Purpose
The purpose of this study was to determine the effect of coracoclavicular (CC) fixation
on biomechanical stability in type IIB distal clavicle fractures fixed with plate
and screws.
Methods
Twelve fresh-frozen matched cadaveric specimens were used to create type IIB distal
clavicle fractures. Dual-energy x-ray absorptiometry (DEXA) scans ensured similar
bone quality. Group 1 (6 specimens) was stabilized with a superior precontoured distal
clavicle locking plate and supplemental suture anchor CC fixation. Group 2 (6 specimens)
followed the same construct without CC fixation. Each specimen was cyclically loaded
in the coronal plane at 40 to 80 N for 17,500 cycles. Load-to-failure testing was
performed on the specimens that did not fail cyclic loading. Outcome measures included
mode of failure and the number of cycles or load required to create 10 mm of displacement
in the construct.
Results
All specimens (12 of 12) completed cyclic testing without failure and underwent load-to-failure
testing. Group 1 specimens failed at a mean of 808.5 N (range, 635.4 to 952.3 N),
whereas group 2 specimens failed at a mean of 401.3 N (range, 283.6 to 656.0 N) (P = .005). Group 1 specimens failed by anchor pullout without coracoid fracture (4
of 6) and distal clavicle fracture fragment fragmentation (1 of 6); one specimen did
not fail at the maximal load the materials testing machine was capable of exerting
(1,000 N). Group 2 specimens failed by distal clavicle fracture fragment fragmentation
(3 of 6) and acromioclavicular (AC) joint displacement (1 of 6); 2 specimens did not
fail at the maximal load of the materials testing machine.
Conclusions
During cyclic loading, type IIB distal clavicle fractures with and without CC fixation
remain stable. CC fixation adds stability to type IIB distal clavicle fractures fixed
with plate and screws when loaded to failure.
Clinical Relevance
CC fixation for distal clavicle fractures is a useful adjunct to plate-and-screw fixation
to augment stability of the fracture.
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Article info
Publication history
Accepted:
February 26,
2013
Received:
April 12,
2012
Footnotes
The authors report the following potential conflict of interest and source of funding in relation to this article: study sponsored by Acumed; M.M. is a consultant for Mitek; I.V. is a consultant for Acumed, Pfizer, and Zimmer, has received support from Arthrex, and research funding from ArthroCare.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
