää S, Pätiälä H, Rokkanen P. Outcome of operative treatment in fresh lateral clavicular fracture. Ann Chir Gynaecol. 1987; 76:167–169.
23. Tae SK, Rhee YG, Park TS, et al. The development and validation of an appraisal method for rotator cuff disorders: the Korean Shoulder Scoring System. J Shoulder Elbow Surg. 2009; 18:689–696.
24. Yamaguchi H, Arakawa H, Kobayashi M. Results of the bosworth method for unstable fractures of the distal clavicle. Int Orthop. 1998; 22:366–368.
25. 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.
26. Chae SB, Choi CH, Kim DY. Usefulness of the additional K-wire fixation and suture for reinforce the treatment of distal clavicle fracture using modified tension band wiring. J Korean Fract Soc. 2016; 29:107–113.
27. Rüedi TP, Buckley RE, Morgan CG. AO principles of fracture management. 2nd ed. New York: Thieme;2007. p. 249–255.
28. Wang J, Chidambaram R, Mok D. Is removal of clavicle plate after fracture union necessary? Int J Shoulder Surg. 2011; 5:85–89.
29. Jeon HS, Woo YK, Hwang SH, Suh SP, Kang SG, Lee JK. Analysis of treatment results of unstable distal clavicle fractures using hook plate. J Korean Orthop Assoc. 2014; 49:374–380.
30. Renger RJ, Roukema GR, Reurings JC, Raams PM, Font J, Verleisdonk EJ. The clavicle hook plate for Neer type II lateral clavicle fractures. J Orthop Trauma. 2009; 23:570–574.
31. Meda PV, Machani B, Sinopidis C, Braithwaite I, Brownson P, Frostick SP. Clavicular hook plate for lateral end fractures: a prospective study. Injury. 2006; 37:277–283.
32. Arciero RA. Operative techniques for displaced distal clavicle fractures. Oper Tech Sports Med. 2004; 12:27–31.
Similar articles