Hook Plate Research Articles

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.

Dual plate has better biomechanical stability than hook plate or superior single plate for the fixation of unstable distal clavicle fractures: a finite element analysis.

A variety of surgical techniques have been addressed for distal clavicle fractures, while none of these is considered to be gold standard fixation. Currently, dual plate fixation has been proposed and achieved satisfying clinical results. However, the biomechanical study about dual plate technique in treating unstable distal clavicle fractures is limited. Thus, the purpose of this study was to investigate the biomechanical properties of this technique by finite element analysis. A geometry model of distal clavicle fractures was combined with hook plate, superior single plate and dual plate, respectively, to simulate the implant fixation process. Two loading conditions and two boundary conditions were applied in the finite element models following a mesh convergence test. The stress distribution was observed, and peak von Mises stress and maximum displacement were used as indexes for analysis. The dual plate model showed the highest clavicle stress (13.1MPa), but lowest fixation stress (18.9MPa) compared to the hook plate and superior single model. In regarded to stability, dual plate model exhibited a minimum displacement with only 0.099mm. Dual plate fixation has better biomechanical stability with lower risk of implant failure. Thus, dual plate fixation is an alternative technique for unstable distal clavicle fracture. The complication of peri-implant fracture of dual plate technique should also be cautious in clinical practice, and more clinical evidence is needed.

Comparative study of three different fixation techniques for the treatment of Neer type IIb distal clavicle fractures: A retrospective cohort study.

Recently, a locking plate (LP) combined with a suture button was applied for distal clavicle Neer type IIb fractures. However, to our knowledge, there is limited information on clinical outcomes surrounding locking plates combined with a suture button in the treatment of Neer type IIb distal clavicle fractures. The aim of this study was to compare the outcomes among three different fixation techniques for the treatment of Neer type IIb distal clavicle fractures. We performed a retrospective cohort study of 53 patients with Neer type IIb distal clavicle fractures who were treated with a hook plate (HP group, 16 patients), a locking plate alone (LP group, 18 patients), or a locking plate with a suture button (LPSB group, 19 patients) in our hospital between March 2014 and August 2019. The clinical and radiological outcomes were evaluated, including union time, postoperative complications, and function of the shoulder joint. The follow-up period was at least 2 years for all patients. All patients in the LPSB group achieved bone healing at the final follow-up. No significant differences were observed, including age, sex, side, time to surgery, duration of surgery, and mean follow-up period among the three groups (p > 0.05). The union time was shorter in the LPSB group than in the other two groups (p < 0.05). Postoperative complications were lower in the LPSB group than in the other two groups (p < 0.05). The visual analog scale score and Constant-Murley score in the LPSB group were better than those in the other groups at 3 and 6 months postoperatively (p < 0.05). Compared with HP and LP alone, LPSB yields better clinical outcomes and lower complication rates in the treatment of Neer type IIb distal clavicle fractures.

CLINICO-FUNCTIONAL AND RADIOLOGICAL OUTCOME OF LATERAL END OF CLAVICLE FRACTURE MANAGED WITH SUBACROMIAL CLAVICULAR HOOK PLATE – AN PROSPECTIVE CASE STUDY

Introduction :- The use of the acromioclavicular hook plate to treat lateral-third clavicle fractures is controversial . This is believed to be a result of issues with the hook plate such as impingement symptoms, which can result in chronic pain and movement limitations. Our goal was to assess the radiological functional outcome of individuals with lateral end clavicle fractures managed with subacromial hook plate. Methods And Methodology :- We prospectively reviewed all 16 patients who underwent surgery from July 2020 to August 2022 using our electronic patient information database. All patients were assessed in the out patient department to determine both Oxford and Constant shoulder scores to assess the clico-functional outcomes. Among 16 patients who underwent surgery with the hook plate Results:- , 10 male and 6 female. The mean age was 36.2 years. The median length of hospital stay was 4 days. The median follow-up was 12 months. The median time from date of injury to surgery was 7 days one patient presented 4 months after injury. The mean time for fracture union was 3 months from the date of surgery and the union rate was 95%. In total, 13 of plates were removed. The median time for implant removal was 4.5 months. In a case of fracture lateral end of Conclusion: Clavicle, open reduction and internal xation with clavicular hook plate achieves reliable internal xation with early mobilization. In view of this we state that clavicular hook plate is an reliable option for treating these types of fractures.

Application of a new sternoclavicular hook plate in bipolar clavicle injuries.

To evaluate the safety and effectiveness of using a new sternoclavicular hook plate combined with a shoulder locking hook plate for the treatment of bipolar clavicle injuries. Retrospective analysis of 7 patients with bipolar clavicle injury, all-male, with a mean age of 51.1 years, who underwent a new sternoclavicular hook plate combined with a shoulder clavicular hook plate implantation. All 7 patients were fixed with a sternoclavicular hook plate combined with a repositioned shoulder locking hook plate and received 13-24 months of follow-up. There were no postoperative complications, no wound infections, and no plate or screw fractures. The mean ASES score was 94.3 ± 2.8. The safety and effectiveness of a new sternoclavicular hook plate combined with a shoulder locking hook plate in the treatment of bipolar clavicle injuries.

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.

SURGICAL TREATMENT OF ACROMIOCLAVICULAR DISLOCATION: HOOK PLATE VERSUS SUTURE BUTTON.

We aimed to compare the functional and radiographical outcomes of reconstruction of acute unstable acromioclavicular joint (ACJ) dislocation using Hook Plate (HP) versus Suture Endobutton (SE) fixation techniques. Forty-six consecutive patients with grade III to V ACJ dislocation according to Rockwood classification who underwent either HP or SE fixation in the period between January 2017 and June 2020 were evaluated. The treatment modalities were divided into either HP or SE fixation. The radiological assessment included standard anterior-posterior (AP) views to evaluate coracoclavicular (CC) distances for vertical reduction. CC distances were grouped as preoperative (CC1), early postoperative (CC2), and late postoperative (CC3). The distance variance between CC2 and CC3 was referred as ΔCC (CC3 - CC2). A statistically significant difference was found in ΔCC between the two groups (p=0.008). ΔCC was significantly higher in the SE group compared to the HP group (p<0.05). The Constant and UCLA Scores of patients in the SE group were found to be significantly higher than in the HP group patients. Clinical outcomes were more satisfactory in patients with acute unstable ACJ dislocation who underwent SE compared to HP procedures, at the end of the first year. Evidence Level IV; Case Series.

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.

Comparison of four different treatment methods in distal clavicle fractures: Conservative treatment, locking plate, hook plate and tension band wiring

Comparison of four different treatment methods in distal clavicle fractures: Conservative treatment, locking plate, hook plate and tension band wiring

Clinical Study of Surgical Management of Olecranon Fracture.

Road Traffic Accidents, falls while walking and running, and Sports are the major causes of the Olecranon fracture. Early intervention is of utmost importance for the mobility of the elbow joint for early recovery of the patients so they can report to their job as soon as possible. The present study aimed to compare the clinical application of cast and surgical intervention. It is a prospective study carried out in Bapuji Hospital and Chigateri General Hospital attached to J. J. M Medical College, Davangere, with the technical assistance of ESIC hospital. Ten cases of fractures of the olecranon treated by Kirschner wire with tension band wiring technique for Transverse and Oblique fractures and Olecranon hook plate for Comminuted fractures. The early elbow mobility is observed in surgical intervention group when compared to cast application as yielded better results. Ten cases of fractures of the olecranon treated by Kirschner wire with tension band wiring technique for Transverse and Oblique fractures and Olecranon hook plate for Comminuted fractures at the Chigateri General Hospital and Bapuji Hospital, attached to J. J. M. Medical College, Davangere, have been presented. Special attention was made to mobilize the affected elbow early. Surgical fixation for Olecranon fractures will helps in early mobility of joints and anatomical fixation of the fractures.

Dual fixation for coracoid fracture with acute acromioclavicular joint disruption: A case series

Introduction: Management of concomitant coracoid fracture with acute acromioclavicular joint disruption has been a matter of debate. The coracoid component is not always radiographically recognized; thus, this combined orthopedic injury is not often common. Management options varied from conservative to surgical management with single or dual fixation strategy. This study aimed at outcome evaluation of clavicular hook plate with coracoid screw fixation in athletics and patients with high-demand activities for at least one year follow-up. Material and methods: Included patients underwent fixation through clavicular hook plate and coracoid screw. The hook plate was removed after an average period of 16.1 weeks, rehabilitation program was followed. Patients were subjected at final follow-up visit to clinical assessment via ROMs, constant, and ASES scores. Besides, radiological judgement of acromioclavicular joint reduction as per CCD and CCD ratio. Results: The average ASES Scores were 39.1±14.6, 67.4±11.5, and 86.7±5.7 at 3, 6, and 12 months, respectively with a statistically significant improvement in between (P-value &lt;0.001). The mean active shoulder abduction and forward elevation ROMs were 156.4°±12.8° and 171.4°±6.3°. The average CCD was 9.04±0.9 mm (7.6-10.2 mm), and the mean CCD ratio was 1.07±0.03% (1.01-1.11%). Conclusion: Dual fixation via hook plate and coracoid screw without CCL reconstruction provides a stable fixation construct with considerable functional and radiological outcome in high demand patients with acute traumatic ACJ disruption combined with coracoid fracture. Study Design: Case series study.

A RARE CASE OF FRACTURE PERIPROSTHETIC SHAFT FEMUR LEFT SIDE OPERATED WITH HOOK PLATE AND CABLES

The overall incidence of different types of periprosthetic fractures is on rise mainly due to increasing number of primary joint arthroplasties and revision arthroplasties. Both increasing implantation numbers of total hip replacements and demographic change with higher populations of older people, indicate that there will be an increase in periprosthetic fractures in near future. We present our experience in a case of post traumatic periprosthetic Vancouver type B fracture after hemiarthroplasty treated with Hook plate and Cables.

Comparison of the Hook Plate versus TightRope System in the Treatment of Acute Type III Acromioclavicular Dislocation

The objective of this study is to compare the effectiveness of the clavicular hook plate (HP) technique and the minimally invasive coracoclavicular (CC) fixation with a TightRope (MITR) procedure in treating acute unstable distal clavicle dislocation. MITR (minimally invasive TightRope) group had 21 patients, and the open reduction and internal fixation (HP) group included 23 patients. Researchers compared MITR and HP (hook plate) outcomes for the treatment of acute type III AC joint dislocation in a retrospective analysis. The patients were followed up at 1 3, 6, and 12 months postoperatively. Complications were analyzed such as redislocation, fractures, implant-related complications, or subacromial erosion. For the clinical outcomes, the visual analog scale (VAS) (0: no pain, 10: worst possible pain), Constant-Murley score (CMS) (100: no pain, 0: maximum pain), the average satisfaction score with their current shoulder function (range: 0-10), and the University of California at Los Angeles Shoulder score (UCLA) (>27 good/excellent <27 fair/poor) were recorded at the last follow-up. There were 21 sufferers in the MITR group, which comprises 19 males and 2 females and 23 individuals in the HP group (20 men and 3 women), with average ages of 43.9 and 39.2, respectively. Age, sex, laterality, and the interval between injury and surgery did not significantly differ between the two groups (0.357, 0.792, 0.432, and 0.55, respectively). No statistically significant difference was found between the groups in terms of the VAS score and CMS score at one year postoperatively. The mean CCD at the initial trauma and last follow-up was not significantly different between the MITR and HP groups (p=0.365, p=0.412 respectively). For treating acute type III AC dislocations, the minimally invasive TightRope (MITR) system and the hook plate technique were great options. However, the minimally invasive TightRope system showed further benefits such as reduced reoperation for implant removal and reduced risk of subacromial distal clavicle osteolysis.

Distal third clavicle fractures : a nationwide trainee-led collaborative review of current practice.

Distal third clavicle (DTC) fractures are increasing in incidence. Due to their instability and nonunion risk, they prove difficult to treat. Several different operative options for DTC fixation are reported but current evidence suggests variability in operative fixation. Given the lack of consensus, our objective was to determine the current epidemiological trends in DTC as well as their management within the UK. A multicentre retrospective cohort collaborative study was conducted. All patients over the age of 18 with an isolated DTC fracture in 2019 were included. Demographic variables were recorded: age; sex; side of injury; mechanism of injury; modified Neer classification grading; operative technique; fracture union; complications; and subsequent procedures. Baseline characteristics were described for demographic variables. Categorical variables were expressed as frequencies and percentages. A total of 859 patients from 18 different NHS trusts (15 trauma units and three major trauma centres) were included. The mean age was 57 years (18 to 99). Overall, 56% of patients (n = 481) were male. The most common mechanisms of injury were simple fall (57%; n = 487) and high-energy fall (29%; n = 248); 87% (n = 748) were treated conservatively and 54% (n = 463) were Neer type I fractures. Overall, 32% of fractures (n = 275) were type II (22% type IIa (n = 192); 10% type IIb (n = 83)). With regards to operative management, 89% of patients (n = 748) who underwent an operation were under the age of 60. The main fixation methods were: hook plate (n = 47); locking plate (n = 34); tightrope (n = 5); and locking plate and tight rope (n = 7). Our study is the largest epidemiological review of DTC fractures in the UK. It is also the first to review the practice of DTC fixation. Most fractures are being treated nonoperatively. However, younger patients, suffering a higher-energy mechanism of injury, are more likely to undergo surgery. Hook plates are the predominantly used fixation method followed by locking plate. The literature is sparse on the best method of fixation for optimal outcomes for these patients. To answer this, a pragmatic RCT to determine optimal fixation method is required.Cite this article: Bone Jt Open2022;3(12):953-959.

Comparison of hook plate alone, hook plate augmented with suture anchor, and arthroscopically-assisted tightrope fixation in the treatment of patients with acute type v acromioclavicular joint dislocations

IntroductionThe best treatment for Rockwood type V acromioclavicular (AC) joint dislocation is unknown. HypothesisHook plate augmented with suture anchor (HA) may have different clinical and radiological results than hook plate alone (H), and arthroscopically assisted TightRope (TR) techniques in treating acute type V AC joint dislocations. Material and methodsThis retrospective study included 71 patients with acute type V AC joint dislocations between December 2010 and August 2018. Patients were categorized into three groups: H group (n=22), HA group (n=23) and TR group (n=26). We measured the coracoclavicular distance (CCD) differences and CCD ratio compared to uninjured side pre-operatively, immediately post-operatively, at 3-month and 2-year after operation. Clinical outcomes were assessed as well at the same time points. Loss of correction was determined by the CCD difference and ratio between surgical and uninjured sides. ResultsThe mean age and follow-up period were 41.8±24.7 years and 30.2±4.3 months, respectively. No significant differences were found in the demographic data between the three groups. The HA group presented a trend of less overcorrection but without significance compared with the H group at immediately post-operation, 3-month, and 2-year follow-up. (CCD difference: –2.4mm vs. –3.7mm, –1.6mm vs. –1.8, and 0.2mm vs –1.9mm, CCD ratio: 67.7% vs. 40.9%, 79.3% vs. 70.1%, and 100.6% vs. 86.5%, respectively). The HA group also had significantly less loss of correction compared with the TR group at 3-month and 2-year after the operation (CCD difference: –1.6mm vs. 1.6mm, 0.2mm vs. 2.4mm; CCD ratio: 79.3% vs. 122.2%, 100.6% vs. 136.1%, all p<0.05). All three methods achieved significant improvement in function and pain without inter-group differences. No coracoid-related or tunnel complications occurred. DiscussionThe hook plate alone, and hook plate with suture anchor augmentation techniques provided less residual vertical instability compared to TightRope fixation at 2-year follow-up. The patient-reported functional outcomes were promising and comparable among the three groups. Level of evidenceIII, Retrospective comparative therapeutic trial.

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.

The Outcomes of Three Surgical Approaches for Acromioclavicular Dislocation Treatment: Findings from Vietnam

Background: Acromioclavicular (AC) dislocation, one of the most common shoulder joint injuries, can be treated by several surgical methods. However, there are still few records about the treatment quality. This study aims to describe the outcomes of three surgical methods for acromioclavicular dislocation treatment at Viet Duc University Hospital, Vietnam. Methods: A cross-sectional study was conducted on 80 patients diagnosed with AC. We retrospectively collected data in the medical records and re-examined the patients. Results: There was no difference between the three groups of surgical approaches relating to the patient’s characteristics, except for the time from the accident to hospital admission. The median length of stay after surgery was highest in the Hook plate group (median (IQR) = 5(2) days), while it was lowest in the K-wire group (median (IQR) = 3(1) days) (p &lt; 0.05). There is statistical significance in the difference of coracoclavicular distance between pre and post-operation in all three surgical method groups (p &lt; 0.001). Conclusion: All of the methods—Hook plate, K-wire, and TightRope—were associated with optimistic outcomes and restored initial anatomy. While the three surgical methods are both safe and effective, the K-wire method is associated with a shorter length of stay and might be economical.

Comparative Evaluation of Arthroscopically Assisted Coracoclavicular Fixation Versus Hook Plate Fixation for Unstable Distal Clavicle Fractures: A Minimum 2-Year Follow-up Study.

Neer type 2 distal clavicular fractures are associated with poor outcomes after nonoperative management. Surgical management is preferred, and various fixation methods have been studied. To assess the clinical and radiological outcomes in patients with unstable distal-end clavicular fractures that were treated with hook plate (HP) or arthroscopically assisted coracoclavicular (AAC) fixation. Cohort study; Level of evidence, 3. We retrospectively compared the clinical and radiological results of HP versus AAC fixation in patients who had unstable lateral-end clavicular fractures and at least 2 years of follow-up. The recorded postoperative Constant score, American Shoulder and Elbow Surgeons score, and shoulder forward flexion were compared between treatment groups using the independent t test. Fracture union was evaluated on routine shoulder radiographs. This study included 34 patients (17 with HP fixation, 17 with AAC fixation) with a mean ± SD age of 36.4 ± 8.3 years for the HP group and 37.2 ± 6.9 years for the AAC group. The mean follow-up period was 30.8 ± 2.8 months for the HP group and 28.8 ± 3.01 months for the AAC group. No statistically significant difference between groups was observed regarding postoperative Constant score (89.7 vs 92.5; P = .07), American Shoulder and Elbow Surgeons score (88.2 vs 91.1; P = .12), or mean time to union (10.1 vs 9.3 weeks; P = .16). Postoperative shoulder forward flexion was better in the AAC group (168.2° ± 4.3°) versus the HP group (161.9° ± 6.6°; P = .002), and the complication rate was lower in the AAC group (5.8% vs 41.1%; P = .03). Both the AAC and HP fixation methods were effective in the surgical fixation of unstable Neer type 2 lateral-third clavicle fractures, with successful functional and radiological outcomes. However, AAC fixation provided an earlier return to work with fewer complications.

Hook plate fixation with coracoclavicular suspensory suture augmentation for Rockwood grade V acromioclavicular joint dislocation in recreational sports activity

Hook plate fixation with coracoclavicular suspensory suture augmentation for Rockwood grade V acromioclavicular joint dislocation in recreational sports activity

Clinical and radiologic outcomes of the modified phemister procedure with coracoclavicular ligament augmentation using mersilene tape versus hook plate fixation for acute acromioclavicular joint dislocation

BackgroundThe clinical superiority of surgical treatment for acromioclavicular (AC) joint dislocation remains controversial. The aim of this study was to compare the clinical and radiological outcomes of the modified Phemister procedure with CC ligament augmentation using Mersilene tape to those of hook plate fixation for acute AC joint dislocation.MethodsIn this study, patients who received modified Phemister surgery with CC ligament augmentation using Mersilene tape (PM group) or hook plate fixation (HK group) for acute unstable AC joint dislocation with a minimum 5-year follow-up period were retrospectively reviewed. The clinical outcomes were evaluated according to blood loss during surgery, surgical duration, visual analogue scale (VAS), Constant-Murley score (CMS), University of California at Los Angeles (UCLA) shoulder rating scale, and the occurrence of complications. Radiological outcomes were assessed from radiographs according to multiple parameters, including CC distance maintenance, acromion osteolysis, and the presence of distal clavicle osteolysis.ResultsA total of 35 patients completed follow-up for more than 5 years and were analyzed in this study (mean = 74.08 months). There were 18 patients in the PM group and 17 in the HK group. The PM group exhibited similar improvement in functional outcome to the HK group. Regarding radiological outcomes, the HK group had a superior performance in terms of CC distance maintenance, of statistical significance (CCDR: 94.29 ± 7.01% versus 111.00 ± 7.69%, p < 0.001) after a one-year follow-up period. However, there were 4 cases of acromion osteolysis and 2 cases of distal clavicle osteolysis in the HK group.ConclusionHook plate fixation was found to be superior to the modified Phemister technique with CC ligament augmentation using Mersilene tape in terms of CC distance maintenance, but there was no significant difference in the functional outcome after 5 years of follow-up. Both surgical methods are reliable options for the treatment of acute AC joint dislocation. Modified Phemister surgery with CC ligament augmentation using Mersilene tape is a relatively lower-cost option for acute AC joint dislocation without the need of a second surgery for implant removal.