Evaluation of hook plate for fixation of displaced lateral third fractures of the clavicle

Abstract

Objectives The aim of this study was to as se ss the effectiveness of open reduction and internal fixation of Neer type II unstable lateral third clavicle fractures using the clavicle hook plate (HP). Background In the last decade, the clavicle HP has been in use. Reports about this plate have showed a high success rate in terms of union. However, there is still concern as regards rate of mid-term complications, particularly the involvement of the acromioclavicular joint (ACJ). Patients and methods To evaluate the results and mid-term effects in use of this plate, we performed a prospective analysis with a mean follow-up of 17 months (1.45 years) of 20 consecutive patients with acute displaced lateral clavicle fractures, treated with the clavicle HP. Results Short-term functional results in all patients were good to excellent. All but one (95%) patient had a united fracture. Five (25%) patients developed impingement symptoms, and in two (10%) patients fsubacromial osteolysis was found. These findings resolved after plate removal. Twenty patients were evaluated at a fixed initial follow-up visit, 3 months postoperatively, and re-evaluated at a mean follow-up period of 1.45 years. The final Constant Shoulder score mean was 95.5 and the disabilities of the arm, shoulder and hand score (DASH) mean was 3.54 preoperatively compared with 92.9 and 4.26, respectively, before plate removal (P = 0.000). One (5%) patient developed ACJ arthrosis, which was symptomatic. Two (10%) patients had extra-articular ossifications, of which one was symptomatic. There was no relation between the impingement symptoms, subacromial osteolysis, and development of ACJ arthrosis or extra-articular ossifications. Conclusion The clavicle HP is a good primary treatment option for acute displaced lateral clavicle fracture with few complications. At mid-term, the results are excellent, and no long-term complications can be attributed to the use of the plate.