Outcomes after locking plate fixation of distal clavicle fractures with and without coracoclavicular ligament augmentati
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ORIGINAL ARTICLE
Outcomes after locking plate fixation of distal clavicle fractures with and without coracoclavicular ligament augmentation Brett P. Salazar1 · Michael J. Chen1 · Julius A. Bishop1 · Michael J. Gardner1 Received: 24 June 2020 / Accepted: 10 September 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Background The need for coracoclavicular (CC) ligament augmentation when performing locking plate fixation of unstable distal clavicle fractures is controversial. The purpose of this study was to compare the results after locking plate fixation for treatment of Neer type-II and type-V distal clavicle fractures with and without suture suspensory augmentation of the CC ligaments. Methods This was a retrospective case series of all Neer type-II and type-V distal clavicle fractures treated with locking plates at a single Level I trauma center. Patients were separated into locking plate-only and locking plate with CC ligament augmentation groups. Postoperative complications and fracture healing rates were recorded. Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores were recorded as functional outcomes during follow-up phone interviews. Standard descriptive statistics were performed. Results Sixteen patients were treated with locking plate fixation-only, and seven patients were treated with additional CC ligament augmentation. There was a similar distribution of Neer fracture types with each group. All fractures in both groups went onto union without loss of reduction or implant failure. There were no cases of infection or wound complications in either group. QuickDASH scores were comparable between locking plate-only fixation (mean 4.1 ± 3.9) and additional suspensory suture fixation (mean 4.5 ± 3.6). Conclusion This comparative study of Neer type-II and type-V distal clavicle fractures demonstrated comparable outcomes after locking plate fixation with and without CC ligament augmentation. CC ligament augmentation may not be necessary when treating unstable distal clavicle fractures if locking plate fixation is used. Keywords Distal clavicle fracture · Locking plate · Suture suspensory fixation · Coracoclavicular ligament
Introduction Nonoperative treatment of unstable distal clavicle fractures leads to unacceptably high rates of nonunion [1]. Locking plate fixation for unstable distal clavicle fractures can reliably maintain reduction without the need for spanning the acromioclavicular joint [2–5]. The need for coracoclavicular (CC) ligament augmentation using suture suspensory fixation is controversial. Several authors have recommended suspensory fixation in addition to locking plates to improve both vertical and horizontal stabilities of the distal clavicle * Brett P. Salazar [email protected] 1
Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063‑6342, USA
[6–9]. However, there are numerous disadvantages of this additional fixation which include unique complicati
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