Summary

Arthroscopically assisted coracoclavicular (CC) stabilization using a suture button device for lateral clavicle fracture with CC ligament injury founded satisfactory radiologic and clinical outcomes with low risk of implant irritation.

Abstract

Background

The treatment for lateral clavicle fracture is still controversial, especially with coracoclavicular (CC) ligament injury. Various fixation techniques including, a pre-contoured plate, a hook plate, K-wire fixation and coracoclavicular (CC) stabilization, has been proposed to manage lateral clavicle fracture. We performed arthroscopically assisted CC stabilization using a suture button device for lateral clavicle fracture with CC ligament injury in order to achieve vertical stability of the central clavicle fragment and decrease the risk of implant irritation and removal. The purpose of this study was to evaluate the radiologic and clinical outcomes of arthroscopically assisted CC stabilization using a suture button device for lateral clavicle fracture with CC ligament injury.

Methods

Five consecutive patients with lateral clavicle fracture with CC ligament injury were treated with arthroscopically assisted CC stabilization using the suture button device. (Dog bone button and FiberTape, Arthrex, Naples, FL, USA). The mean follow-up period was 10 months (range, 6-12 months). Radiological analysis was performed to evaluate bone union and the existence of CC ligament ossification using serial plain radiographs at 3 and 6 months after operation. Post-operative range of motion (ROM) was evaluated at 3 and 6 months after operation. Shoulder functional score was evaluated using Japanese Orthopedics Association score (JOA score) at 6 months after operation.

Results

Mean operation time and amount of bleeding were 75.8 ± 8.2 min and 20.2 ± 10.8 ml. There were no perioperative complications, including surgical site infection, nerve injury, and fractures of coracoid and clavicle. All cases showed complete bony union (2 cases at 3 months and 5 cases at 6 months after operation). Mean postoperative ROMs at 3 and 6 months after operation were 140.0 ± 21.0 and 162.0 ± 17.2 in anterior elevation, 49.0 ± 15.0 and 64.0 ± 8.0 in external rotation, and L1 ± 4.0 and Th11 ± 4.0 in internal rotation. Mean JOA score was 98.0 ± 3.1 at 6 months after operation. No case showed implant irritation and needed for implant removal.

Conclusion

Arthroscopically assisted CC stabilization using a suture button device for lateral clavicle fracture with CC ligament injury founded satisfactory radiologic and clinical outcomes. The major advantages of this technique are high rate of bone union and low rate of complications including implant irritation.