Residual coracoclavicular separation after plate fixation for distal clavicle fractures: comparison between fracture patterns

• Main Authors: Ryogo Furuhata, MD, Noboru Matsumura, MD, Kazuhiko Udagawa, MD, Satoshi Oki, MD, Hideo Morioka, MD
• Format: Article
• Language: English
• Published: Elsevier 2021-09-01
• Series: JSES International
• Subjects: Distal clavicle fracture; Plate; Scorpion plate; Outcome; Coracoclavicular ligament; Coracoclavicular distance
• Online Access: http://www.sciencedirect.com/science/article/pii/S2666638321001353

Background: Plate fixation is an established treatment for Neer type II and V distal clavicle fractures; however, residual coracoclavicular (C-C) separation after osteosynthesis for unstable distal clavicle fractures has rarely been discussed. This study aimed to reveal the extent of postoperative C-C separation after plate fixation for distal clavicle fractures and to evaluate the relationship between residual C-C separation and the risk of postoperative complications. Methods: We retrospectively reviewed 60 patients with a displaced distal clavicle fracture that was treated with a Scorpion plate without C-C reconstruction and successfully united. Distal clavicle fractures were divided as per the Neer classification into type IIA (12 patients), IIB (36 patients), and V (12 patients) groups. The modified C-C distance ratio at the time of injury and after bone union, and the postoperative complications (plate-related pain, delayed union, infection, and contracture) were compared among the three groups. Results: The mean postoperative modified C-C distance ratio was 115.0% ± 12.0%; this ratio was significantly larger in the type IIB and V groups than in the type IIA group (P = .021 and P = .006, respectively). However, there was no significant difference in the frequency of postoperative complications among the three groups. Conclusions: Our study demonstrated that a certain degree of C-C separation remained after plate fixation for Neer type II and V distal clavicle fractures, even when bone union was achieved. The postoperative residual C-C separation was greater for the type IIB and V groups than for the type IIA group; however, this difference may not affect postoperative complications.