Abstract
Abstract Background In 18% of clavicular fractures, the lateral part is affected. Recently, a variety of surgical techniques have been discussed. This study aimed to analyze clinical and radiological results of a consecutive case series with arthroscopy-only coracoclavicular stabilization in unstable lateral clavicle fractures of Neer type IIB, utilizing a double-button fixation technique. Methods Between 2013 and 2015 we followed up ten patients who exclusively had an arthroscopically assisted augmentation of the coracoclavicular ligaments using a double-button fixation (Dog Bone, Arthrex, Naples, FL, USA). Radiological scores and functional outcome measures were evaluated: Subjective Shoulder Value (SSV), Constant–Murley Score (CMS), Taft Score (TF), ASES Score (ASES), Nottingham Clavicle Score (NCS), and a Visual Analogous Scale (VAS). Results Eight of ten patients (5 males, 3 females; 80%) had follow-ups 37 ± 14 months postoperatively. The mean age was 32.4 ± 11.6 years and the mean operation time was 53 ± 21 min. Clinical examination showed a CMS of 91.9 ± 7.9 points (pt), a TF of 10.5 ± 1.1 pt, and an NCS of 76.5 ± 15.3 pt. The VAS score was 0.7 ± 1.5 pt with an average SSV of 83.1 ± 13.4 pt and an ASES of 87.0 ± 12.5 pt. In three cases (37.5%) a concomitant intra-articular pathology was found. Radiological analysis showed a preoperative CC distance of 19.7 ± 3.3 mm, a postoperative distance of 6.9 ± 3.0 mm and 12.0 ± 4.9 mm at follow-up. The clavicular drill hole widened from 3.0 ± 0.4 mm postoperatively to 6.0 ± 1.5 mm at follow-up; 50% of cases had radiological signs of bony non-union, two of which were symptomatic and received revision surgery. Conclusion The solely arthroscopic double-button technique shows good clinical results. Although not symptomatic in all cases, the non-union rate is quite high. Thus, this technique should be reserved for special cases with small lateral fragments where anchoring techniques are not an option.
Highlights
In 18% of clavicular fractures, the lateral part is affected
The aim of our study was to evaluate the outcomes of lateral clavicle fractures that were treated with a Dog Bone implant (Arthrex, Naples, FL, USA)
From this lateral view an arthroscopic depiction of the coracoid arch is made. This is followed by a second stab incision above the clavicle, more accurately above the medial fracture fragment, withthe aim ofpositioning the aiming device in the direction of the transclavicular and transcoracoidal drill holes
Summary
In 18% of clavicular fractures, the lateral part is affected. Recently, a variety of surgical techniques have been discussed. This study aimed to analyze clinical and radiological results of a consecutive case series with arthroscopy-only coracoclavicular stabilization in unstable lateral clavicle fractures of Neer type IIB, utilizing a doublebutton fixation technique. The clavicular drill hole widened from 3.0 ± 0.4 mm postoperatively to 6.0 ± 1.5 mm at follow-up; 50% of cases had radiological signs of bony non-union, two of which were symptomatic and received revision surgery. The solely arthroscopic doublebutton technique shows good clinical results. Not symptomatic in all cases, the non-union rate is quite high. This technique should be reserved for special cases with small lateral fragments where anchoring techniques are not an option
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