Abstract
PurposeDifferent fixation methods are used for treatment of unstable lateral clavicle fractures (LCF). Definitive consensus and guidelines for the surgical fixation of LCF have not been established. The aim of this study was to compare patient-reported functional outcome after open reduction and internal fixation with the clavicle hook plate (CHP) and the superior clavicle plate with lateral extension (SCPLE).MethodsA dual-center retrospective cohort study was performed. All patients operatively treated for unstable Neer type II and type V LCF between 2011 and 2016, with the CHP (n = 23) or SCPLE (n = 53), were eligible for inclusion. The primary outcome was the QuickDASH score. Secondary outcomes were the numerical rating scale (NRS) pain score, complications, and implant removal.ResultsA total of 67 patients (88%) were available for the final follow-up. There was a significant difference in bicortical lateral fragment size, 15 mm (± 4, range 6–21) in the CPH group compared to 20 mm (± 8, range 8–43) in the SCPLE group (p ≤ 0.001). There was no significant difference in median QuickDASH score (CHP; 0.00 [IQR 0.0–0.0], SCPLE; 0.00 [IQR 0.0–4.5]; p = 0.073) or other functional outcome scores (NRS at rest; p = 0.373, NRS during activity; p = 0.559). There was no significant difference in median QuickDASH score or other functional outcome scores between Neer type II and type V fractures. There was no significant difference in complication rate, CHP 11% and SCPLE 8% (relative risk 1.26; [95% CI 0.25–6.33; p = 0.777]). The implant removal rate was 100% in the CHP group compared to 42% in the SCPLE group (relative risk 2.40; [95% CI 1.72–3.35; p ≤ 0.001]).ConclusionBoth the CHP and SCPLE are effective fixation methods for the treatment of unstable LCF, resulting in excellent patient-reported functional outcome and similar complication rates. SCPLE fixation is an effective fixation method for the treatment of both Neer type II and type V LCF. The SCPLE has a lower implant removal rate. Therefore, if technically feasible, we recommend SCPLE fixation for the treatment of unstable LCF.
Highlights
The fracture of the clavicle is frequently encountered in the emergency department, accounting for 2.6–4% of fractures in the adult population
All patients operatively treated for unstable Neer type II and type V lateral clavicle fractures (LCF) between 2011 and 2016, with the clavicle hook plate (CHP) (n = 23) or superior clavicle plate with lateral extension (SCPLE) (n = 53), were eligible for inclusion
There was a significant difference in bicortical lateral fragment size, 15 mm (± 4, range 6–21) in the CPH group compared to 20 mm (± 8, range 8–43) in the SCPLE group (p ≤ 0.001)
Summary
The fracture of the clavicle is frequently encountered in the emergency department, accounting for 2.6–4% of fractures in the adult population. Clavicle fractures represent 35–44% of fractures in the shoulder region. The majority involve the midshaft, lateral fractures account for 10–30% [1,2,3,4,5,6]. Lateral clavicle fractures (LCF) are classified according to Neer based on their relation to the coracoclavicular ligaments [6, 7]. Neer types I, III and IV are considered to be stable fractures and are generally treated conservatively. The unstable Neer type II and V fractures account for approximately 10–52% of LCF. Surgical management is recommended for these unstable LCF, as non-operative treatment results in a 22–50% non-union rate [1,2,3,4,5,6, 8, 9]
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