Interfragmentary suture fixation for displaced acute type II distal clavicle fractures

Xavier A Duralde, Scott D Pennington, Douglas H Murray
Journal of Orthopaedic Trauma 2014, 28 (11): 653-8

OBJECTIVES: Stable fixation of displaced type II distal clavicle fractures presents a challenge to the surgeon because of distal fragment comminution and the large deforming forces created by the weight of the arm. We hypothesized that suture fixation around the coracoid and interfragmentary suture fixation would adequately counteract these forces and lead to a high rate of union and restoration of function.

DESIGN: This is a retrospective study of 20 sequential patients treated between 1997 and 2009.

SETTING: In-patient operating room followed by the clinic.

PATIENTS/PARTICIPANTS: All patients presenting with acute displaced distal clavicle fractures to 2 surgeons were included. All patients completed the study without loss to follow-up.

INTERVENTION: Open repair was performed by placing two #5 Fiberwire sutures around the coracoid and through drill holes in the clavicular shaft. Interfragmentary fixation was performed with figure-of-eight #2 Fiberwire sutures.

MAIN OUTCOME MEASURES: Patients evaluation included the American Shoulder and Elbow Surgeons scale, range of motion, radiographic evaluation, and patient satisfaction.

RESULTS: All fractures healed without loss of reduction at an average of 2.6 months, and all patients were satisfied. American Shoulder and Elbow Surgeons score was 98.5 out of 100. Average follow-up was 7.1 years (range, 3.1-14.3 years). One postoperative wound hematoma and one superficial wound infection were treated nonoperatively.

CONCLUSIONS: Interfragmentary and coracoclavicular suture fixation for displaced acute distal clavicle fractures is a safe and effective treatment with an excellent union rate, low complication rate, and high patient satisfaction.

LEVEL OF EVIDENCE: Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.

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