Clavicle Hook Plate Research Articles

Comparative clinical outcomes and radiological images of clavicle hook plate versus Scorpion Plate® for unstable distal clavicle fractures

BackgroundAlthough various surgical methods are available for unstable distal clavicle fractures, consensus remains lacking on the optimal technique. Therefore, the present retrospective study aimed to compare the clavicle hook plate and Scorpion Plate® in terms of clinical outcomes and radiological findings for unstable distal clavicle fractures. MethodsFifty-seven patients with unstable distal clavicle fractures who underwent treatment using a clavicle hook plate (Group H; 28 patients) or Scorpion Plate® (Group S; 29 patients) were included in the present study. No patients received additional augmentation and all were followed-up for >1 year (mean follow-up, 28 months). Clinical outcomes were operation time, bleeding volume, complications, range of motion (ROM) at 6 months after surgery and final follow-up, and clinical scores (Constant–Murley score and University of California, Los Angeles (UCLA) shoulder score). Radiological outcomes assessed were coracoclavicular distance (CCD), difference in CCD between affected and non-affected sides (ΔCCD), and acromioclavicular subluxation ratio (%ACS) from plain X-rays. The χ2 test and Mann–Whitney U test were used to compare each outcome. ResultsComplications were seen in 3 shoulders (10.7%) in Group H. ROM was significantly worse in Group H at 6 months postoperatively, but no significant differences between groups were evident at final follow-up. Moreover, no significant differences in clinical outcomes were seen between groups. In terms of radiological results, Group H showed greater improvement in CCD and ΔCCD than Group S. Further, %ACS was significantly worse in Group S. ConclusionsThe clavicle hook plate allows reconstruction of a more anatomical position than the Scorpion Plate®, but carries a greater risk of complications. Conversely, the Scorpion Plate® has a low risk of complications, but acromioclavicular subluxation remains. However, no significant differences in ROM or clinical outcomes were apparent at final follow-up.

Optimizing hook implantation angle of the clavicular hook plate: a cadaveric study.

While Clavicle hook plates have demonstrated favorable results regarding bone and shoulder function, their design can potentially lead to complications due to pressure concentration at the plate's tip. This study aims to investigate the impact of different hook implantation angles on the contact surface area between the hook plate and acromion, with the goal of minimizing mismatch and maximizing contact surface area. Twenty soft shoulder cadavers were included in the study, and the contact surface area of the hook plate was measured in different positions based on the hook implantation angle. The results showed variations in compatibility, width, and length of the contact surface area depending on the hook implantation angle and the medial or lateral row placement. The lateral row generally demonstrated superior compatibility (84.0% vs 46.67%, p-value < 0.001), with a broader contact area (3.55 ± 0.08 mm vs 3.09 ± 0.10 mm, p-value = 0.004) and a longer contact area (7.36 ± 0.19 mm vs 5.10 ± 0.23 mm, p-value < 0.001) at specific angles. A detailed analysis of the lateral position revealed that the zero angle of implantation resulted in the greatest contact surface area, measuring 3.91 ± 0.70 mm in width (p value = 0.083) and 8.85 ± 1.24 mm in length (p value < 0.001). Placing the hook laterally and at the zero position according to the hook implantation angle can maximize contact surface area, may reduce stress concentration, and minimize complications in hook plate fixation. Further research and consideration of anatomical variations are warranted to refine the placement technique and enhance patient outcomes. Level V evidence.

Open reduction and internal fixation in treatment of four cases of bipolar clavicle dislocations

To summarize the method and effectiveness of open reduction and internal fixation in the treatment of 4 cases of bipolar clavicle dislocations. Between June 2017 and June 2022, 4 patients with bipolar clavicle dislocations were admitted. There were 3 males and 1 female. The age ranged from 27 to 63 years, with an average age of 45 years. There were 2 cases of crushing injury of mine car, 1 case of traffic accident injury, and 1 case of heavy object injury. The time from injury to operation was 3-7 days, with an average of 5.0 days. The sternoclavicular joint dislocations were classified as Grade Ⅱ in 1 case and type Ⅲ in 3 cases, and anterior dislocation in 3 cases and posterior dislocation in 1 case. The acromioclavicular joint dislocations were classified as Tossy type Ⅱ in 2 cases and type Ⅲ in 2 cases. After open reduction, the sternoclavicular joint and acromioclavicular joint were fixed with lateral malleolus locking titanium plate and clavicular hook plate, respectively. All operations were successfully completed without vascular or nerve injury. All incisions healed by first intention. All patients were followed up 12-18 months, with an average of 14 months. At last follow-up, the shoulder joint functions were rated as excellent in 3 cases and good in 1 case according to Rockwood score. During follow-up, there was no loosening of internal fixator or fracture. The internal fixators were removed in all patients at 5-7 months after operation (mean, 6 months), and no re-dislocation occurred after removal. For bipolar clavicle dislocation, open reduction combined with lateral malleolus locking titanium plate fixation of the sternoclavicular joint and clavicle hook plate fixation of the acromioclavicular joint can achieve good effectiveness. It has the advantages of simple operation, high safety, firm fixation, and fewer complications, and the shoulder function recovers well.

Biomechanical evaluation of fixation of the coracoclavicular stand-alone cow-hitch suture reconstruction in comparison to two established techniques for highly unstable distal clavicle fractures (Neer type V)

BackgroundTreatment of displaced distal clavicle fractures with bony avulsion of the coracoclavicular (CC) ligaments often warrants surgical fixation, yet a gold-standard surgical technique is to be defined. The purpose of this study was to compare the biomechanical fixation strength of a new fixation technique, the CC stand-alone Cow-Hitch suture reconstruction, and to compare this technique with a clavicle hook plate and a lateral locking plate with CC suture reconstruction. MethodsSimulated Neer type V distal clavicle fractures fractures of the clavicle were created in 18 cadaveric shoulders, which were matched by age and gender in 3 groups: (1) clavicle hook plate (Group HP), (2) lateral locking plate fixation with CC suture reconstruction (Group LPCC) and (3) CC stand-alone suture reconstruction using the Cow-Hitch technique (Group CH). After preconditioning with 25 N for 10 cycles the specimens were cycled in the coronal plane for 500 cycles from 10N to 70N. Displacement and ultimate load to failure were documented and analyzed with the data acquisition system. ResultsThere was a significant difference in the fracture displacement during cyclic loading between the LPCC group and the HP group (0.6 vs. 1.7 mm; p=0.02), and between CH and HP groups (0.5 vs. 1.7 mm; p=0.004). Fracture displacement was not different between the LPCC and the CH groups (p=0.544). The CH group and the LPCC group showed a significant higher stiffness compared to the HP group (p<0.001 and p=0.003, respectively). The CH group showed a significant higher ultimate load to failure compared with the HP group (429 vs. 172 N; p=0.005), and showed a tendency towards higher ultimate load to failure when compared with the LPCC group (429 vs. 258 N; p=0.071). ConclusionThe CC stand-alone Cow-Hitch suture reconstruction and the locking plate with CC reconstruction showed higher fixation strength compared with the hook plate for simulated Neer type V distal clavicle fractures. There was a tendency of higher ultimate load to failure with the Cow-Hitch technique compared with the lateral locking plate with CC suture reconstruction, and given the potential advantages of less soft tissue stripping, metal-free fixation, low costs, and simple surgical technique, clinical application of the all-suture CC reconstruction using the Cow-Hitch for Neer type V distal clavicle fractures appears warranted.

Extra-articular locking plate and trans-articular clavicle hook plate for displaced medial clavicle fractures

IntroductionFracture of the medial end of the clavicle is very rare. There is no consensus on the standard surgical strategy for medial clavicle fracture, and treatment is challenging. This study aimed to retrospectively evaluate the efficacy of internal plate fixation for displaced medial clavicle fracture. MethodsPatients who underwent internal plating of a displaced medial clavicle fracture were included in this retrospective study. Each patient underwent open reduction and fixation with an internal extra-articular locking plate or trans-articular hook plate based on their fracture type. Postoperative follow-up included radiographs for assessment of bone union, Constant-Murley score for shoulder function, Disability of the Arm, Shoulder, and Hand (DASH) questionnaire for upper limb function, and visual analog scale (VAS) for pain. Any complications were also recorded. ResultsBetween May 2014 and July 2021, 34 patients (9 females, 25 males; mean age, 50.0 ± 14.8 years) were treated with internal plate fixation and included in this study. The fracture line was located in the medial fifth of the clavicle in 32 patients, and 20 patients had intra-articular fracture. Eighteen patients had the fracture fixed with a locking plate, namely an inverted distal clavicle plate (n = 7), straight locking plate (n = 3), distal fibular plate (n = 3), and T-plate (n = 5); the other 16 patients were treated with a clavicle hook plate. During a mean follow-up of 30.7 ± 26.5 months, 33 patients achieved bone healing, the average Constant-Murley score was 90.9 ± 11.0 points, the mean DASH score was 6.0 ± 6.6 points, and the mean VAS was 0.4 ± 1.1 points. Complications occurred in five patients. ConclusionsBoth locking plates and hook plates are effective in treating displaced medial clavicle fracture. A locking plate is recommended when there is enough bone stock in the medial fragment for stable fixation. A clavicle hook plate is recommended for cases in which the medial clavicle fracture is too small, comminuted, or has signs of sternoclavicular joint instability.

Clinical outcomes for grades III–V acromioclavicular dislocations favor double-button fixation compared to clavicle hook plate fixation: a systematic review and meta-analysis

IntroductionThe purpose of this study was to perform a systematic review and meta-analysis of both randomized controlled and observational studies comparing double-button suture fixation to hook plate fixation for types III–IV acromioclavicular joint dislocation.MethodsSystematic review of Medline, Embase, Scopus, and Google Scholar, including all levels 1–3 studies from 2000 to 2022. Clinical outcome scores, range of motion, and complications were included. Risk of bias was assessed using the Cochrane Collaboration’s ROB2 tool and ROBINs-I tool. MINORS and modified Coleman Methodology Score (CMS) were used to assess within study quality. The GRADE system was used to assess the overall quality of the body of evidence. Heterogeneity was assessed using χ2 and I2 statistics.ResultsFifteen studies were included. Three of the four included LOE II and eleven of the LOE III studies had a high risk of bias. Study quality was considered poor and fair for 67% by MINORS criteria and 93% for CMS criteria. The pooled estimate (SMD 0.662) for all clinical outcomes was statistically significant and in favor of button repair (p = 0.0001). The pooled estimate (SMD 0.662) for all VAS pain scores was statistically significant, again in favor of button repair (p = 0.001).ConclusionsThe results of this meta-analysis demonstrated significantly better outcomes of button repair for acute ACJ dislocations when compared to clavicle hook plate. Button repair is also associated with a 2.2 times lower risk for complications. However, risk of bias is high, and study quality within and between studies was low. These results, therefore, must be viewed with caution.Level of evidenceLevel III; systematic review and meta-analysis.

Treatment of bipolar clavicle injury with internal plating: a case series and literature review

BackgroundBipolar clavicle injury is a rare injury involving any combination of dislocation and/or fracture at both ends of the clavicle. Most reports of bipolar clavicle injury have been based on a single case, and treatment of this injury remains controversial. The present study was performed to evaluate the efficacy of surgical management with internal plating for bipolar clavicle injuries.MethodsWe performed internal plating to treat seven consecutive bipolar clavicle injuries with different injury patterns from May 2013 to June 2021. A clavicle hook plate was used for five sternoclavicular joint injuries (including a revision surgery) and three acromioclavicular joint dislocations, a T plate was used for one sternoclavicular joint injury, and an anatomic plate was used for one distal clavicle fracture. At follow-up, radiographs were assessed for bone alignment, joint congruity, fracture union or malunion, and implant failure or migration. Clinical evaluation included determination of the Disability of the Arm, Shoulder, and Hand (DASH) score; Constant–Murley score; visual analog scale (VAS) score; and complications.ResultsThe patients were regularly followed up after the operation, and functional parameters were assessed over time. At a mean follow-up of 28.1 ± 22.0 months, each fracture had solid bone union, and each dislocation showed no sign of recurrent instability. The mean shoulder forward flexion was 159.3° ± 7.9°, and the mean DASH score was 8.8 ± 5.1. The mean Constant–Murley score was 88.9 ± 7.9, with six cases assessed as excellent and one case assessed as good. The mean VAS score was 1.0 ± 1.5, and the mean patient satisfaction score was 9.3 ± 0.8. No complications occurred, and each patient was able to resume their preinjury daily activity and was highly satisfied with their treatment.ConclusionsIn the present study, internal plating for bipolar clavicle injury allowed early mobilization and resulted in good joint function. We recommend fixation of the more severely affected side first because the other side may be passively reduced and acquire stability once the more severely affected side has been fixed. Internal fixation of the other end may therefore be unnecessary unless residual instability exists.

Comparing the Efficacy of Anatomical Locked Plate Fixation with Coracoclavicular Ligament Augmentation to Hook Plate Fixation in Treating Distal Clavicle Fractures.

Hook plate fixation is the traditional method for treating distal clavicle fractures. However, in recent years, locked plate applications have emerged as a promising treatment method. This study aimed to compare the short- and mid-term clinical efficacy of anatomical locked plate fixation with coracoclavicular ligament augmentation using anchor nails to that of hook plate fixation in treating distal clavicle fractures. This was a retrospective single-center cohort study investigating patients with distal clavicle fractures treated between January 2016 and February 2019 in Zhongnan Hospital of Wuhan University. Fifty-nine eligible patients who underwent either anatomical locked plate fixation with coracoclavicular ligament augmentation using anchor nails (LPF&CLA group; 20 patients) or clavicle hook plate fixation (CHPF group; 39 patients) were included. The visual analog scale (VAS) and Constant-Murley shoulder scores were used to assess shoulder function. In addition, the coracoclavicular distance between the affected and unaffected shoulders (ΔCC distance) was measured to assess the reduction. Patients were followed up at 3 months, 6 months, and 1 year postoperatively. The comparisons between the two groups were made using Student's t-test, chi-square test, or Fisher's exact test, if appropriate. Preoperative VAS scores were similar in both groups. At 3- and 6-month follow-up, the VAS score was significantly higher in the CHPF group than in the LPF&CLA group. In contrast, the Constant-Murley shoulder score was significantly lower in the CHPF group than in the LPF&CLA group. When the hook plates were removed, there was no statistical difference in both VAS (0.2 ± 0.4 in LPF&CLA group vs. 0.5 ± 0.5 in CHPF group, p= 0.05) and Constant-Murley shoulder (96.1 ± 3.1 in LPF&CLA group vs. 93.8 ± 5.2 in CHPF group, p= 0.08) scores at the last follow-up. Postoperatively, the ΔCC distance was 2.37 ± 1.93 mm in the LPF&CLA group and -1.56 ± 1.34 mm in the CHPF group. One year after surgery, ΔCC distance increased to 3.96 ± 1.17 mm in the LPF&CLA group and to -0.89 ± 1.39 mm in the CHPF group. For distal clavicle fractures in which the coracoclavicular ligament is disrupted, anatomical locked plate fixation with coracoclavicular ligament augmentation achieved better functional recovery and less pain than hook plate fixation at the 6-month follow-up. However, the hook plate provided better reduction throughout the follow-up period and shoulder pain could be relieved using removal surgery. Therefore, locked plates with coracoclavicular ligament augmentation favors post-surgery pain relief while harvesting similar functional outcomes to hook plate fixation.

Biomechanical effects of different numbers and locations of screw-in clavicle hook plates.

Purpose: We sought to analyze the biomechanical effects which both different numbers and locations of screws have on three different clavicle hook plates, as well as any possible causes of sub-acromial bone erosion and peri-implant clavicular fractures. Methods: This study built thirteen groups of finite element models using three different clavicle hook plates (short plates, long plates, and posterior hook offset plates) in varying numbers and locations of the screws. The von Mises stress distribution of the clavicle and hook plate, as well as the reaction force of the acromion was evaluated. Results: The results show that inserting screws in all available screw holes on the hook plate produces a relatively large reaction force on the acromion, particularly in the axial direction of the bone plate. The fewer the screws implanted into the clavicle hook plate, the larger the area of high-stress distribution there is in the middle of the clavicle, and also, the higher the stress distribution on the clavicle hook plate. Conclusion: This study provides orthopedic physicians with the biomechanical analysis of different numbers and locations of screws in clavicle hook plates to help minimize surgical complications.

Relationship Between Subacromial Bone Erosion and Hook Position of Clavicular Plate in Distal Clavicle Fractures.

To evaluate the influence of posterior hook position on subacromial bone erosion during surgical treatment of distal clavicle fractures with locking compression plate clavicle hook plate (CHP). Single-center retrospective study. Level V trauma center (university hospital). Twenty-one patients (mean age, 45.8 years) treated with CHP were included. One, 3, 15, and 2 patients had Neer type I, IIa, IIb, and V fractures, respectively. Open reduction and internal fixation were performed with locking compression plate CHP. All implants were removed after a mean of 6.1 months postoperatively. Japanese Orthopaedic Association shoulder scores were used to assess recovery. Radiographically, the coracoclavicular distance was measured as the distance between the tip of the coracoid process and the undersurface of the clavicle. Three-dimensional computed tomography was performed to identify bone erosion at the hook tips after implant removal. The distance from the acromioclavicular joint center to the bone erosion was divided into 5 areas at 5-mm intervals, and the position and depth of bone erosion were measured in each area. The mean follow-up period was 17.4 months; mean ± SD Japanese Orthopaedic Association score was 75.9 ± 4.7 at the final follow-up, whereas the mean duration of bony union was 4.4 ± 1.0 (SD) months. Delayed bony union was observed in one patient, whereas a second surgery was required in another due to acromion cut-out. Radiography showed overreduction in 95% of cases. The correlation coefficient showed a difference between coracoclavicular distance and the position of bone erosion measured by CT (Rs = 0.32, P = 0.006). Erosion under the acromion surface was found in all patients. The depth of erosion correlated with the posterior hook position (Rs = 0.29, P = 0.023). Posterior hook tip placement increased the likelihood of bone erosion and complications due to overreduction. CHP should be set more anteriorly beneath the acromion to prevent complications. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Case-control study on the Endobutton plate and clavicular hook plate for the treatment of acromioclavicular joint dislocation

To study the clinical efficacy and complications of Endobutton titanium plate and clavicle hook plate in the treatment of acromioclavicular dislocation. Total 48 patients with Rockwood Ⅲ to Ⅴ acromioclavicular joint dislocation from March 2015 to May 2019 were retrospectively divided into two groups according to different surgical methods. Among the patients, 23 patients were treated with Endobutton loop titanium plate fixation (observation group), including 15 males and 8 females, ranging in age from 23 to 59 years old, with an average of(36.2±8.1) years old;Rockwood type Ⅲ in 6 cases, type Ⅳ in 11 cases and type Ⅴ in 6 cases. Twenty-five patients were treated with clavicular hook plate(control group), including 17 males and 8 females, ranging in age from 22 to 54 years old, with an average of (34.7±6.4) years old; Rockwood type Ⅲ in 6 cases, type Ⅳ in 14 cases and type Ⅴ in 5 cases. The operation time, intraoperative bleeding, hospitalization time, visual analogue scale (VAS) of pain, Constant-Murley score of shoulder function and postoperative complications were compared between the two groups. All the patients were followed up, and the duration ranged from 24 to 51 months, with a mean of (30.5±6.5) months. The amountof bleeding and hospitalization time in the observation group were (71.9±4.0) ml and(8.2±1.6) d respectively;and those in the control group were (97.6±13.4) ml and (12.8±1.2) d respectively. There was significant difference between the two groups (P<0.05). There was no significant difference in operation time between the two groups(P>0.05). The VAS scores of the observation group immediately after operation and 12 months after operation were 4.00±0.39 and 1.58±0.13 respectively, which were statistically significant compared with 7.32±0.43 and 3.09±0.23 in the control group (P<0.05). The Constant-Murley scores of shoulder function in the observation group were 59.65±0.15 and 85.97 ±0.73 immediately and 12 months after operation, which were significantly different from those in the control group 52.77±0.19 and 55.78±0.19(P<0.05). In the observation group, there were 1 case of shoulder pain and 1 case of ectopic ossification; in the control group, there were 1 case of internal fixation failure, 3 cases of acromion impact, 3 cases of shoulder pain and 3 cases of ectopic ossification. There was significant difference between the two groups (P<0.05). Compared with clavicular hook plate internal fixation in the treatment of acromioclavicular joint dislocation, Endobutton loop titanium plate internal fixation technology has the advantages of less surgical bleeding, shorter hospitalization time, less postoperative pain, good recovery of shoulder joint function and less complications.

Biomechanical Analysis of Clavicle Hook Plates with a Range of Posterior Hook Offsets Implanted at Different Acromion Positions in the Acromioclavicular Joint: A Finite Element Analysis Study

The clavicle hook plate is commonly used in acromioclavicular injuries; however, the biomechanical effect of the posterior hook offset and hook position is unclear. This study applied a finite element analysis (FEA) to evaluate these parameters to improve the clinical strategy. Nine FEA models with 0-mm, 5-mm, and 10-mm posterior hook offsets implanted in the anterior, middle, and posterior acromion were established to evaluate the stress distribution and the reaction force on the acromion. The 5-mm and 10-mm posterior hook offsets at all acromion positions reduced the reaction force on the acromion but slightly increased the stress on the clavicle. The 0-mm offset increased the reaction force at all acromion positions and was relatively lower at the middle acromion. The clavicle hook plate with a posterior hook offset reduces the reaction force on the acromion, providing a flexibility of the hook position. These results provide surgeons with the biomechanical basis for the hook offset and position and engineers with the mechanical basis for the implant design.

Os acromiale may be a contraindication of the clavicle hook plate: case reports and literature review

BackgroundOs acromiale can be potentially missed or misdiagnosed as acromion fracture, and this can affect treatment determination if it is complicated with an ipsilateral shoulder injury. The clavicle hook plate is a widely used technique for distal clavicle injuries, leading to transacromial erosion, particularly when in the presence of os acromiale.Case presentationA 70-year-old man and a 78-year-old man who had limited mobility and severe pain in their right shoulders following falls attended the emergency center. Both patients were diagnosed with os acromiale with CT or MRI and acute distal clavicle fracture or acromioclavicular joint dislocation. Following a comprehensive evaluation, os acromiale may limit the application of a clavicle hook plate due to potential transacromial erosion. The distal clavicle fracture with ipsilateral os acromiale received treatment with a volar radius locking T plate, and the acromioclavicular joint dislocation with ipsilateral os acromiale was reconstructed using suture anchors. Both yielded satisfactory outcomes and voided transacromial erosion.ConclusionsIpsilateral os acromiale may be a relative contraindication to the clavicle hook plate. An axillary lateral radiograph is recommended to detect potential os acromiale in patients using a hook plate.

Clavicular hook plate with coracoclavicular ligament augmentation by suture anchor in the treatment of unstable distal clavicle fractures

To evaluate the effectiveness of a clavicular hook plate with coracoclavicular ligament augmentation by suture anchor in the treatment of Neer types Ⅱ and Ⅴ distal clavicle fractures. Between January 2010 and June 2016, 16 patients with Neer types Ⅱ and Ⅴ distal clavicle fractures were treated with clavicle hook plates and coracoclavicular ligament augmentation by suture anchor. There were 12 males and 4 females with an average age of 45.6 years (range, 14-81 years). The injury mechanism included falling in 10 cases, traffic accident injury in 2 cases, falling from height in 2 cases, and heavy object injury in 2 cases. The Neer classification of clavicle fractures included 2 cases of type Ⅱa, 13 cases of type Ⅱb, and 1 case of type Ⅴ. The injury severity score (ISS) was 6-29, with an average of 11.2. The time from injury to operation was 1-18 days, with an average of 6.4 days. The operation time, intraoperative blood loss, hospitalization stay, fracture healing, and postoperative complications were recorded; the disability of arm, shoulder, and hand (DASH) score, the shoulder joint Constant score, and the Oxford shoulder score (OSS) were used to evaluate the shoulder joint at last follow-up. All operations were successfully completed. The operation time was 50-100 minutes, with an average of 75.6 minutes; intraoperative blood loss was 30-100 mL, with an average of 52.8 mL; hospitalization stay was 4-47 days, with an average of 13.7 days. All patients were followed up 1.2-7.5 years, with an average of 3.5 years. All clavicle fractures healed, and the healing time was 9.4-13.6 weeks, with an average of 11.9 weeks. No fracture nonunion, fracture displacement, failure of internal fixation, or incision infection, etc. occurred. Fifteen patients took out the hook plate after fracture healing and functional recovery, and 1 case refused to remove the hook plate from the second operation because of no obvious discomfort. At last follow-up, the DASH score was 0-13, with an average of 2.2; the shoulder joint Constant score was 90-100, with an average of 96.8; the OSS score was 12-14, with an average of 12.3. Clavicular hook plate with coracoclavicular ligament augmentation by suture anchor can help achieve good effectiveness with less postoperative complication in the treatment of Neer types Ⅱ and Ⅴ distal clavicular fractures.

Prospective study of clinico radiological outcome of distal end clavicle fractures treated with hook plate

Background & Objectives: Clavicle fracture is the commonest fracture amongst adults and roughly a quarter of all clavicle fractures occur at the lateral end [1]. These fractures are unstable due to the various deforming forces which act on the fragments as well as the small distal fracture fragment. At most times the deforming forces are not taken into consideration, and the fracture is not fixed securely. In this study, we assessed a fixation technique using the lateral end clavicle hook plates to find out whether it provided a stable fixation with good functional outcome. Methods: This study is a prospective, hospital based study conducted in Anil Neerukonda Hospital and NRI Institute of Medical Sciences, Visakhpatnam, between May 2018 to May 2021. The fractures were classified according to Neer’s classification and were followed up at regular intervals.In total, 12 patients with lateral end clavicle fracture (Neer's Type II) were included in the study. After the informed consent and preoperative investigations were obtained, open reduction and internal fixation was done using a 3.5 mm lateral end clavicular hook plate under regional anesthesia. Postoperative X-rays were done on day 1 and every 6 weeks after operation, until radiological union was achieved. The postoperative pain was assessed using Visual Analogue Scale (VAS) on postoperative days 1, 2 and 10. Postoperatively arm pouch sling was given for 10 days followed by active mobilization. Patients were asked to do their daily routine work and avoid lifting heavy weights. The functional outcome was assessed at the end of 2nd and 6th months with the help of Disabilities of the Arm, Shoulder and Hand (DASH) scoring. Results: There were no intraoperative complications in the procedure. The mean VAS score on postoperative day 1 was found to be 5 which decreased to 3 on day 2 and 0 on day 10. The mean DASH score was calculated as 10.58 at the end of postoperative month 2 and then 4.2 at the end of month 6. There was one case of superficial infection which was resolved with local debridement, there was initial restriction of overhead abduction in this case but was not painful and was managed conservatively. Conclusion: Lateral end clavicular hook plate is a good fixation system for lateral end clavicle fractures. Operative time is reduced and surgical dissection is minimum. Device provides good angular stability and helps in early mobilization. It may well be the answer to the fixation questions of the lateral clavicle fractures, although larger comparative studies between the surgical treatment methods are required to confirm the same.

Zip-Tight AC jointを併用したフックプレートによる鎖骨遠位端骨折の治療成績

Zip-Tight AC jointを併用したフックプレートによる鎖骨遠位端骨折の治療成績

Functional outcome of clavicle hook plate for fractures of lateral end of clavicle and acromio-clavicular joint disruption

Background: The acromioclavicular joint (AC joint) provides a ‘keystone’ link between the clavicle and the scapula. Objectives: To evaluate the functional outcome of clavicle hook plate for fractures of lateral end of clavicle & acromioclavicular joint disruption. Method: This study is a descriptive analysis, approved by the Institution Review Board and the Ethic Committee for the evaluation of the results of hook plate fixation for acromioclavicular joint disruption (Rockwood and Young III-VI) and unstable fractures of the lateral end of clavicle (Neer type II-III). Duration of study from 1st November 2018 to 31st May 2020. Results: 35 patients were followed of which 28 were males and 7 were females. Left shoulder was involved in 26 patients and right shoulder was involved in 9 patients. There were 25 patients with lateral end clavicle fractures and 10 patients with AC joint injury. Two patients had Diabetes mellitus and 5 patients had hypertension. One patient had both DM and hypertension. Two patients developed shoulder stiffness and two patients developed impingement during the course of follow up. All the patients had a unified surgical approach and operative procedure. The postoperative protocol regarding medication and physiotherapy was also unified (as mentioned earlier). At the last follow up, 27 patients had a excellent outcome according to Quick DASH score. 6 had a good outcome and 2 had a poor outcome. The score ranged from 2.3 to 25 (avg was 7.26) Conclusion: It was concluded Hook plate is a good option for treatment of AC joint disruption and unstable lateral end clavicle fractures, limited use of instrumentation, short duration of the procedure, stability to the AC joint attained without the need for ligament repair or reconstruction and short learning curve.

Effectiveness of Surgical Treatment of Rockwood Type III Acromioclavicular Joint Dislocation Using Clavicle Hook Plate and Tension Band Wiring: A Comparative Study to Evaluate the Functional and Surgical Outcome

Introduction: Acromioclavicular joint dislocation Type III is still controversial for its management, despite of numerous trials and reviews. Aims: To compare and evaluate the functional and surgical outcome of Rockwood Type III acromioclavicular joint dislocation treated surgically with clavicular Hook plate and Tension Band wiring with K-wires. Methods: In a prospective hospital based interventional study comprising of total 22 patients with a mean age of 31.36 ± 7.53 years who presented with Rockwood Type III acromioclavicular joint dislocation were carried between January 2018 to December 2019. They were graded according to Rockwood et al. classification. All 22 patients underwent open reduction and internal fixation. These patients were divided into two groups according to operative procedure; of which 11 patients were treated with clavicular hook plate (CHP) and rest 11 were treated with tension band wiring with K-wires (TBW). Descriptive comparison was tabulated during pre-operative, intra-operative and post-operative periods. The Constant-Murley Shoulder scoring system was applied for evaluating the results. Results: The mean follow up period was 7.6 months. The clavicular hook plate was removed at 10 months in one patient due to severe pain and limited range of motion , and removal of Tension Band wiring with K-wires were done in two patients due to wound dehiscence and Kirschner wire back out at 5 and 6 months. The mean Constant- Murley shoulder score was 82.6 (min. 70 &amp; max. 93) in clavicular hook plate and 74.72 (min 68 &amp; max. 84) in Tension band wiring with K-wires which found to be significantly difference in mean scoring between two groups. Conclusion: Patients treated with Clavicular Hook Plate for Rockwood Type III acromioclavicular joint dislocation had a very good functional and surgical outcome over Tension Band wiring with K-wires.

Treatment of fractures of lateral end of clavicle with open reduction using clavicle hook plate

Background: Fracture of lateral end clavicle constitutes merely 15% of clavicle fracture, only a third of these fractures are displaced. No solo treatment method has been hailed as the most favored technique to deal with the fracture lateral end clavicle, yielding consistently good union, with least complications. Objective: This early study attempts to assess the role of Clavicle Hook Plate, in the dealing lateral end clavicle fractures, whether it promises to be the most preferred technique.Material and Methods: To assess the results and long term effects in use of this plate we performed a retrospective analysis with a mean follow up of 24 months (2 years) of 20 patients with acute displaced lateral clavicle fractures, fixed with the clavicle hook plate. Results: Our short term results in all patients were first-class to excellent. None underwent non- union. Impingement symptoms were detected in 4 patients, 1 patient had skin/soft tissue issues and 1 had infection, warranting early implant removal. patients were re-evaluated at a mean follow-up period of 2 years. Conclusions: Clavicle hook plate is a reasonably good key treatment choice in fixing the acute displaced lateral end clavicle fractures. Proper selection of patients with good skin conditions and infection control are essential.

Peri-implant Fractures Following Hook Plate Fixation for Unstable Distal Clavicle Fractures

Clavicle hook plate is a common implant for treating distal clavicle fracture. Although high bone union rate and good functional outcome have been reported, so have several complications, such as osteolysis and fracture of the acromion, loss reduction, hook impingement, and rotator cuff tear. Peri-implant fracture over the medial side of the hook plate is a rare complication. Sporadic cases have been reported, and most of them have had no history of trauma. Between June 2015 and August 2018, 7 patients treated for distal clavicle fracture with a 3.5-mm locking compression hook plate with no history of trauma experienced peri-implant fracture of the medial clavicle. This complication occurred at a mean of 29 days. The incidence rate was 9.8%. Peri-implant fracture following hook plate fixation for distal clavicle fracture was not rare. Small hook angle, prolonged retention of the implant, an eccentric medial screw, high plate screw density, and small clavicle diameter may be risk factors for peri-implant fracture. Regarding treatment, 2 patients chose fracture revision with a distal clavicle locking plate and 5 patients chose conservative treatment. All patients achieved bone union at fracture sites. Surgical and conservative management of peri-implant fracture can achieve good functional outcome. [Orthopedics. 2020;43(5);e359-e363.].