Clavicular hook plate with coracoclavicular ligament augmentation by suture anchor in the treatment of unstable distal clavicle fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Shuang ¹ , CHEN Jialei ¹ , ZHANG Jie ² , Sujan Shakya ¹ , XING Fei ¹ ,  XIANG Zhou ¹

1. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. International Medical Center, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

XIANG Zhou, Email: xiangzhou15@hotmail.com

Keywords：

Distal clavicle fracture; coracoclavicular ligament; clavicular hook plate; suture anchor

DOI：

10.7507/1002-1892.202101094

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Objective To evaluate the effectiveness of a clavicular hook plate with coracoclavicular ligament augmentation by suture anchor in the treatment of Neer types Ⅱ and Ⅴ distal clavicle fractures.Methods Between January 2010 and June 2016, 16 patients with Neer types Ⅱ and Ⅴ distal clavicle fractures were treated with clavicle hook plates and coracoclavicular ligament augmentation by suture anchor. There were 12 males and 4 females with an average age of 45.6 years (range, 14-81 years). The injury mechanism included falling in 10 cases, traffic accident injury in 2 cases, falling from height in 2 cases, and heavy object injury in 2 cases. The Neer classification of clavicle fractures included 2 cases of type Ⅱa, 13 cases of type Ⅱb, and 1 case of type Ⅴ. The injury severity score (ISS) was 6-29, with an average of 11.2. The time from injury to operation was 1-18 days, with an average of 6.4 days. The operation time, intraoperative blood loss, hospitalization stay, fracture healing, and postoperative complications were recorded; the disability of arm, shoulder, and hand (DASH) score, the shoulder joint Constant score, and the Oxford shoulder score (OSS) were used to evaluate the shoulder joint at last follow-up.Results All operations were successfully completed. The operation time was 50-100 minutes, with an average of 75.6 minutes; intraoperative blood loss was 30-100 mL, with an average of 52.8 mL; hospitalization stay was 4-47 days, with an average of 13.7 days. All patients were followed up 1.2-7.5 years, with an average of 3.5 years. All clavicle fractures healed, and the healing time was 9.4-13.6 weeks, with an average of 11.9 weeks. No fracture nonunion, fracture displacement, failure of internal fixation, or incision infection, etc. occurred. Fifteen patients took out the hook plate after fracture healing and functional recovery, and 1 case refused to remove the hook plate from the second operation because of no obvious discomfort. At last follow-up, the DASH score was 0-13, with an average of 2.2; the shoulder joint Constant score was 90-100, with an average of 96.8; the OSS score was 12-14, with an average of 12.3.Conclusion Clavicular hook plate with coracoclavicular ligament augmentation by suture anchor can help achieve good effectiveness with less postoperative complication in the treatment of Neer types Ⅱ and Ⅴ distal clavicular fractures.

Citation： WU Shuang, CHEN Jialei, ZHANG Jie, Sujan Shakya, XING Fei, XIANG Zhou. Clavicular hook plate with coracoclavicular ligament augmentation by suture anchor in the treatment of unstable distal clavicle fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(8): 978-983. doi: 10.7507/1002-1892.202101094 Copy

1.	Kim DW, Kim DH, Kim BS, et al. Current concepts for classification and treatment of distal clavicle fractures. Clin Orthop Surg, 2020, 12(2): 135-144.
2.	Ochen Y, Frima H, Houwert RM, et al. Surgical treatment of Neer type Ⅱ and type Ⅴ lateral clavicular fractures: comparison of hook plate versus superior plate with lateral extension: a retrospective cohort study. Eur J Orthop Surg Traumatol, 2019, 29(5): 989-997.
3.	Frima H, van Heijl M, Michelitsch C, et al. Clavicle fractures in adults; current concepts. Eur J Trauma Emerg Surg, 2020, 46(3): 519-529.
4.	Moverley R, Little N, Gulihar A, et al. Current concepts in the management of clavicle fractures. J Clin Orthop Trauma, 2020, 11(Suppl 1): S25-S30.
5.	Wang HK, Liang LS, He RG, et al. Comparative analysis of locking plates versus hook plates in the treatment of Neer type Ⅱ distal clavicle fractures. J Int Med Res, 2020, 48(4): 300060520918060. doi: 10.1177/0300060520918060.
6.	Qiao R, Yang J, Zhang K, et al. To explore the reasonable selection of clavicular hook plate to reduce the occurrence of subacromial impingement syndrome after operation. J Orthop Surg Res, 2021, 16(1): 180. doi: 10.1186/s13018-021-02325-5.
7.	Xu H, Chen WJ, Zhi XC, et al. Comparison of the efficacy of a distal clavicular locking plate with and without a suture anchor in the treatment of Neer Ⅱb distal clavicle fractures. BMC Musculoskelet Disord, 2019, 20(1): 503. doi: 10.1186/s12891-019-2892-6.
8.	Nüchtern JV, Sellenschloh K, Bishop N, et al. Biomechanical evaluation of 3 stabilization methods on acromioclavicular joint dislocations. Am J Sports Med, 2013, 41(6): 1387-1394.
9.	Seo JB, Kim SJ, Ham HJ, et al. Comparison between hook plate fixation with and without coracoclavicular ligament suture for acute acromioclavicular joint dislocations. J Orthop Surg (Hong Kong), 2020, 28(1): 2309499020905058. doi: 10.1177/2309499020905058.
10.	Chang HM, Hong CK, Su WR, et al. Comparison of clavicular hook plate with and without coracoclavicular suture fixation for acute acromioclavicular joint dislocation. Acta Orthop Traumatol Turc, 2019, 53(6): 408-413.
11.	Yin J, Yin Z, Gong G, et al. Comparison of hook plate with versus without double-tunnel coracoclavicular ligament reconstruction for repair of acute acromioclavicular joint dislocations: A prospective randomized controlled clinical trial. Int J Surg, 2018, 54(Pt A): 18-23.
12.	Renger RJ, Roukema GR, Reurings JC, et al. The clavicle hook plate for Neer type Ⅱ lateral clavicle fractures. J Orthop Trauma, 2009, 23(8): 570-574.
13.	Ropars M, Thomazeau H, Huten D. Clavicle fractures. Orthop Traumatol Surg Res, 2017, 103(1S): S53-S59.
14.	Boonard M, Sumanont S, Arirachakaran A, et al. Fixation method for treatment of unstable distal clavicle fracture: systematic review and network meta-analysis. Eur J Orthop Surg Traumatol, 2018, 28(6): 1065-1078.
15.	Wang J, Guan J, Liu M, et al. Treatment of distal clavicle fracture of Neer type Ⅱ with locking plate in combination with titanium cable under the guide. Sci Rep, 2021, 11(1): 4949. doi: 10.1038/s41598-021-84601-2.
16.	Brouwer KM, Wright TC, Ring DC. Failure of superior locking clavicle plate by axial pull-out of the lateral screws: a report of four cases. J Shoulder Elbow Surg, 2009, 18(1): e22-25.
17.	Baunach D, Eid K, Ricks M, et al. Long-term clinical and radiological results after hook plate osteosynthesis of lateral clavicle fractures. J Orthop Trauma, 2020. doi: 10.1097/BOT.0000000000002007.
18.	Alaee F, Apostolakos J, Singh H, et al. Lateral clavicle fracture with coracoclavicular ligament injury: a biomechanical study of 4 different repair techniques. Knee Surg Sports Traumatol Arthrosc, 2017, 25(7): 2013-2019.
19.	Madsen W, Yaseen Z, LaFrance R, et al. Addition of a suture anchor for coracoclavicular fixation to a superior locking plate improves stability of type ⅡB distal clavicle fractures. Arthroscopy, 2013, 29(6): 998-1004.
20.	Choi S, Lee TJ, Kim MK, et al. Midterm results of coracoclavicular stabilization with double augmentation for acute acromioclavicular dislocation. Springerplus, 2016, 5(1): 1858. doi: 10.1186/s40064-016-3527-0.
21.	Mirbolook A, Sadat M, Golbakhsh M, et al. Distal clavicular fracture treatment with suture anchor method. Acta Orthop Traumatol Turc, 2016, 50(3): 298-302.
22.	Fan J, Zhang Y, Huang Q, et al. Comparison of treatment of acute unstable distal clavicle fractures using anatomical locking plates with versus without additional suture anchor fixation. Med Sci Monit, 2017, 23: 5455-5461.
23.	Lee W, Choi CH, Choi YR, et al. Clavicle hook plate fixation for distal-third clavicle fracture (Neer type Ⅱ): comparison of clinical and radiologic outcomes between Neer types ⅡA and ⅡB. J Shoulder Elbow Surg, 2017, 26(7): 1210-1215.
24.	Lopiz Y, Checa P, García-Fernández C, et al. Complications with the clavicle hook plate after fixation of Neer type Ⅱ clavicle fractures. Int Orthop, 2019, 43(7): 1701-1708.
25.	Deng Z, Cai L, Ping A, et al. Anatomical research on the subacromial interval following implantation of clavicle hook plates. Int J Sports Med, 2014, 35(10): 857-862.
26.	Lin HY, Wong PK, Ho WP, et al. Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion—dynamic sonographic evaluation. J Orthop Surg Res, 2014, 9: 6. doi: 10.1186/1749-799X-9-6.
27.	Liu CT, Yang TF. Hook plate with or without coracoclavicular ligament augmentation in the treatment of acute acromioclavicular separation. BMC Musculoskelet Disord, 2020, 21(1): 701. doi: 10.1186/s12891-020-03726-z.
28.	Zhang L, Xiao H, Gao Y, et al. Late function and complications of hook plate implantation for distal-third clavicle fractures: a retrospective study. Acta Orthop Belg, 2018, 84(4): 485-490.
29.	Wu K, Su X, Roche SJL, et al. Relationship between the lateral acromion angle and postoperative persistent pain of distal clavicle fracture treated with clavicle hook plate. J Orthop Surg Res, 2020, 15(1): 217. doi: 10.1186/s13018-020-01737-z.
30.	Shin SJ, Kim NK. Complications after arthroscopic coracoclavicular reconstruction using a single adjustable-loop-length suspensory fixation device in acute acromioclavicular joint dislocation. Arthroscopy, 2015, 31(5): 816-824.
31.	汤红伟, 殷勇, 韩擎天, 徐小平, 李云飞. 解剖锁定钢板内固定联合喙锁韧带重建治疗 Neer Ⅱb 型锁骨远端骨折的疗效研究. 中国修复重建外科杂志, 2018, 32(9): 1181-1186.
32.	Salazar BP, Chen MJ, Bishop JA, et al. Outcomes after locking plate fixation of distal clavicle fractures with and without coracoclavicular ligament augmentation. Eur J Orthop Surg Traumatol, 2021, 31(3): 473-479.

1. Kim DW, Kim DH, Kim BS, et al. Current concepts for classification and treatment of distal clavicle fractures. Clin Orthop Surg, 2020, 12(2): 135-144.
2. Ochen Y, Frima H, Houwert RM, et al. Surgical treatment of Neer type Ⅱ and type Ⅴ lateral clavicular fractures: comparison of hook plate versus superior plate with lateral extension: a retrospective cohort study. Eur J Orthop Surg Traumatol, 2019, 29(5): 989-997.
3. Frima H, van Heijl M, Michelitsch C, et al. Clavicle fractures in adults; current concepts. Eur J Trauma Emerg Surg, 2020, 46(3): 519-529.
4. Moverley R, Little N, Gulihar A, et al. Current concepts in the management of clavicle fractures. J Clin Orthop Trauma, 2020, 11(Suppl 1): S25-S30.
5. Wang HK, Liang LS, He RG, et al. Comparative analysis of locking plates versus hook plates in the treatment of Neer type Ⅱ distal clavicle fractures. J Int Med Res, 2020, 48(4): 300060520918060. doi: 10.1177/0300060520918060.
6. Qiao R, Yang J, Zhang K, et al. To explore the reasonable selection of clavicular hook plate to reduce the occurrence of subacromial impingement syndrome after operation. J Orthop Surg Res, 2021, 16(1): 180. doi: 10.1186/s13018-021-02325-5.
7. Xu H, Chen WJ, Zhi XC, et al. Comparison of the efficacy of a distal clavicular locking plate with and without a suture anchor in the treatment of Neer Ⅱb distal clavicle fractures. BMC Musculoskelet Disord, 2019, 20(1): 503. doi: 10.1186/s12891-019-2892-6.
8. Nüchtern JV, Sellenschloh K, Bishop N, et al. Biomechanical evaluation of 3 stabilization methods on acromioclavicular joint dislocations. Am J Sports Med, 2013, 41(6): 1387-1394.
9. Seo JB, Kim SJ, Ham HJ, et al. Comparison between hook plate fixation with and without coracoclavicular ligament suture for acute acromioclavicular joint dislocations. J Orthop Surg (Hong Kong), 2020, 28(1): 2309499020905058. doi: 10.1177/2309499020905058.
10. Chang HM, Hong CK, Su WR, et al. Comparison of clavicular hook plate with and without coracoclavicular suture fixation for acute acromioclavicular joint dislocation. Acta Orthop Traumatol Turc, 2019, 53(6): 408-413.
11. Yin J, Yin Z, Gong G, et al. Comparison of hook plate with versus without double-tunnel coracoclavicular ligament reconstruction for repair of acute acromioclavicular joint dislocations: A prospective randomized controlled clinical trial. Int J Surg, 2018, 54(Pt A): 18-23.
12. Renger RJ, Roukema GR, Reurings JC, et al. The clavicle hook plate for Neer type Ⅱ lateral clavicle fractures. J Orthop Trauma, 2009, 23(8): 570-574.
13. Ropars M, Thomazeau H, Huten D. Clavicle fractures. Orthop Traumatol Surg Res, 2017, 103(1S): S53-S59.
14. Boonard M, Sumanont S, Arirachakaran A, et al. Fixation method for treatment of unstable distal clavicle fracture: systematic review and network meta-analysis. Eur J Orthop Surg Traumatol, 2018, 28(6): 1065-1078.
15. Wang J, Guan J, Liu M, et al. Treatment of distal clavicle fracture of Neer type Ⅱ with locking plate in combination with titanium cable under the guide. Sci Rep, 2021, 11(1): 4949. doi: 10.1038/s41598-021-84601-2.
16. Brouwer KM, Wright TC, Ring DC. Failure of superior locking clavicle plate by axial pull-out of the lateral screws: a report of four cases. J Shoulder Elbow Surg, 2009, 18(1): e22-25.
17. Baunach D, Eid K, Ricks M, et al. Long-term clinical and radiological results after hook plate osteosynthesis of lateral clavicle fractures. J Orthop Trauma, 2020. doi: 10.1097/BOT.0000000000002007.
18. Alaee F, Apostolakos J, Singh H, et al. Lateral clavicle fracture with coracoclavicular ligament injury: a biomechanical study of 4 different repair techniques. Knee Surg Sports Traumatol Arthrosc, 2017, 25(7): 2013-2019.
19. Madsen W, Yaseen Z, LaFrance R, et al. Addition of a suture anchor for coracoclavicular fixation to a superior locking plate improves stability of type ⅡB distal clavicle fractures. Arthroscopy, 2013, 29(6): 998-1004.
20. Choi S, Lee TJ, Kim MK, et al. Midterm results of coracoclavicular stabilization with double augmentation for acute acromioclavicular dislocation. Springerplus, 2016, 5(1): 1858. doi: 10.1186/s40064-016-3527-0.
21. Mirbolook A, Sadat M, Golbakhsh M, et al. Distal clavicular fracture treatment with suture anchor method. Acta Orthop Traumatol Turc, 2016, 50(3): 298-302.
22. Fan J, Zhang Y, Huang Q, et al. Comparison of treatment of acute unstable distal clavicle fractures using anatomical locking plates with versus without additional suture anchor fixation. Med Sci Monit, 2017, 23: 5455-5461.
23. Lee W, Choi CH, Choi YR, et al. Clavicle hook plate fixation for distal-third clavicle fracture (Neer type Ⅱ): comparison of clinical and radiologic outcomes between Neer types ⅡA and ⅡB. J Shoulder Elbow Surg, 2017, 26(7): 1210-1215.
24. Lopiz Y, Checa P, García-Fernández C, et al. Complications with the clavicle hook plate after fixation of Neer type Ⅱ clavicle fractures. Int Orthop, 2019, 43(7): 1701-1708.
25. Deng Z, Cai L, Ping A, et al. Anatomical research on the subacromial interval following implantation of clavicle hook plates. Int J Sports Med, 2014, 35(10): 857-862.
26. Lin HY, Wong PK, Ho WP, et al. Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion—dynamic sonographic evaluation. J Orthop Surg Res, 2014, 9: 6. doi: 10.1186/1749-799X-9-6.
27. Liu CT, Yang TF. Hook plate with or without coracoclavicular ligament augmentation in the treatment of acute acromioclavicular separation. BMC Musculoskelet Disord, 2020, 21(1): 701. doi: 10.1186/s12891-020-03726-z.
28. Zhang L, Xiao H, Gao Y, et al. Late function and complications of hook plate implantation for distal-third clavicle fractures: a retrospective study. Acta Orthop Belg, 2018, 84(4): 485-490.
29. Wu K, Su X, Roche SJL, et al. Relationship between the lateral acromion angle and postoperative persistent pain of distal clavicle fracture treated with clavicle hook plate. J Orthop Surg Res, 2020, 15(1): 217. doi: 10.1186/s13018-020-01737-z.
30. Shin SJ, Kim NK. Complications after arthroscopic coracoclavicular reconstruction using a single adjustable-loop-length suspensory fixation device in acute acromioclavicular joint dislocation. Arthroscopy, 2015, 31(5): 816-824.
31. 汤红伟, 殷勇, 韩擎天, 徐小平, 李云飞. 解剖锁定钢板内固定联合喙锁韧带重建治疗 Neer Ⅱb 型锁骨远端骨折的疗效研究. 中国修复重建外科杂志, 2018, 32(9): 1181-1186.
32. Salazar BP, Chen MJ, Bishop JA, et al. Outcomes after locking plate fixation of distal clavicle fractures with and without coracoclavicular ligament augmentation. Eur J Orthop Surg Traumatol, 2021, 31(3): 473-479.

Chinese Journal of Reparative and Reconstructive Surgery

Clavicular hook plate with coracoclavicular ligament augmentation by suture anchor in the treatment of unstable distal clavicle fractures

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