Clinical and radiographic outcomes of a transosseous suture technique for displaced lateral clavicle fractures

Abstract

The purpose of this study was to evaluate the clinical and radiographic outcomes of a transosseous suture fixation technique for the treatment of unstable lateral clavicle fractures. The appropriate treatment for lateral clavicle fractures is controversial. Many authors have argued for nonsurgical treatment of these injuries; however, recent literature has shown a role for the surgical treatment of unstable fractures. The paucity of lateral clavicular bone and the unique anatomy of this area of the shoulder makes surgical treatment of these injuries challenging. This article reports a single-surgeon experience with a transosseous suture fixation technique for the treatment of unstable lateral clavicle fractures. A retrospective review of all patients with unstable lateral clavicle fractures treated with a transosseous suture technique from 2015-2018 was performed. The indication for surgery was significant displacement between the main medial and lateral clavicle fragments. The surgical technique used was a modification of the technique as described by Levy. Patients were followed postoperatively with active and passive range of motion (ROM) measurements, strength testing, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, visual analog scale score, and standard radiographs. Patients were followed to radiographic union. Twelve patients underwent surgical fixation of unstable lateral clavicle fractures from 2015-2018. All patients had excellent function, full ROM, minimal pain, and improved functional scores at final follow-up. Eleven patients achieved complete union of the fracture. One patient healed with a fibrous union; however, the fracture had maintained alignment and the patient was asymptomaticand satisfied with the result. No patient required a second surgery. We found that the transosseous suture technique for fixation is an effective treatment for unstable lateral clavicle fracture. This technique is reproducible, cost effective, and limits the need for revision surgery often encountered with other techniques.