Treatment of Neer type II fractures of the lateral clavicle using distal radius locking plates combined with TightRope augmentation of the coraco-clavicular ligaments

Abstract

Neer type II lateral clavicle fractures are inherently unstable and debate continues regarding optimal treatment. The purpose of this study was to review the outcome of Neer type II lateral clavicle fractures treated using a novel technique, which incorporates a superiorly placed distal radius locking plate combined with TightRope™ fixation to augment the coraco-clavicular ligaments. Between 2007 and 2010, a total of 31 Neer type II fractures were managed operatively at our institution. Clinical outcomes were assessed using the SPADI, DASH, Constant, and Taft scores. Subjects were evaluated at 6 weeks, 3, 6 months, and 1 year. For the latest follow-up (mean 38.7 months), all patients were telephoned by an independent research associate and interviewed to establish SPADI and DASH scores. Radiological union was evaluated using standard views including an antero-posterior view, an angled (Zanca) view, and a trans-scapular view. Bony union was achieved at a mean follow-up of 6.3 ± 4.1 weeks. At the 1-year follow-up, the AC joint remained reduced radiologically in all cases. At 1 year, the mean Constant score was 95.6 ± 4.82, the DASH score was 3.45 ± 3.02, and the SPADI score was 2.58 + 1.94. At the latest follow-up, at a mean of 38.7 + 14.8 months, the DASH score was 0.6 ± 2.1 and the SPADI score was 0.6 ± 2. Surgical fixation of Neer type II lateral clavicle fractures using a 2.4-mm distal radius locking plate in combination with TightRope™ suture augmentation results in a predictable outcome, preserving excellent shoulder function while maintaining a low complication rate.