Stabilisation of vertical unstable distal clavicular fractures (Neer 2b) using locking T-plates and suture anchors

S Herrmann, G Schmidmaier, S Greiner
Injury 2009, 40 (3): 236-9
Distal clavicular fractures are associated with an increased risk of delayed union and non-union, and therefore operative treatment is favoured. Fragment dislocation and instability result from detachment of the coracoclavicular ligaments. Various methods for operative treatment can be found in the literature, but no gold standard has been established. In this retrospective study, we present a new surgical technique using a locking T-plate for osseous stabilisation in combination with vertical stabilisation by suture anchors. Between October 2006 and December 2007, eight people underwent surgery for unstable distal clavicular fracture (Neer type 2b). Subsequently one patient could only be contacted by phone and was excluded from further analysis. Mean follow-up for the remaining seven individuals was 8.3 months. The Constant and DASH scores were evaluated and stress radiographs were performed to check for vertical instability. In all cases bony union was achieved within 6 weeks postoperatively. No intraoperative or early postoperative complications were observed. All but one patient regained excellent shoulder function, the mean Constant and DASH scores were 93.3 and 15.3, respectively. Coracoclavicular distance was successfully restored with a mean 1mm (range 0-2mm) side-to-side difference. Early clinical and radiographic results of this new method are promising, with good to excellent outcome in all cases.

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