Reconstruction of coracoclavicular ligament combined with hook plate technique for treatment of distal clavicle fractures involving avulsion of coracoclavicular ligament

Abstract

Objective To explore the operative strategy of distal clavicle fracture involving coracoclavicular ligament. Methods Data of 17 cases of distal clavicle fracture involving coracoclavicular ligament in our hospital from January 2013 to December 2018 were analyzed retrospectively. According to whether the coracoclavicular ligament was reconstructed or not, the patients were divided into two groups: non reconstruction group (10 cases), male (7 cases), female (3 cases), 19-60 years old (37.9±11.9). In the reconstruction group, 7 cases were male 5, female 2, 25-62 years old (44.9±13.0). Three dimensional CT was used to judge the ligament injury and X-ray was used to evaluate the fracture reduction and healing after operation. The time of fracture healing was compared between the two groups. The function of shoulder joint was evaluated by visual analog scale (VAS) and Constant score of shoulder joint. Results The patients in both groups were followed up for (18.7±6.7) months (range, 9-27 months). At the latest follow-up, the time of fracture healing in the reconstruction group was 12.6±0.7 weeks (range, 12-14 weeks); VAS score was 3.0±1.3 and Constant-Murley score was 85±11. While those in the non reconstruction group were 23.7±7.9 (range, 16- 48 weeks), 3.1±1.8 and 77±10 respectively. The time of fracture healing was statistically significant (t=3.361, P=0.004). There was no significant difference in VAS score and Constant score (P> 0.05). In the non reconstruction group, there were 1 case of delayed union of fracture (healed 48 weeks after operation), 1 case of loosening of clavicular hook plate, 5 cases of acromioclavicular joint dislocation (Rockwood type II) after removal of internal fixation, and the overall complication rate was 70% (7/10). Reconstruction group: 1 case of acromial fracture, the overall complication rate was 14.3% (1/7). There was significant difference between the two groups (χ2=5.13, P=0.024). Conclusion Reconstruction of clavicular insertion of coracoclavicular ligament can effectively reduce the postoperative complications of distal clavicular fracture involving the coracoclavicular insertion. Attention should be paid to the repair and reconstruction of coracoclavicular ligament injury during fracture treatment. Key words: Clavicle; Fractures, bone; Ligaments