Functional results of superior anterior locking plate in treatment of unstable distal clavicle fractures (type 2)

Abstract

Background: Clavicle fractures is the most common upper body fractures, as it is superficially placed [1, 2]. Clavicle fractures presents about 10–15% in children and 3–5% in adults [1, 2]. Depending on the lateral end fractures of clavicle which are classified into 3 types, based on their relation to coraco-clavicular ligaments by Neer [3]. In this study we wanted to evaluate the functional results of superior anterior locking plates use in the surgical management of unstable distal clavicle fractures (type II). The functional outcome were assessed by Quick DASH score, [12] we also analysed: union rates, earliest duration for the patients got back to their routine and regular activities and its complications. Methods: An observational, retrospective and prospective study of 84 patients, where 73 patients had unstable unilateral fractures where 52- right sided and 21 - left sided and 11 patients had bilateral fracture and all the patients were treated with superior anterior locking plate from January 2018 to December 2020 in our tertiary hospital. Patients were followed up at 3 weeks, 6 weeks, 3 months, 6 months and 1 year after surgery. Quick DASH score was used to evaluate the functional outcome [13]. X-rays were taken regularly to look for migration of implants, rate of union and any acromioclavicular pathology. The duration to get back to their routine and regular activities from range of 6 – 8 weeks from surgery were also assessed.Results: At each follow up both clinically and radiologically evaluation showed gradually improvement. All the patients at the 1 year follow up showed full range of movement and with good union. The Quick DASH score range of 0-13.5 with average score of 4.6 which shows good satisfactory outcome (13). There was superficial wound infection in one patient and that was treated by antibiotics. All the patients got back to their routine and regular activities within 7 weeks of surgery, from a range of 6 - 8 weeks of surgery. Conclusion: The unstable distal end of clavicle fractures type II needs a particular surgical intervention with superior anterior locking plates which have specially designed pre-contoured locking plate which provides a good fitting and stable fixation, which gives an amazing results in terms of clinical and functional outcome and without any surgical intervention related complications.