Journal of Orthopaedic Reports (Jun 2024)
Simple all suture transclavicular to coracoid fixation technique for management of distal third clavicular fractures: Retrospective case series
Abstract
Introduction: surgical management of acute unstable distal third clavicle fractures is challenging. Despite the variety of proposed surgical techniques, there is no consensus on the most appropriate surgical technique. The authors of the study hypothesize that simple all suture transclavicular to coracoid fixation technique will provide stable construct and enhance the final functional outcome. Patients and methods: twenty patients [18 male and 2 female] with a mean age of 21.5 ± 5.6 years who sustained acute unstable distal third clavicular fractures and were surgically managed in our center [using all suture technique with two sets of osseous sutures; 1st set is a transclavicular-around coracoid suture and 2nd set is a transclavicular cerclage-like suture transfixing the fracture] have been retrospectively reviewed. All patients were assessed on both radiological and functional levels for a minimum of one year. Radiologically, Zanca view and true anteroposterior clavicular view were routinely performed and assessed until complete radiological union was achieved. Functionally, visual analogue scale (VAS) in addition to the (Disability of Arm, Shoulder and Hand) DASH score were recorded. The finally assessed scores were those reported at the final follow up. Results: Radiological union was achieved in a mean time of 8.1 ± 1.4 weeks [range: 6–10]. The mean DASH score was 3.6 ± 5.5 [range: 0–23]. There was statistically significant pain reduction following surgery at the last follow-up (P < 0.001). Only three patients experienced minor complications in the form of skin irritation by suture knots which necessitated a second surgery for knots removal. Conclusion: The proposed all suture technique provides an ideal technique for management of acute unstable distal third clavicular fractures owed to achieving rapid bony union besides its simple nature, cost-effectiveness in addition to providing vertical, horizontal and rotational stability with no or minimal morbidity.
