Outcomes following the treatment of acute unstable distal clavicular fractures using anatomic locking plate

WEI Jian-jun; YAN Shi-Chang; YANG Yong-jiang; YANG Feng-zhen; ZHANG Wei-long; CHEN Hui

doi:10.3969/j.issn.2095-252X.2018.03.006

Abstract：Objective To evaluate clinical and radiographic outcomes of the treatment using anatomic locking plate ( ALP ) for acute unstable distal clavicular fractures, and to introduce technique strategy. Methods In this retrospective study, 32 patients ( 24 males and 8 females ) were collected from October 2012 to October 2015 with an average age of 45.7 years ( range: 21 - 66 years ). The mean follow-up was 18.8 months ( range: 14 - 36 months ). The average time to injury was 3.2 days ( range: 1 - 15 days ). The average operation time: 97.8 min ( range: 60 - 135 min ). Intraoperative bleeding: 42.2 ml ( range: 20 - 100 ml ). Eighteen patients were treated with domestic plate and 14 cases with Peri-loc plate. The mean bone healing time was 14.5 weeks ( range: 8 - 20 weeks ). Results of Constant-Murley Shoulder Outcome Score ( Constant score ) and University of California, Los Angeles shoulder rating scale ( UCLA ) as well as radiographic data coracoclavicular ratio ( CCR ) were recorded. Functional scores and CCR were compared between the affected and contralateral side by paired Student-t test. Results The mean fracture line from AC joint was 22.4 mm ( range: 15 - 32 mm ). After an average of 3.2 days ( range: 1 - 15 days ) following the injury, anatomical locking plate fixation was performed. Six patients were performed with additional interfragmentary fixation, 2 with coracoclacicular loop-and-sling technique using suture 5#, 2 with bone allograft during open reduction and ALP fixation. The mean bone union time was 14.5 weeks ( range: 8 - 20 weeks ). No major complications were observed. The CCR of the affected side after operation was statistically and significantly decreased compared with pre-operation ( P = 0.008 ), while no significant differences were found in the latest follow-up ( P = 0.175 ). The mean Constance score of the injured side: 91 ( range: 86 - 95 ); UCLA: 30 ( range: 26 - 32 ); no statistically significant differences compared with the contralateral side ( P = 0.13, 0.238 respectively ). Conclusions ALPs have some biomechanical advantages and can provide enough stability in the distal fragment ( size > 20 mm from AC joint ), which can be augmented with coracoclacicular sutures and / or intrafragmentary fixation or bone graft simultaneously to avoid potential complications of implant failure. It is applicable in the treatment of acute unstable distal clavicular fractures.