Intramedullary fixation of Neer type 2 fractures of the distal clavicle with an AO/ASIF screw

Abstract

Neer 2 fractures of the distal clavicle are notorious for their high rates of non-union and numerous methods of fixation are recommended. We review a simple method of fixation of these fractures with an intramedullary AO/ASIF malleolar screw. Ten patients with Neer type 2 fractures of the distal clavicle were treated between 1996 and 2002. All had open reduction and internal fixation with an intramedullary 4.5 mm AO/ASIF malleolar screw. In all cases the coraco-clavicular ligaments were not repaired, and the screws were removed once the fractures had united. All fractures united at between 6 and 12 weeks. All patients had a good functional result, with an excellent to good Oxford Shoulder score. This is a simple technique with a universally available implant and good fracture healing. We report no cases of screw breakage or migration and we question the necessity to repair the coraco-clavicular ligaments.