Objective and design
The aim was to compare the clinical and radiological results of internal fixation of displaced distal clavicular fractures using 3.5 mm locking T-plate alone and the same plate augmented by coracoclavicular (CC) loop using coracoid-based anchor loaded by two high-strength suture threads. This is a prospective clinical study.
Patients and methods
A total of 41 patients (33 males and eight females) with a displaced distal clavicular fracture were divided randomly into two groups. The mean age of the patients was 30.2 years (range: 21–41 years). All patients underwent internal fixation using 3.5-mm locking T-plate: in group 1 (21 patients), the fracture was fixed with locked plate only (single attack), and in group 2 (20 patients), fracture was fixation with locked plate augmented with CC reconstruction using suture anchor fixed at base of coracoid (double attack). Constant functional score was used to assess the overall clinical outcome and patients’ satisfaction. A standard anteroposterior radiograph was used to assess the union and measure the acromioclavicular overlap.
Results
The mean follow-up period was 20 months (range: 18–28 months). At the final follow-up, there was a highly significant improvement in Constant score (<0.001) in both groups. However, patients treated by locked plate augmented by anchor reconstruction of CC ligaments (double attack approach) had better early clinical and range-of-motion outcomes.
Conclusion
Osteosynthesis with CC ligament reconstruction is an effective technique for fixation of displaced distal clavicular fractures. It does not only provide rigid fixation but also offers promising early clinical results especially regarding the range of motions.
Level of evidence
The level of evidence is that of a therapeutic case series level IV.