Clavicular Hook Plate Fixation Research Articles

Efficacy of allogeneic tendon material coracoclavicular ligament reconstruction combined with Kirschner wire and titanium alloy hook plate material fixation in the treatment of acromioclavicular joint dislocation.

To compare the effects of allogeneic tendon coracoclavicular ligament reconstruction combined with Kirschner wire fixation and clavicular hook plate fixation on early postoperative pain, postoperative shoulder joint function score and shoulder joint mobility in patients with acromioclavicular joint dislocation. From January 2020 to January 2023, 43 patients with acromioclavicular joint dislocation admitted to Xi 'an Honghui Hospital were included. Among them, 24 patients were treated with the clavicular hook plate technique (Hook Plate,HP) group, and 19 patients were treated with allogeneic tendon coracoclavicular ligament reconstruction combined with the Kirschner wire technique (Allogeneic Tendon, AT) group. The Constant-Murley score of shoulder joint function 6months after operation, postoperative shoulder joint activity, preoperative and postoperative pain, operation time, intraoperative blood loss and complications were compared between the two groups. All 43 patients were followed up for an average of 9.7 (9-12) months. The intraoperative blood loss in the allogeneic tendon group was less than in the hook plate group. The Constant-Murley shoulder function score was higher than that in the hook plate group 6 months after the operation. The abduction and lifting activity was greater than that in the hook plate group. The visual analogue scale scores at 3days and 14 days after operation were lower than those in the hook plate group. The difference was statistically significant (p < 0.001). There was 1 case (5.3%) of exudation around the Kirschner needle track in the allogeneic tendon reconstruction group, and 5 cases (20.8%) of complications in the hook plate group, including 1 case of internal fixation stimulation, 2 cases of acromion impingement syndrome, 1 case of acromioclavicular joint osteoarthritis, and 1 case of shoulder joint stiffness. The complication rate of the allogeneic tendon group was lower than that of the hook plate group. The clinical efficacy of allogeneic tendon coracoclavicular ligament reconstruction combined with Kirschner wire fixation in treating acromioclavicular joint dislocation (Rockwood type III-V) is better than hook plate internal fixation. The patients have less early postoperative pain and better recovery of shoulder joint function and shoulder joint mobility.

Clinical Outcome after Clavicular Hook Plate Fixation for Displaced Medial-End Clavicle Fractures.

Surgery of the medial end of the clavicle remains a challenge for orthopedic surgeons. Moreover, there is no standard surgical procedure for treating displaced fractures or dislocation of the medial clavicle. Thus, the present study aimed to evaluate the safety and efficacy of using a hook plate for treating medial-end clavicular fractures and present functional outcomes. We retrospectively investigated 18 patients who underwent surgery with a hook plate from July 2016 to December 2021. There were 14 men and 4 women with a mean age of 57.4 years. Fracture union was assessed at follow-up by computed tomography (CT). Other outcome parameters were complications, including implant failure, infection, nonunion, osteolysis of sternal manubrium, and migration of the hook portion. Range of motion (ROM), visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH), and American Shoulder and Elbow Society (ASES) scores were evaluated 6 months postoperatively and at the last follow-up. The mean operation time was 43.8 minutes (range, 35-50 minutes) and the mean follow-up was 22.8 months (range, 12-42 months). Bone union was confirmed in all cases. The mean union time was 6.2 months (range, 6-7 months). Implant removal was performed routinely according to the clinical course in 17 cases. The mean implant removal time was 10.0 months (range, 6-14 months). Clinical and functional outcomes measured at the last follow-up were significantly improved compared to those at 6 months postoperatively (p < 0.05). Regarding complications, there were 6 cases (33.3%) of osteolysis of the sternal manubrium. Although the anteroposterior length of the manubrium and hook depth showed significant differences between the non-osteolysis group and the osteolysis group (p = 0.024), ROM, VAS, Quick DASH, and ASES scores were not significantly different between the two groups (all p > 0.05). Clavicle hook plating can be a safe and effective method that can be easily applied with good outcomes if it is used with appropriate surgical planning and technique for medial-end clavicle fracture. CT scans are useful for preoperative planning and postoperative evaluation of bone union or complications.

Comparative analysis of arthroscopic-assisted Tight-rope technique and clavicular hook plate fixation in the treatment of Neer type IIB distal clavicle fractures

BackgroundThe aim of the present study was to compare the clinical efficacy of arthroscopic-assisted fixation using the Tight-rope system and clavicular hook plate fixation in the treatment of Neer IIB distal clavicle fractures.MethodsWe enrolled 48 consecutive patients with Neer IIB distal clavicle fractures who were treated at our institution from February 2016 and August 2020. These patients were divided into 2 groups based on the fixation method (16 cases with Tight-rope system and 32 cases with clavicular hook plate), and demographics and clinical characteristics of patients in different groups were compared.ResultsAll 48 patients had functional outcome scores of the affected shoulder available at a mean of 23.8 ± 5.1 months, and there was a statistically significant improvement in the constant score, American shoulder and elbow surgeons (ASES) score, visual analogue scale (VAS) score at the end of follow-up (p < 0.001 respectively). However, the smaller length of skin incision, less estimated blood loss and shorter hospital stay were detected in the Tight-rope technique group patients than those of clavicular hook plate group patients (p < 0.001, respectively). Furthermore, the constant score, ASES score and VAS score were significantly improved in the Tight-rope technique group patients than those of clavicular hook plate group patients (p < 0.05, respectively).ConclusionsBoth Tight-rope technique and clavicular hook plate fixation can provide satisfactory clinical and radiological results in the treatment of distal clavicular Neer IIB fracture. However, arthroscopic-assisted fixation using the Tight-rope technique showed better results in terms of length of hospital stay, surgical trauma, clinical scores, and diagnose and treat concomitant glenohumeral pathologies.Levels of EvidenceIII, Case–control study Retrospective comparative study.

Comparative Analysis of Clavicular Hook Plate Versus Distal Radius Volar Plate With Coracoclavicular Augmentation for Neer's Type 2b Lateral Clavicle Fractures: A Prospective Study.

BackgroundClavicle fractures are common injuries in the adult population. The commonest site of fracture in the clavicle is the mid-shaft followed by the lateral end fracture. The anatomy and biomechanics of the lateral end clavicle make it prone to be unstable. Conservative management usually fails due to the deforming forces.AimOur study evaluates pain relief, functional outcome, and the union rate in unstable lateral end clavicle fracture fixed by two different modalities of operative management, namely clavicular hook plate fixation and distal radius volar plate fixation.Materials and methodA total of 60 patients with the unstable lateral end of clavicle fracture were evaluated in this study at a single tertiary care center between August 2015 and September 2021. Half of the patients (30 patients) were managed by open reduction and internal fixation with clavicular hook plate. The remaining half (30 patients) underwent open reduction and internal fixation by distal radius volar plate supplemented with coracoclavicular fixation. All patients were followed up for a mean duration of 20 months. The functional outcome was assessed at regular intervals by Constant score and Disability of the Arm, Shoulder and the Hand (DASH) score for a period of one year.ResultThere was significant pain relief and improvement in the functional status of patients. The pain relief was significant in the group managed by distal radius volar plate. The decrease in DASH score and increase in Constant score suggests better functional outcomes in these patients.ConclusionOur study highlights the fact that the distal radius volar plate is an excellent alternative to the hook plate in the treatment of unstable lateral third clavicle fractures. The decrease in pain and improved functional outcome stresses the fact that the volar locking plate is the recent most advancement in the fracture fixation of Neer’s type ll fractures. The distal radius volar plate is the recent internal fixation technique to manage unstable lateral end clavicle fractures.

Comparison of Suture-Button Versus Hook-Plate Fixation for Acromioclavicular Joint Injuries

Background: This retrospective study aimed to compare the clinical and radiological results of clavicular hook plate fixation versus suture-button fixation of acromioclavicular joint (ACJ) dislocations. Methods: 21 patients are retrospectively evaluated in the present study whom diagnosed as type III-V ACJ dislocations and treated by two different surgical methods. The hook plate group comprised 9 patients to whom acromioclavicular fixation. The suture-button group comprised 12 patients to whom coracoclavicular fixation. All patients were evaluated by Constant Murley Score (CMS) and visual analogue score (VAS). Loss of reduction and radiological results were evaluated with the coracoclavicular distance (CCD). Results: The average follow-up was 31 months (range, 15–56 months). There was no significant difference between hook-plate and suture-button groups in terms of CMS. However, VAS in hook plate group better than suture-button group (p = 0.038). Suturebutton fixation adjusted the CCD more than hook plate fixation compared to the opposite shoulder (p = 0.482). Conclusions: There was no statistically significant difference between the hook plate and suture-button group in terms of the clinical outcomes. However, CCD in the suture-button group was better adjusted to the hook plate group. Suture-button fixation is a good option for the treatment of ACJ dislocations, as implant removal may be required in most cases in which the hook plate is applied.

Neer Type II Distal End Clavicular Fracture: Outcome with Clavicular Hook Plate Fixation

Background: Distal end clavicular fractures are rare type of injuries seen in adult population. These fractures are unstable because of various deforming forces. Clavicular hook plate aligns the clavicle along with ligaments. The aim of this study is to observe the outcome of displaced distal end clavicular fracture managed with hook plate fixation.Methods: Twenty five patients with displaced distal end clavicular fractures (Neer type II) were evaluated retrospectively from November 2018 to September 2020. Functional outcome were assessed via Constant and Murley score at one year final follow-up.Results: 60% of patient had excellent outcome, 32% of patient had good outcome and 8% of patient had fair outcome at final follow-up. Mean Constant and Murley score was 86. Four patients developed subacromial osteolysis which resolved at final follow-up. One patient had extra-articular ossification whereas none of the patient developed non-union and AC joint arthrosis.Conclusion: Clavicular hook plate provides stable fixation of distal end clavicular fracture with few complications and is cost-effective.Keywords: Clavicular Hook Plate; Complications; Distal End Clavicular Fractures; Subacromial Osteolysis

Treatment of fractures of the lateral end clavicle by hook plate

Aim To assess the outcomes of management of an unstable fracture of the lateral end of the clavicle with clavicular hook plate. Patients and methods A total of 23 patients with displaced fracture lateral end clavicle were treated with clavicular hook plate fixation. The mean age of patients was 38.5 years (range, 28–55 years). Results The mean follow-up period was 20 months (range, 28–39 months). The mean fracture healing time was 12 weeks after operation. One (4.2%) patient had nonunion with good alignment without functional disability and was asymptomatic. One patient had a superficial wound infection. One patient had impingement, and his pain was resolved shortly after plate removal. AC joint arthrosis was reported in one patient. The mean constant score for the affected shoulder was 90 points (87–100), whereas the mean score for the contralateral shoulder was 96 points (92–100). The plate was removed in three (13%) patients only. Conclusion Clavicular hooked plate is a good method for management of lateral end clavicle fractures. It can provide stable fixation with a low rate of complications. Removal of the plate is not necessary.

Outcome of acromioclavicular joint fixation with hook plate in rookwood type III, IV, V acromioclavicular dislocations

Acromioclavicular disruption is common injury in cases of athletic male adults. Internal fixation by Clavicular Hook plate fixation is one of the method used to treat Acromioclavicular Disruption. The aim is to study the results of Acromioclavicular joint fixation with Hook plate in Rookwood type III, IV and V Acromioclavicular dislocations. A Prospective analysis was performed on 22 patients treated with hook plate for acromioclavicular disruption in Department of Orthopaedics, SSG hospital, Vadodara from June 2017 to July 2018. All 22 cases were assessed post-operatively for outcome using the Constant-Murley shoulder function score and radiology at 24 weeks, 48 weeks and 8 weeks after the removal of the hook plate if patient provides consent for removal. In our study; 18 cases were Rockwood type III and 4 cases were Type V. The Constant-Murley Shoulder function score was average 72.4 (Satisfactory) at 24 weeks post-operative; average 80.6(Good) at 48 weeks in all 18 patients without removal of plate. Of 4 patients opting for removal of plate; Constant-Murley score was average 68.2 (Adequate) at 6 weeks post-operatively, which increased significantly to average 92.2 (Excellent) at 8 weeks after removal of plate. Hook plate is a good implant for fixation of Rockwood type III, IV and V Acromioclavicular disruption with minimal complications.

Comparison of clavicular hook plate with and without coracoclavicular suture fixation for acute acromioclavicular joint dislocation

ObjectiveThe aim of this study was to compare the clinical and radiographic outcomes of clavicular hook plate fixation with and without coracoclavicular (CC) tape augmentation for the treatment of acute unstable AC dislocation. MethodsWe treated 47 patients (31 men and 16 women; mean age: 47 years (range, 21–81)) with unstable acute AC dislocations (Rockwood III–V) and divided them into two groups according to the treatment modality, with hook plate fixation (hook plate group) or hook plate plus CC tape augmentation (combined group). We assessed radiologic findings, such as subacromial osteolysis and AC osteoarthritis. We also evaluated the clinical outcomes using a visual analogue scale (VAS) for pain, as well as the University of California at Los Angeles (UCLA) Shoulder Rating Scale and the American Shoulder and Elbow Surgeons (ASES) Shoulder Score. ResultsWe found that the combined group had less subacromial osteolysis upon radiography, although the CC distance was similar in both groups (119 ± 29.7% of contralateral side CC distance in hook plate group versus 119 ± 34.8% in the combined group, p = 0.77). Compared with the hook plate group, the combined group had a lower VAS score (4.5 ± 2.3 in hook plate group versus 2.3 ± 1.4 in the combined group, p < 0.001), better UCLA scores (19.9 ± 4.9 in hook plate group versus 27.2 ± 4.0 in the combined group, p < 0.001) as well as better ASES scores (51.9 ± 17.8 in hook plate group versus 73.8 ± 13.1 in the combined group, p < 0.001) at 3 and 6 months after surgery. ConclusionHook plate fixation plus CC tape augmentation may prevent subacromial osteolysis and yield better short-term functional outcomes. Level of EvidenceLevel III, Therapeutic Study.

Acromion morphology affects acromion osteolysis and fracture after clavicular hook plate fixation

Objective To investigate the impacts of acromion morphology on acromion osteolysis and fracture after clavicular hook plate fixation. Methods The clinical data were analyzed retrospectively of 255 patients who had been treated by clavicle hook plate from January 1st, 2011 through December 31th, 2012 at Department of Orthopedics, Shanghai Sixth People’s Hospital. They were 182 males and 73 females with an average age of 46.6 years (from 14 to 76 years). Of them, 130 were diagnosed with distal clavicular fracture, of which 126 were acute cases (within 14 days) and 4 chronic ones. The other 125 patients were diagnosed with acromioclavicular dislocation, of which 121 were acute cases and 4 chronic ones. Radiological data were reviewed to analyze the morphology and clinical outcome of acromion osteolysis. The hook-acromion (HA) angle was measured and the relationships between HA angles and different types of acromion osteolysis were statistically analyzed. Results The follow-up for the 255 patients averaged 6 months (from 1 to 24 months). Acromion osteolysis with different migrations of clavicular hook plate was observed in 175 cases (68.6%), of which 77 were type I (osteolysis with clavicular hook migration) and 98 type Ⅱ (osteolysis without clavicular hook migration). Acromion fractures were observed in the other 6 cases (2.35%). The HA angles in type Ⅰosteolysis (11.05°±11.69°) were significantly larger than that in type Ⅱ (6.36°±11.47°) (P<0.05) Conclusions An increased HA angle may be a risk factor for acromion osteolysis with clavicular hook migration and acromion fracture. Variation in acromion morphology may increase the HA angle. Stress localization may be one of the mechanisms of acromion osteolysis and fractures. Key words: Acromion; Acromioclavicular joint; Internal fixators; Stress; Complications

A novel hybrid fixation (coracoclavicular screw supplemented with K-wire) for the treatment of acute acromioclavicular joint dislocation: A prospective study

ObjectiveThe aim of this study was to compare the radiological and clinical outcomes of clavicular hook plate fixation and the coracoclavicular lag screw supplemented with K-wire fixation in the treatment of acute acromioclavicular joint dislocation. MethodsBetween January 2012 to December 2015, 81 patients with acute acromioclavicular joint dislocation were included in this prospective study. 43 patients were treated with clavicular hook plate fixation (Group A) and 38 patients were treated with coracoclavicular lag screw supplemented with K-wire fixation (Group B). Incision length, operation duration, blood loss volume, intraoperative fluoroscopy times and length of hospitalization were recorded. Radiographic outcomes, functional outcomes and complications were also recorded. ResultsBoth two groups could achieve good radiographic and functional outcomes after operation. Group B exhibited significantly shorter operation duration, shorter length of incision, less blood loss volume and shorter length of hospitalization than Group A (P < 0.001). In addition, significant difference could be found between the two groups regarding the VAS scores three month postoperatively and the final follow-up (P < 0.001). However, there was no significant difference in radiographic and functional outcomes between the two groups (P > 0.05). ConclusionThe two groups can both achieve satisfactory radiological and functional outcomes in treating acute AC joint dislocation. However, CC screw fixation supplemented with K-wire exerts some advantages regarding the incision length, operation duration, blood loss volume, length of hospitalization. Furthermore, it can better relieve the pain caused by dislocation. Therefore, the novel hybrid fixation (CC screw fixation supplemented with K-wire) provides an alternative treatment for acute AC joint dislocation.

Modified closed-loop double-endobutton technique for repair of rockwood type III acromioclavicular dislocation.

Acromioclavicular dislocation (ACD) is a common injury. According to the Rockwood classification, ACD is classified into six types (type I–VI); however, for type III injuries, it remains controversial whether or not operative treatment should be applied. Numerous studies have advocated early surgical treatment to ensure early rehabilitation activities. Thus, the present study aimed to investigate a modified closed-loop double-endobutton technique (MCDT), that may be used to repair Rockwood type III ACD. In the current study, 61 patients with Rockwood type III ACD were enrolled during a period of 5 years at the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. Patients were divided into three groups according to the surgical method used, the MCDT group (n=20), the common closed-loop double-endobutton technique (CCDT) group (n=21), and the clavicular hook plate fixation (CHPF) group (n=20). Preoperative and intraoperative information were recorded. Furthermore, the functional scores of injured shoulder were evaluated prior to surgery and following surgery with a 1-year follow-up. Among the three groups, postoperative functional scores were significantly more improved compared with those prior to surgery (P<0.05), and no significant difference was observed regarding the coracoclavicular interval with the 1-year follow-up (P>0.05). Postoperative functional scores in the MCDT and CCDT groups were significantly more improved compared those in the CHPF group (P<0.05). In addition, the duration of surgery in the MCDT group was significantly shorter compared with that in the CCDT group (P<0.05). Furthermore, compared with the CHPF group, the incision length was significantly shorter with reduced hemorrhage in the MCDT group (P<0.05). In conclusion, the results of the current study suggest that MCDT is more simple, convenient and efficient compared with CCDT, and is worth popularizing.

The outcome of clavicular hook plate fixation for acromioclavicular dislocation associated with coracoid process fracture

The outcome of clavicular hook plate fixation for acromioclavicular dislocation associated with coracoid process fracture

Hook plate fixation for acute acromioclavicular dislocations without coracoclavicular ligament reconstruction: a functional outcome study in military personnel.

The aim of our study was to evaluate the shoulder function after clavicular hook plate fixation of acute acromioclavicular dislocations (Rockwood type III) in a population group consisting exclusively of high-demand military personnel. This prospective study was carried out at a tertiary care military orthopaedic centre during 2012–2013 using clavicular hook plate for management of acromioclavicular injuries without coracoclavicular ligament reconstruction in 33 patients. All patients underwent routine implant removal after 16 weeks. The functional outcome was assessed at 3, 6 and 12 months after hook plate removal and 2 years from the initial surgery using the Constant Murley and UCLA Scores. All the patients were male serving soldiers and had sustained acromioclavicular joint dislocation (Rockwood type III). Mean age of the patient group was 34.24 years (21–55 years). The mean follow-up period in this study was 23.5 months (20–26 months) after hook plate fixation and an average of 19.9 months (17–22 months) after hook plate removal. The average Constant Score at 3 months after hook plate removal was 60.3 as compared to 83.7 and 90.3 at 6 months and 1 year, respectively, and an average of 91.8 at the last follow-up that was approximately 2 years after initial surgery which was statistically significant (p value <0.05). The UCLA Score was an average of 15.27, 25.9 and 30.1 at 3, 6 months and 1 year, respectively, after removal of hook plate which improved further an average of 32.3 at the last follow-up, which was also statistically significant (p value <0.05). Clavicular hook plate fixation without coracoclavicular ligament reconstruction is a good option for acute acromioclavicular dislocations producing excellent medium-term functional results in high-demand soldiers.

Clavicular hook plate for grade-III acromioclavicular dislocation.

To review the outcomes of clavicular hook plate fixation for grade-III acromioclavicular (AC) dislocation in young athletes. Medical records of 14 male and 5 female athletes aged 18 to 49 (mean, 29) years who underwent fixation with a 3.5-mm-thick, 15-mm-long clavicular hook plate for acute grade-III AC dislocation were reviewed. The visual analogue score for pain and the Constant shoulder score were assessed. The mean follow-up was 4.2 years. The mean visual analogue score for pain was 1.8 (range, 1-3). The Constant shoulder score was excellent (≥ 90) in 14 patients and good (83-89) in 5 patients. All patients achieved range of motion equal to that of the contralateral side at week 5. Sports activities were resumed by month 6 at the latest. The clavicular hook plate for grade- III AC dislocation enables quick return to sports activities and achieves good-to-excellent functional outcome.

Arthroscopic evaluation for omalgia patients undergoing the clavicular hook plate fixation of distal clavicle fractures.

BackgroundThe aim of this study is to investigate the anatomic changes in the shoulder joints responsible for omalgia after the clavicular hook plate fixation under arthroscope.MethodsArthroscopic examination was carried out for 12 omalgia patients who underwent clavicular hook plate fixation due to distal clavicle fractures. Functional outcome of shoulder was measured by the Japanese Orthopaedic Association (JOA) score before and after the withdrawal of the fixation plate.ResultsThe rotator cuff compression by the clavicular hook was arthroscopically observed in 11 of the 12 cases. The JOA scores of the shoulder were significantly improved at 1 month after the withdrawal of the fixation plate (pain, 28 ± 2.4 vs. 15 ± 5.2; function, 19.2 ± 1.0 vs. 11.7 ± 1.9; range of movements, 26.8 ± 2.6 vs. 14.8 ± 3.4) compared with before.ConclusionsThe impingement of the hook to the rotator cuff may be the main cause for the omalgia. The appropriate hook and plate that fit to the curve of the clavicle as well as the acromion are necessary to decrease the severity of omalgia.

Has the arthroscopically assisted reduction of acute AC joint separations with the double tight-rope technique advantages over the clavicular hook plate fixation?

The purpose of this study was to compare the results after arthroscopically assisted double TightRope(®)-(TR) reduction with results after clavicular hook plate (HP) fixation in acute high-grade acromioclavicular (AC) joint separations. Between 2004 and 2010, 69 consecutive patients with acute AC joint separations type Rockwood III and V were subjected to surgical reconstruction. 56 patients (81 %) were available for evaluation. Thereof, 30 (median age: 39 years; n = 12 acute Rockwood III and n = 18 Rockwood V injuries) were treated by a clavicular HP and 26 (median age: 39 years; n = 10 acute Rockwood III and n = 16 Rockwood V injuries) using the double TR technique. Group HP was evaluated at a median of 48 (7-77) months after surgery and the TR group 17 (7-29) months after stabilization. Visual Analogue Scale (VAS) for Pain, Simple Shoulder Test (SST), Constant Score (CS) and Taft Score (TS) were assessed. Sonographic measurements were performed to evaluate recurrent instability. Clinical examination demonstrated comparable results without significant differences. In the groups HP and TR, the VAS was median 0.8 (range, 0.0-7.5) and 0.4 (range, 0.0-5.7), the SST reached median 11 (range, 0-12 points) and 12 points (range, 8-12 points). The CS was median 92.4 % (range, 21.5-105.4 %) and 94.0 % (range, 54.6-105.3 %) and the TS median 10 (range, 3-12 points) and 10 points (range, 5-12 points). Sonographic measurements showed a mean coracoclavicular (CC) distance of 25.3 ± 4.5 (HP) and 25.5 ± 4.3 mm (TR) (n.s.). In both groups, CC distance of the operated side was significantly higher compared to the uninjured side. The complication rate was 13 % in group HP and 12 % in group TR. In acute high-grade AC joint instabilities, both techniques lead to mostly good and excellent clinical results, although comparable partial recurrent vertical instability could be observed. Diagnosis and therapy of concomitant glenohumeral injuries and no obligatory implant removal are advantages of the arthroscopic procedure.

Clinical Results of Treatment Using a Clavicular Hook Plate Versus a T-plate in Neer Type II Distal Clavicle Fractures

AO clavicular hook plate fixation provides more rigid fixation and good bony union rates for Neer type II distal clavicular fractures. However, the hook may cause rotator cuff tears and subacromial impingement, which adversely affect the clinical results. T-plate fixation is another surgical method of treatment for unstable clavicle fractures, and its clinical efficacy has been demonstrated. The purpose of this study was to compare the clinical outcomes of AO clavicular hook plate and T-plate fixation for Neer type II distal clavicular fractures. Forty-two patients with Neer type II fractures were divided into 2 groups. The hook plate group comprised 23 patients who underwent hook plate fixation, and the T-plate group comprised 19 patients who underwent distal radius volar locking T-plate fixation. Hook plates were removed 3 to 14 months postoperatively in 15 patients because of shoulder function limitations. All patients were evaluated postoperatively for shoulder pain, activities of daily living, range of motion, strength, and satisfaction according to the University of California, Los Angeles (UCLA) Shoulder rating scale. All fractures in the 2 groups achieved stable fixation and bony union. Both groups yielded similar outcomes with regard to shoulder strength and patient satisfaction (P=.207 and P=.398, respectively). Significant differences existed between the 2 groups in the mean scores of shoulder pain, activities of daily living, range of motion, and total UCLA score (P=.001, P=.011, P=.038, and P=.001, respectively). More patients (74%) in the hook plate group had mild to severe shoulder pain than in the T-plate group (16%). However, shoulder pain was relieved and function improved significantly after removal of the hook plate (P=.001).

Arthroscopic-assisted Locking Compression Plate clavicular hook fixation for unstable fractures of the lateral end of the clavicle: a prospective study

The aim of this prospective study was to assess the clinical outcomes of an unstable fracture of the lateral end of the clavicle treated with an arthroscopic-assisted locking compressive plate (LCP) clavicular hook plate. Twenty-three patients underwent arthroscopic assisted LCP clavicular hook plate fixation for these fractures. All patients achieved clinical and radiological union over a mean of 4.2 months (range, 3.4-5 months). Four patients (17%) showed some degree of acromial osteolysis. Three patients (13%) showed radiological signs of arthrosis of the acromioclavicular joint. In one patient, a second fracture (stress) was observed between the medial two screws of the plate without an additional injury. Five patients (22%) showed subacromial bursitis on dynamic ultrasonography. The mean Constant and Murley score was 91 points (range, 81-98). The average level of pain in the shoulder at rest and on abduction was 1 (range, 0-2) and 2.4 (range, 0-4), respectively. Based on our experience, arthroscopic-assisted LCP hook plate fixation for the treatment of unstable fractures of the lateral end of the clavicle is not without complications. However, it is an acceptable alternative method that is easy to apply with good results. Furthermore, it prevents rotator cuff impingement, allows early mobilisation and maintains the acromioclavicular joint biomechanics.

Surgical treatment of acromiodavicular dislocation (Tossy III) with coracoclavicular screw and clavicular hook plate fixation:a comparative study

：Objective To compareclinical outcomes of clavicular hook plate and coracoclavicu-lar screw fixation intreatment of acrmioclavicular dislocation (Tossy Ⅲ). Methods From August 2003to January 2008,38 patients with acromioclavicular dislocation (Tossy Ⅲ)were randomly divided into two groups that were treated with coracoclavicular screw andclavicular hook plate fixation respective-ly. The range of shoulder movement wasrestricted after operation until the fixation was removed three months later. The shoulderfunction was evaluated by using Japanese Orthopedic Association (JOA) sco-ring system. Thefunctional scores were compared before and after removal of the internal fixation in twogroups. Results All patients were followed up, which showed no statistical difference uponfinal shoulder function of two groups. There was no loosening or migration of internalfixators. No redislocation occurred after removal of internal fixations. Seven patientscomplained shoulder pain and three had severe shoulder pain affecting sleep quality incoracoclavicular screw group. The pain was alleviated after remov-al of fixation.Conclusions Coraeeclavicular screw and clavicular hook plate fixation have similarclinical effect in treatment of acromioclavicular dislocation (Tossy Ⅲ), with satisfactory recovery ofshoul-der function. Many complications of acromioclavicular fixations can be avoided byrestriction of shoulder movement after operation and early functional exercise afterremoval of fixation. Key words: Acromioclavieularjoint; Dislocation; Internal fixators