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.
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.
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.
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.
CC fixation for distal clavicle fractures is a useful adjunct to plate-and-screw fixation to augment stability of the fracture.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Arthroscopy
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Primary nonoperative treatment of displaced lateral fractures of the clavicle.J Bone Joint Surg Am. 2004; 86-A: 778-782
- Special status of lateral clavicular fracture.Orthopade. 1992; 21: 163-171
- Fractures of the distal clavicle: A case for fixation.Injury. 1992; 23: 44-46
- Injuries to the clavicle and acromioclavicular joint.Orthop Clin North Am. 1987; 18: 433-438
- Fractures in adults.Ed 2. JB Lippincott, Philadelphia1984
- Management of distal clavicle fractures.J Am Acad Orthop Surg. 2011; 19: 392-401
- The treatment of lateral clavicle fractures.Injury. 2000; 31: 175-179
- Early and intermediate results of conservatively and surgically treated lateral clavicular fractures.Aktuelle Traumatol. 1991; 21: 148-152
- Type II distal clavicle fractures: A retrospective review of surgical treatment.J Orthop Trauma. 1990; 4: 115-120
- Coracoclavicular screw fixation for unstable fractures of the distal clavicle. A report of five cases.J Bone Joint Surg Br. 1991; 73: 291-294
- Results of the Bosworth method for unstable fractures of the distal clavicle.Int Orthop. 1998; 22: 366-368
- Therapy and outcome of lateral clavicular fractures.Unfallchirurg. 1997; 100: 17-23
- Surgical treatment of comminuted fractures of the distal clavicle using Wolter clavicular plates.J Nippon Med Sch. 2000; 67: 32-34
- Dynamic fixation of the avulsed clavicle.J Trauma. 1976; 16: 841-844
- Treatment of distal clavicle fracture using Kirschner wires and tension-band wires.J Trauma. 2001; 51: 522-525
- Surgical treatment of lateral clavicular fracture with the “clavicular hooked plate.”.Z Unfallchir Versicherungsmed. 1994; 87: 145-152
- A method for internal fixation of unstable distal clavicle fractures: early observations using a new technique.J Shoulder Elbow Surg. 2008; 17: 60-62
- Stabilisation of vertical unstable distal clavicular fractures (Neer 2b) using locking T-plates and suture anchors.Injury. 2009; 40: 236-239
- Cyclical loading of coracoclavicular ligament reconstructions: a comparative biomechanical study.Am J Sports Med. 2008; 36: 1990-1997
- How many steps/day are enough? Preliminary pedometer indices for public health.Sports Med. 2004; 34: 1-8
- Fracture of the distal clavicle with detachment of the coracoclavicular ligaments in adults.J Trauma. 1963; 3: 99-110
- Surgical treatment for distal clavicle fracture with coracoclavicular ligament disruption.J Trauma. 2002; 52: 72-78
- Outcome of operative treatment in fresh lateral clavicular fracture.Ann Chir Gynaecol. 1987; 76: 167-169
- Fatal aortic perforation and cardiac tamponade due to a Kirschner wire migrating from the right sternoclavicular joint.South Med J. 1974; 67: 316-318
- Clavicular fracture non-union surgical outcome and complications.Injury. 2002; 33: 135-143
- Stress fracture of the clavicle leading to nonunion secondary to coracoclavicular reconstruction with Dacron.Am J Sports Med. 1989; 17: 128-129
- Results of surgical treatment for unstable distal clavicular fractures.J Shoulder Elbow Surg. 2010; 19: 1049-1055
- Precontoured superior locked plating of distal clavicle fractures: a new strategy.Clin Orthop Relat Res. 2011; 469: 3344-3350
- The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study.Am J Sports Med. 2008; 36: 2398-2406
- Arthroscopic reconstruction of the acromioclavicular joint disruption: surgical technique and preliminary results.Arch Orthop Trauma Surg. 2006; 126: 575-581
Accepted: February 26, 2013
Received: April 12, 2012
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.
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.