![]() There is an array of surgical options in the literature including K-wire transfixation, tension band wires, coracoclavicular screw fixation, ligament repair or reconstruction, and clavicular hook plate. Surgery has been recommended and been shown to reduce this non-union rate and improve clinical outcomes. These fractures have been documented to have a significant non-union rate (as high as 22–31%) when treated conservatively, particularly Neer type II. They are divided into three types according to the relationship of the fracture line to the coracoclavicular ligaments and acromioclavicular joint by Neer. Retrospective review, level of evidence IV.ĭistal clavicle fractures are usually caused by indirect violence and account for approximately 21% of all clavicle fractures. Early limited mobility and removal of the implant may improve the prognosis and resolve the postoperative shoulder pain. The incidence of subacromial impingement and rotator cuff lesion (RCL) increased with the α angle. Lateral acromion angle appears to be an important factor in the development of postoperative pain and worse outcomes (JOA scores) in patients treated with the hook plate. ![]() Japanese Orthopaedic Association (JOA) scores in group D were worse at 3 months post-surgery, 3 months post plate removal, and at the last follow-up despite a slightly earlier removal in this group. Compared to those with common lateral acromion angle, the incidence of postoperative impingement in group D was undoubtedly much higher (100%). ResultsĪll patients in group D (large lateral acromion angle (α) > 40°, acromion coronal angle (β) < 60°) complained of postoperative symptoms. The mean follow-up was 25.5 months (range, 24 to 28 months). We reviewed their clinical features, including Neer’s impingement sign, MRI findings, and outcomes using Japanese Orthopaedic Association Scores. The angle was defined as the incline angle between the superior surface of distal clavicle and the inferior facet of acromion on coronal plane. They were divided into four groups according to lateral acromion angle on shoulder AP view X-rays. We retrospectively reviewed 102 patients with distal clavicle fractures treated with hook plates at our institution from 2010 to 2017. We reviewed the clinical records of patients who had distal clavicle fractures with different lateral acromion angles treated using a clavicle hook plate and evaluated their clinical outcomes with respect to shoulder pain and acromial morphology. The relationship of the characteristics of the hook plate, acromioclavicular joint and acromion morphology, and clinical outcome has remained poorly understood. The clavicular hook plate is an accepted surgical procedure for distal clavicle fractures.
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