Functional Results of Unstable (Type 2) Distal Clavicle Fractures Treated with Superior Anterior Locking Plate

Document Type : RESEARCH PAPER


Department of Orthopaedics, Vinayaka Missions Medical College and Hospital, Karaikal, Pondy, India


Background: The treatment of distal clavicle fracture is always a challenge, as it is mostly unstable and has higher
rate of delayed union, malunion, non-union and associated acromioclavicular arthritis. So the management of these
fractures remains controversial. The purpose of this study is to evaluate the functional results of Type 2 distal end
clavicle fractures treated with superior anterior locking plate.
Methods: From June 2011 to August 2015 a retrospective study of12 male patients (mean age of 41.3 years) 11 with
unilateral and 1 with bilateral distal clavicle fractures treated with superior anterior locking plate was done. They were
evaluated at regular intervals with mean follow up of 14 months(12-18 months).Those with minimum one year follow
up were included in our study. All were evaluated for the functioning of the shoulder joint by both Oxford shoulder score
and Quick DASH scores, rate of bone union, complications and earliest time for return to work.
Results: All fractures union seen within 6-8 weeks (mean time: 7.1 weeks).All had good shoulder range of motion. The
average oxford shoulder and Quick DASH score were 46.2 and 6.5.There were no major complications in our study
viz. non-union, plate failure, secondary fracture. But one patient had superficial wound infection. All patients returned to
work within 3 months of postoperative period.
Conclusion: Displaced distal clavicle fractures treated with superior anterior locking plates achieved excellent results
in terms of bony union with rarely any complications and demonstrate promising results with this novel technique.


Main Subjects

1. Postacchini F, Gumina S, De Santis P, Albo F.
Epidemiology of clavicle fractures. J Shoulder Elbow
Surg. 2002; 11(5):452-6.
2. Robinson CM. Fractures of the clavicle in the adult.
Epidemiology and classification. J Bone Joint Surg Br.
1998; 80(3):476-84.
3. Neer CS 2nd. Fractures of the distal third of the
clavicle. Clin Orthop Relat Res. 1968; 58(1):43-50.
4. Ritche PK, McCarty EC. Distal clavicle fractures: a
current review. Curr Opin Orthop. 2004; 15(4):257-60.
5. Nordqvist A, Petersson C, Redlun-Johnell I. The
natural course of lateral clavicle fracture. 15 (11–21)
year follow-up of 110 cases. Acta Orthop Scand. 1993;
6. Robinson CM, Cairns DA. Primary non operative
treatment if displaced lateral fractures of clavicle. J
Bone Joint Surg Am. 2004; 86-A(4):778-82.
7. Jou IM, Chiang EP, Lin CJ, Lin CL, Wang PH, Su WR.
Treatment of unstable distal clavicle fracture with
Knowles pin. J Shoulder Elbow Surg. 2011; 20(3):414-9.
8. Yamaguchi H, Arakawa H, Kobayashi M. Results of the
Bosworth method for unstable fractures of the distal
clavicle. Int Orthop. 1998; 22(6):366-8.
9. Kay SP, Ellman H, Harris E. Arthroscopic distal clavicle
excision. Technique and early results. Clin Orthop
Relat Res. 1994; 301(1):181-4.
10. Zhang C, Huang J, Luo Y, Sun H. Comparison of the
efficiency of a distal clacicular locking plate versus
clavicular hook plate in the treatment of unstable
distal clavicle fractures and a systematic literature
review. Int Orthop. 2014; 38(7):1461-68.
11. Anderson JR, Willis MP, Nelson R, Mighell MA.
Precontoured superior locked plating of distal clavicle
fractures: a new strategy. Clin Orthop Relat Res. 2011;
12. Rockwood CA. The shoulder. Philadelphia: Saunders/
Elsevier; 2009. P. 381-445.
13. Smith MV, Calfee RP, Baumgarten KM, Brophy RH,
Wright RW. Upper extremity-specific measures of
disability and outcomes in orthopaedic surgery. J
Bone Joint Surg Am. 2012; 94(3):277-85.
14. Neer CS 2nd. Fractures of the clavicle. In: Rockwood
CA, Green DP, editors. Fractures in adults. 2nd ed.
Philadelphia: Lippincott Co; 1984. P. 703-21.
15. Neviaser RJ. Injuries to the clavicle and
acromioclavicular joint. Orthop Clin North Am. 1987;
16. Abdelnoor J, Mantoura J, Nahas A. Cervicothoracic
pin migration following open reduction and pinning
of a clavicular fracture: case report. East J Med. 2000,
17. Badhe SP, Lawrence TM, Clark DI. Tension band
suturing for the treatment of displaced type-2 lateral
end clavicle fractures. Arch Orthop Trauma Surg.
2007; 127(1):25-8.
18. Kaipel M, Majewski M, Regazzoni P. Double-plate
fixation in lateral clavicle fractures-a new strategy. J
Trauma. 2010; 69(4):896-900.
19. Moneim MS, Balduini FC. Coracoid fracture as a
complication of surgical treatment by coracoclavicular
tape fixation. A case report. Clin Orthop Relat Res.
1982; 168(7):133-5.
20. Andersen JR, Willis MP, Nelson R, Mighell MA.
Precontoured superior locked plating of distal clavicle
fractures: a new strategy. Clin Orthop Relat Res. 2011;
21. Choo SK, Nam JH, Kim Y, Oh HK. The surgical outcome
of unstable distal clavicle fractures treated with 2.4
mm volar distal radius locking plate. J Korean Fract
Soc. 2015; 28(1):38-45.
22. Bhatia DN, Page RS. Surgical treatment of lateral clavicle
fractures associated with complete coracoclavicular
ligament disruption: clinico-radiological outcomes
of acromioclavicular joint sparing and spanning
implants. Int J Shoulder Surg. 2012; 6(4):116.