Concomitant glenohumeral injuries in Neer type II distal clavicle fractures

Tobias Helfen,Florian Haasters,Georg Siebenbürger,Ben Ockert,Wolfgang Böcker

doi:10.1186/s12891-018-1944-7

Abstract

BackgroundTo identify the prevalence of concomitant glenohumeral injuries in surgically treated Neer type II distal clavicle fractures and relate its clinical importance.MethodsBetween 11/2011 and 11/2015 41 patients, suffering from a displaced and unstable distal clavicle fracture were included. 20 patients (group 1) received surgical treatment by means of plate osteosynthesis in combination with an arthroscopically assisted coraco-clavicular ligament augmentation. In group 2 (n = 21 patients) the fracture was treated by hooked plating solely, and diagnostic arthroscopy was conducted during hardware retrieval after the fracture had healed. All arthroscopies were performed in a standardized fashion, images were blinded retrospectively, and evaluated by two independent investigators.ResultsIn total, concomitant glenohumeral pathologies were found in 26.8% of cases (41 patients, mean age 43.6 ± 16.6 years). In Group 1 (n = 20, arthroscopically assisted fracture treatment) the prevalence was 25%, in Group 2 (n = 21, diagnostic arthroscopy during implant removal) 28.5% (p = 0.75). Concomitant glenohumeral injuries included Labrum- and SLAP-tears, partial and full thickness rotator cuff tears as well as lesions to the biceps pulley system. Concomitant injuries were addressed in 2 patients of group 1 (10%, 2× labrum repair) and in 3 patients of group 2 (14.3%, of Group 2 (2× arthroscopic cuff repair of full thickness tear, 1× subpectoral biceps tenodesis in an type IV SLAP lesion, p = 0.68).ConclusionThe present study could clarify the acute and for the first time mid-term implication and clinical relevance of concomitant glenohumeral injuries. They have been observed in averaged 27% of Neer type II distal clavicle fractures at these two times. However, the findings of this study show that not all concomitant lesions remain symptomatic. While lesions are still present after fracture healing, it’s treatment may be depicted upon symptoms at the time of implant removal. In turn, early diagnosis and treatment of concomitant injuries seems reasonable, as untreated injuries can remain symptomatic for more than 6 months after the fracture and recovery may be delayed.

Highlights

To identify the prevalence of concomitant glenohumeral injuries in surgically treated Neer type II distal clavicle fractures and relate its clinical importance
Of 41 patients with a Neer type II displaced fracture of the distal clavicle, concomitant glenohumeral pathologies were found in 11 patients (27%)
In Group 1 (n = 20, mean age: 53 ± 17.5 years, fracture pattern: Neer IIa n = 3, Neer IIb = 17) concomitant glenohumeral pathologies were detected in 5 patients (25%) during primary arthroscopically assisted treatment (Table 1)

Summary

Introduction

To identify the prevalence of concomitant glenohumeral injuries in surgically treated Neer type II distal clavicle fractures and relate its clinical importance. Fractures of the distal clavicle account for approximately 17% of all clavicle fractures [1]. For stable and nondisplaced fractures conservative treatment leads to satisfactory outcome, in unstable fractures surgical treatment is recommended [2]. Arthroscopic assisted treatment of displaced distal clavicle fractures has been reported with the advantage of a minimal invasive approach, early recovery and good functional outcome. As arthroscopic assisted treatment is increasingly performed concomitant intraarticular glenohumeral pathologies are observed with distal clavicle fractures [3]. Injuries involve the superior labrum anterior-posterior complex (SLAP), the biceps pulley or the rotator cuff and account for approximately 25–46% of cases

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