Comparison of Hook Plate and Tension Band Wire in the Treatment of Distal Clavicle Fractures

Abstract

Tension band wire and hook plating for the treatment of distal clavicle fractures are each associated with clinical benefits and complications. In this study, we compared outcomes of 2 treatments for short-term distal clavicle fracture management for patients asking for faster improvement. From February 2005 to November 2008, 65 patients with distal clavicle fractures randomly received surgical treatment with tension band wires (n=30) or hook plates (n=35). Postoperative data including complications, radiographic union, sonographic findings and range of motion, and Oxford shoulder score at 3 and 6 months were collected and analyzed. No major operative complications occurred in either group and all patients achieved union. In the hook plate group, 9 patients experienced subacromial erosion P=.003), whereas implant dislodgement occurred in 5 patients in the tension band wire group (P=.012). Forward elevation (P=.006) and abduction (P=.004) were significantly better in the tension band wire group at 3 and 6 months postoperatively. The Oxford shoulder score was significantly better in the tension band wire group (P=.016) at 3 months postoperatively, but no different at 6 months postoperatively. We concluded that tension band wire fixation resulted in faster functional recovery than hook plate fixation for distal clavicle fractures resulting from less soft tissue dissection and injury when the tension band wire was implanted. Regardless of the implant chosen for the distal clavicle fracture, postoperative rehabilitation for the injured shoulder joint is critical for function recovery.