Outcomes following fixation of distal clavicle fractures utilizing arthroscopically assisted coracoclavicular ligament stabilization with a suspensory endobutton and cerclage tape

Abstract

Background: Distal one-third clavicle fractures are frequently unstable and often require surgical fixation due to high rates of nonunion. Many common methods of fixation have high rates of union but are associated with hardware discomfort and need for secondary surgery. The purpose of this study was to evaluate the outcomes of a fixation technique involving arthroscopically assisted open reduction internal fixation of unstable distal clavicle fractures via a coracoclavicular (CC) suspensory endobutton and cerclage tape. Methods: This was a retrospective case series evaluating patients who underwent fixation of unstable distal clavicle fractures via arthroscopically assisted CC stabilization by a single fellowship-trained shoulder and elbow surgeon between 2020 and 2022. Demographic and injury-related data were collected via chart review. Preoperative and postoperative radiographs were reviewed to evaluate for signs of radiographic union. Primary outcome measures included fracture union, complications, and need for additional procedures. Patients were also contacted via telephone to obtain American Shoulder and Elbow Surgeons scores. Results: Six patients were eligible for inclusion in this study with a mean age of 52.8 ± 14.0 and a mean follow-up of 2.0 years (range 1.6-2.7 years). Mean American Shoulder and Elbow Surgeons scores were 86.2 ± 21.8 (range 52-100). There were no postoperative complications, signs of symptomatic hardware, or need for secondary surgery at the final follow-up among this cohort of patients. All patients had achieved and maintained full radiographic union at a mean radiographic follow-up of 5.5 months (range 2.0-12.9 months). Conclusion: Arthroscopically assisted CC stabilization of distal clavicle fractures demonstrated high union rates while limiting complications or need for secondary hardware removal. Further analysis on a larger scale is recommended to determine long-term outcomes and direct comparison to other surgical techniques.

Keywords

• Distal clavicle fracture
• Neer type II
• Coracoclavicular stabilization
• Arthroscopically assisted surgery
• Suspensory endobutton
• Cerclage tape