Abstract
BackgroundClavicular hook plates are effective fixation devices for distal clavicle fractures and severe acromioclavicular joint dislocations. However, increasing number of studies has revealed that subacromial portion of the hook may induce acromial bony erosion, shoulder impingement, or even rotator cuff damage. By sonographic evaluation, we thus intended to determine whether the presence of hook plate may induce subacromial shoulder impingement and its relationship relative to surrounding subacromial structures.MethodsWe prospectively followed 40 patients with either distal clavicle fracture or acromioclavicular joint dislocation that had surgery using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate. All patients were evaluated by monthly clinical and radiographic examinations. Static and dynamic musculoskeletal sonography examinations were performed at final follow-up before implant removal. Clinical results for pain, shoulder function, and range of motion were evaluated using Constant-Murley and Disability of Arm, Shoulder, and Hand (DASH) scores.ResultsClinically, 15 out of 40 patients (37.5%) presented with subacromial impingement syndrome and their functional scores were poorer than the non-impinged patients. Among them, six patients were noted to have rotator cuff lesion. Acromial erosion caused by hook pressure developed in 20 patients (50%).ConclusionsWe demonstrated by musculoskeletal sonography that clavicular hook plate caused subacromial shoulder impingement and rotator cuff lesion. The data also suggest an association between hardware-induced impingement and poorer functional scores. To our knowledge, the only solution is removal of the implant after bony consolidation/ligamentous healing has taken place. Thus, we advocate the removal of the implant as soon as bony union and/or ligamentous healing is achieved.
Highlights
Clavicular hook plates are effective fixation devices for distal clavicle fractures and severe acromioclavicular joint dislocations
All patients were informed that the hook plate was to be removed after bony union and/or ligamentous healing was achieved on radiographs and should not be retained for longer than 6 months
In the past few years, a number of studies have revealed that the clavicular hook plate is an effective fixation implant for distal clavicle fracture or AC dislocation regarding its reliable fixation and fast bony union [1,2,13,14,15,16,17,18,19,20,21]
Summary
Clavicular hook plates are effective fixation devices for distal clavicle fractures and severe acromioclavicular joint dislocations. Conventional methods utilizing extraarticular or transarticular Kirshner wire [1,2,3], Knowles pin [4,5], tension bands [6], and coracoclavicular screws [7], simple, often carry considerable risk for complications [5,6,7,8,9,10]. These include uncontrollable pin migration, pin breakage, loss of fixation, and non-union [8,9,10,11,12]. Several studies using the hook plate in treating these fractures and dislocations have shown satisfactory clinical results as defined by reliable fixation, fast bony union and/or ligamentous healing, and few complications [1,14,15,16,17,18,19,20,21]
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