Abstract
Purpose
This retrospective study aimed to compare the fracture union and functional results of clavicular hook plate fixation versus arthroscopy-assisted TightRope fixation of unstable fractures of the distal clavicle.
Materials and methods
Forty patients with unstable (Neer II) distal clavicular fracture were treated surgically using either a clavicular hook plate (n = 19) or arthroscopy-assisted TightRope fixation (n = 21) between 2007 and 2012 in our hospital. Medical records were retrospectively reviewed. Clinical and radiological results after an average period of 62 months for the clavicular hook plate and 32 months for TightRope were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) score, the Constant score, and the RAND 36-item health questionnaire.
Results
One fracture in each group was failed to unite. The mean Constant score was 93 in the TightRope group and 89 in the clavicular hook plate group, with mean DASH scores of 6 and 11, respectively. According to data from the RAND 36-item questionnaire, health-related quality of life returned to normal in both groups. Removal of the plate was the main reason for reoperation.
Conclusions
TightRope and clavicular hook plate repairs of unstable distal clavicular fractures result in similar fracture union and good clinical outcomes.
Similar content being viewed by others
References
Aalto A-M, Aro AR, Teperi J (1999) RAND36 as a measure of health-related quality of life. Reliability, construct validity and reference values in the Finnish general population. Stakes, Research Reports 101, Helsinki English summary
Checcia SL, Doneux PS, Miyazaki AN, Fregoneze M, Silva LA (2008) Treatment of distal clavicle fractures using an arthroscopic technique. J Shoulder Elbow Surg 17:395–398. doi:10.1016/j.jse.2007.08.011
Chiang CL, Yang SW, Tsai SW, Kuen-Huang Chen C (2010) Acromion osteolysis and fracture after hook plate fixation for acromioclavicular joint dislocation: a case report. J Shoulder Elbow Surg 19:e13–e15. doi:10.1016/j.jse.2009.12.005
Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop 214:160–164
Ding M, Ni J, Hu J, Song D (2011) Rare complication of clavicular hook plate: clavicle fracture at the medial end of the plate. J Shoulder Elbow Surg 20:e18–e20. doi:10.1016/j.jse.2011.06.005
Flinkkilä T, Ristiniemi J, Lakovaara M, Hyvönen P, Leppilahti J (2006) Hook plate fixation of unstable lateral clavicle fractures: a report on 63 patients. Acta Orthop 77:644–649. doi:10.1080/17453670610012737
Flinkkilä T, Ihanainen E (2013) Results of arthroscopy-assisted TightRope repair of acromioclavicular dislocations. Shoulder Elbow. doi:10.1111/sae.12040
Gilbart MK, Gerber C (2007) Comparison of the subjective shoulder value and the constant score. J Shoulder Elbow Surg 16:717–721. doi:10.1016/j.jse.2007.02.123
Good DW, Lui DF, Leonard M, Morris S, McElwain JP (2012) Clavicle hook plate for displaced lateral- third clavicle fractures (Neer type II): a functional outcome study. J Shoulder Elbow Surg 21:1045–1048. doi:10.1016/j.jse.2011.07.020
Haidar SG, Krishnan KM, Deshmukh SC (2006) Hook plate fixation for type II fractures of the lateral end of the clavicle. J Shoulder Elbow Surg 15:419–423. doi:10.1016/j.jse.2005.11.012
Hoffler CE, Karas SG (2010) Transacromial erosion of a locked subacromial hook plate: case report and review of literature. J Shoulder Elbow Surg 19:e12–e15. doi:10.1016/j.jse.2009.10.019
Hohmann E, Hansen T, Tetsworth K (2012) Treatment of Neer type II fractures of the lateral clavicle using distal radius locking plates combined with TightRope augmentation of the coraco-clavicular ligaments. Arch Orthop Trauma Surg 132:1415–1421. doi:10.1007/s00402-012-1570-z
Hsu TL, Hsu SK, Chen HM, Wang ST (2010) Comparison of hook plate and tension band wire in the treatment of distal clavicle fractures. Orthopedics 33:879. doi:10.3928/01477447-20101021-04
Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608
Lee YS, Lau MJ, Tseng YC, Chen WC, Kao HY, Wei JD (2009) Comparison of the efficacy of hook plate versus tension band wire in the treatment of unstable fractures of the distal clavicle. Int Orthop 33:1401–1405. doi:10.1007/s00264-008-0696-7
Milewski MD, Tompkins M, Jm Giugale, Carson EW, Miller MD, Diduch DR (2012) Complications related to anatomic reconstruction of the coracoclavicular ligaments. Am J Sports Med 40:1628–1634. doi:10.1177/0363546512445273
Motta P, Bruno L, Maderni A, Tosco P, Mariotti U (2013) Acute lateral dislocated clavicular fractures: arthroscopic stabilization with TightRope. J Shoulder Elbow Surg. doi:10.1016/j.jse.2013.05.016
Nourissat G, Kakuda C, Dumontier C, Sutet A, Doursounian L (2007) Arthroscopic stabilization of Neer type 2 fracture of the distal part of the clavicle. Arthroscopy 23:e1–e4. doi:10.1016/j.arthro.2006.08.028
Pandya NV, Hosalkar HS, Babatunde OM, Huffman GF (2009) Distal third clavicular fracture fixation: a new arthroscopically-assisted technique. Curr Orthop Practice 20:454–457. doi:10.1097/BCO.0b013e31819d5e90
Pujol N, Philippeau JM, Richou J, Lespagnol F, Graveleau N, Hardy P (2008) Arthroscopic treatment of distal clavicle fractures: a technical note. Knee Surg Sports Traumatol Arthrosc 16:884–886. doi:10.1007/s00167-008-0578-y
Pujol N, Desmoineaux P, Boisrenoult P, Beaufils P (2013) Arthroscopic treatment of comminuted distal clavicle fractures (Latarjet Fractures) using 2 double-button devices. Arthrosc Tech 2:e61–e63. doi:10.1016/j.eats.2012.11.001
Rieser GR, Edwards K, Gould GC, Markert RJ, Goswami T, Rubino LJ (2013) Distal-third clavicle fracture fixation: a biomechanical evaluation of fixation. J Shoulder Elbow Surg 22:848–855. doi:10.1016/j.jse.2012.08.022
Stegeman SA, Nacak H, Huvenaars KH, Stijnen T, Krijnen P, Schipper IB (2013) Surgical treatment of Neer type-II fractures of the distal clavicle: a meta-analysis. Acta Orthop 84:184–190. doi:10.3109/17453674.2013.786637
Takase K, Kono R, Yamamoto K (2012) Arthroscopic stabilization for Neer 2 fracture of the distal clavicle. Arch Orthop Trauma Surg 132:399–403. doi:10.1007/s00402-011-1455-6
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Flinkkilä, T., Heikkilä, A., Sirniö, K. et al. TightRope versus clavicular hook plate fixation for unstable distal clavicular fractures. Eur J Orthop Surg Traumatol 25, 465–469 (2015). https://doi.org/10.1007/s00590-014-1526-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-014-1526-9