Comparison of the Efficacy of Hook Plate Versus Kirschner Wire in the Surgical Treatment of Unstable Fractures of the Distal Clavicle

Abstract

Objectives: Unstable fractures of the distal clavicle usually require surgical fixation to achieve satisfactory results. The traditional method using Kirschner-wire (K-wire) fixation has always been adopted in the past. However, complications commonly occur. Over the last two years, we have adopted a claviclular hook plate fixation method to treat such cases and the preliminary results are highly satisfactory. The purpose of this study is to review the clinical outcomes of the to techniques. Patients and Methods: Between 1999 and 2002, ten unstable fractures of the distal clavicle were operated on using K-wire fixation at our institution. During 2002-2004, eight consecutive cases were treated by hook plate fixation. The clinical results were evaluated by a popular shoulder scoring system. The Fisher's exact test was used to analyze gender versus type, confounding medical conditions, complication rates, symptomatic hardware rates, elective hardware removal rates, and the ability to return to work. A Mann-Whitney U test was used to compare the shoulder scores. Results: The mean shoulder score for K-wire fixation was 80±5.3 points and for hook plate fixation was 94±4.8 points (p=0.05). Hook plating had a significantly lower rate of loss of reduction (p=0.013) and symptomatic hardware (p=0.025). In addition, hook plate fixation resulted in a higher rate of return to work (p=0.025). Conclusion: If surgery of distal clavicular fractures is indicated, internal fixation with a hook plate has distinct advantages over the K-wire method.