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Clin Shoulder Elbow > Volume 17(4); 2014 > Article
Clinics in Shoulder and Elbow 2014;17(4):175-180.
DOI:    Published online December 31, 2014.
Coracoclavicular Ligament Suture Augmentation with Anatomical Locking Plate Fixation for Distal Clavicle Fracture
Tae Kang Lim, Min Soo Shon, Hyung Gon Ryu, Jae Sung Seo, Jae Hyun Park, Young Ko, Kyoung Hwan Koh
1Department of Orthopaedic Surgery, Eulji Hospital, Eulji University School of Medicine, Korea.
2Department of Orthopaedic Surgery, National Medical Center, Korea.
3Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, Korea.
4College of Nursing, Gachon University, Incheon, Korea.
5Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea.
Received: 9 August 2014   • Revised: 14 October 2014   • Accepted: 17 October 2014
BACKGROUND: For Neer type IIB fracture of distal clavicle with coracoclavicular ligament injury, various surgical treatments have been used in literatures. However, there was no consensus on the optimal treatment. The aim of this study is to report the clinical and radiological results of open reduction and internal fixation of unstable distal clavicle fracture and suture augmentation of disrupted coracoclavicular ligament.
A prospective study was performed in 23 patients with Neer type IIB distal clavicle fracture in Seoul Medical Center, Eulji Hospital, and National Medical Center. Firstly, suture anchors are inserted in the base of coracoid process and preliminary reduction was achieved by tie-off of three suture limbs around the clavicle. Then, the final fixation was completed with anatomical locking plate. Bony union and the distance between coracoclavicular ligaments were evaluated. Clinical results and complications including stiffness and secondary procedures were evaluated.
Bony union was achieved in all cases except one (22 of 23). At mean 14.9 months, no significant difference in the mean coracoclavicular distance was observed compared to uninjured shoulder (8.2 +/- 7.9 mm versus 7.3 +/- 3.4 mm, p=0.14). Pain visual analogue scale, American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were 0.5, 83.4, 78.5, and 6.2, respectively. Revision surgery was performed in one case of nonunion. Four patients who complained of skin irritation underwent implant removal.
In cases of an unstable distal clavicle fracture with coracoclavicular ligament disruption, satisfactory clinical results were obtained by locking plate fixation and coracoclavicular ligament suture augmentation concurrently.
Key Words: Shoulder fractures; Clavicle; Plate; Coracoclavicular joint


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