Effectiveness analysis of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicle fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIANG Jishi , ZHAI Yunlei , HUANG Xubing , JIAO Wei , WANG Wei , GUO Biao , LI Li , LI Xuejun , NIE Yu ,  YU Haiyang

Department of Orthopedics, Fuyang People’s Hospital, Fuyang People’s Hospital Affiliated to Anhui Medical University, Fuyang Anhui, 236000, P. R. China;

Corresponding?author：

YU Haiyang, Email: fy.yhy@163.com

Keywords：

Distal clavicle fracture; Endobutton plate; coracoclavicular fixation; Kirschner wire; Nice knot

DOI：

10.7507/1002-1892.202109069

Video：

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Objective To investigate the effectiveness of Endobutton plate coracoclavicular fixation combined with fracture site high-strength suture Nice knot cerclage fixation in the treatment of distal clavicle fracture with coracoclavicular ligament injury. Methods The clinical data of 33 cases of distal clavicular fracture with coracoclavicular ligament injury treated by Endobutton coracoclavicular plate fixation between January 2017 and December 2020 were analyzed retrospectively. According to the fixation methods of fracture site, they were divided into two groups: the high-strength suture Nice knot fixation group (study group, 16 cases) and the transacromial Kirschner wire fixation group (control group, 17 cases). There was no significant difference between the two groups in common data such as age, gender, injury side, cause of injury, Craig type, combined injury, time from injury to operation, and preoperative visual analogue scale (VAS) score and Constant-Murley score (P>0.05). Postoperative fracture healing and complications were observed, and the increase rate of coracoclavicular space on the affected side was calculated at last follow-up. VAS score was used to evaluate shoulder pain before operation, at 1 week, 1 month, 3 months after operation, and at last follow-up. The shoulder function was evaluated according to Constant-Murley shoulder score before operation, at 1 month, 3 months after operation, and at last follow-up. Results The operations were successfully completed in both groups without severe complications such as vascular nerve injury and coracoid fracture. In the control group, 1 case (5.9%) had slight pin tract infection and 1 case (5.9%) had Kirschner wire displacement; there was no obvious complication in the study group. The patients in both groups were followed up 9-36 months (mean, 22.9 months). The fracture healing time of the study group and the control group were (12.56±0.73) weeks and (13.59±0.87) weeks, respectively, and the difference was significant (t=?3.661, P=0.001). At last follow-up, the increase rates of coracoclavicular space on the affected side of the study group and the control group were 8.88%±1.19% and 8.55%±1.07%, respectively, showing no significant difference (t=0.837, P=0.409). The postoperative VAS score and Constant-Murley score of the two groups significantly improved when compared with those before operation, and the two scores gradually improved with the extension of time after operation (P<0.05). Except that the VAS score at 1 week and 1 month after operation and the Constant-Murley score at 1 month after operation in the study group were significantly better than those in the control group (P<0.05), there was no significant difference between the two groups at other time points after operation (P>0.05). Conclusion For oblique fracture or combined with butterfly fracture in the distal clavicle fracture with coracoclavicular ligament injury, the fracture site high-strength suture Nice knot fixation is a good supplement to the Endobutton plate coracoclavicular fixation. It can stabilize the fracture end, reduce the complications of Kirschner wire fixation, and is more conducive to fracture healing. The effectiveness is satisfactory.

Citation： JIANG Jishi, ZHAI Yunlei, HUANG Xubing, JIAO Wei, WANG Wei, GUO Biao, LI Li, LI Xuejun, NIE Yu, YU Haiyang. Effectiveness analysis of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicle fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(2): 155-162. doi: 10.7507/1002-1892.202109069 Copy

1.	Robinson CM, Cairns DA. Primary nonoperative treatment of displaced lateral fractures of the clavicle. J Bone Joint Surg (Am), 2004, 86(4): 778-782.
2.	van der Meijden OA, Gaskill TR, Millett PJ. Treatment of clavicle fractures: current concepts review. J Shoulder Elbow Surg, 2012, 21(3): 423-429.
3.	Kahn LA, Bradnock TJ, Scott C, et al. Fractures of the clavicle. J Bone Joint Surg (Am), 2009, 91(2): 447-460.
4.	Kim DW, Kim DH, Kim BS, et al. Current concepts for classification and treatment of distal clavicle fractures. Clin Orthop Surg, 2020, 12(2): 135-144.
5.	Oh JH, Kim SH, Lee JH, et al. Treatment of distal clavicle fracture: a systematic review of treatment modalities in 425 fractures. Arch Orthop Trauma Surg, 2011, 131(4): 525-533.
6.	Boonard M, Sumanont S, Arirachakaran A, et al. Fixation method for treatment of unstable distal clavicle fracture: systematic review and network meta-analysis. Eur J Orthop Surg Traumatol, 2018, 28(6): 1065-1078.
7.	Sharma V, Modi A, Armstrong A, et al. The management of distal clavicle fractures-A survey of UK shoulder and elbow surgeons. Cureus, 2021, 13(8): e17305. doi: 10.7759/cureus.17305.
8.	韋永安, 周繼輝, 陳文瑤, 等. 鎖骨遠端骨折治療及內置物的選擇. 中國組織工程研究, 2021, 25(30): 4877-4882.
9.	林浩東, 周軍, 李瀟, 等. 鎖骨遠端不穩定性骨折治療需重視喙鎖韌帶的修復. 中國骨與關節雜志, 2019, 8(11): 801-803.
10.	吳劍宏, 吳曉明, 韓志華, 等. 喙鎖韌帶重建結合鋼板固定治療伴喙鎖韌帶鎖骨止點撕脫的鎖骨遠端骨折. 中華骨科雜志, 2020, 40(1): 17-22.
11.	吳雙, 陳家磊, 張潔, 等. 鎖骨鉤鋼板聯合縫合錨釘重建喙鎖韌帶治療不穩定鎖骨遠端骨折. 中國修復重建外科雜志, 2021, 35(8): 978-983.
12.	Hislop P, Sakata K, Ackland DC, et al. Acromioclavicular joint stabilization: A biomechanical study of bidirectional stability and strength. Orthop J Sports Med, 2019, 7(4): 2325967119836751. doi: 10.1177/2325967119836751.
13.	Yagnik GP, Brady PC, Zimmerman JP, et al. A biomechanical comparison of new techniques for distal clavicular fracture repair versus locked plating. J Shoulder Elbow Surg, 2019, 28(5): 982-988.
14.	Fox HM, Ramsey DC, Thompson AR, et al. Neer type-Ⅱ distal clavicle fractures: A cost-effectiveness analysis of fixation techniques. J Bone Joint Surg (Am), 2020, 102(3): 254-261.
15.	Kapicioglu M, Erden T, Bilgin E, et al. All arthroscopic coracoclavicular button fixation is efficient for Neer type Ⅱ distal clavicle fractures. Knee Surg Sports Traumatol Arthrosc, 2021, 29(7): 2064-2069.
16.	Erden T, Kapicioglu M, Ersen A, et al. Arthroscopic coracoclavicular button fixation versus anatomic locking plate fixation for unstable distal clavicular fractures. JSES Int, 2021, 5(5): 835-839.
17.	Singh B, Mohanlal P, Bawale R. Early failure of coracoclavicular ligament reconstruction using TightRope system. Acta Orthop Belg, 2016, 82(1): 119-123.
18.	Vannabouathong C, Chiu J, Patel R, et al. An evaluation of treatment options for medial, midshaft, and distal clavicle fractures: a systematic review and meta-analysis. JSES Int, 2020, 4(2): 256-271.
19.	Souza Vilela JC, de Andrade RP, Jacques Gon?alves LB, et al. Fractures of the distal clavicle: comparison between two surgical treatment methods. Rev Bras Ortop, 2015, 50(2): 136-141.
20.	Reghine éL, Cirino CCI, Neto AA, et al. Clavicle Kirschner wire migration into left lung: A case report. Am J Case Rep, 2018, 19: 325-328.
21.	Lyons FA, Rockwood CA. Migration of pins used in operations on the shoulder. J Bone Joint Surg (Am), 1990, 72(8): 1262-1267.
22.	Boileau P, Alami G, Rumian A, et al. The doubled-suture Nice knot. Orthopedics, 2017, 40(2): e382-e386.
23.	Craig EV. Fractures of the clavicle//Rockwood CA Jr, Matsen FA 3rd. The shoulder. Philadelphia: WB Saunders, 1990: 367-401.
24.	Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res, 1987, (214): 160-164.
25.	Gordon JE, Kelly-Hahn J, Carpenter CJ, et al. Pin site care during external fixation in children: results of a nihilistic approach. J Pediatr Orthop, 2000, 20(2): 163-165.
26.	Seo JB, Kwak KY, Yoo JS. Comparative analysis of a locking plate with an all-suture anchor versus hook plate fixation of Neer Ⅱb distal clavicle fractures. J Orthop Surg (Hong Kong), 2020, 28(3): 2309499020962260. doi: 10.1177/2309499020962260.
27.	Wu K, Su X, Roche SJL, et al. Relationship between the lateral acromion angle and postoperative persistent pain of distal clavicle fracture treated with clavicle hook plate. J Orthop Surg Res, 2020, 15(1): 217. doi: 10.1186/s13018-020-01737-z.
28.	Lopiz Y, Checa P, García-Fernández C, et al. Complications with the clavicle hook plate after fixation of Neer type Ⅱ clavicle fractures. Int Orthop, 2019, 43(7): 1701-1708.
29.	Asadollahi S, Bucknill A. Hook plate fixation for acute unstable distal clavicle fracture: A systematic review and meta-analysis. J Orthop Trauma, 2019, 33(8): 417-422.
30.	Furuhata R, Matsumura N, Udagawa K, et al. Residual coracoclavicular separation after plate fixation for distal clavicle fractures: comparison between fracture patterns. JSES Int, 2021, 5(5): 840-845.
31.	Perskin CR, Tejwani NC, Jazrawi LM, et al. Clinical outcomes of a combined osteoligamentous reconstruction technique of Neer type ⅡB distal clavicle fractures. J Orthop, 2021, 25: 134-139.
32.	Xie Z, Song M, Zhou J, et al. Precontoured locking compression plate with titanium alloy cable system: In treatment of Neer type Ⅱb distal clavicle fracture. Orthop Surg, 2021, 13(2): 451-457.
33.	Vikas V, Bhatia N, Jalan D, et al. Clinical outcome of Neer type Ⅱ lateral end clavicle fractures with coracoclavicular ligament disruption treated with pre-contoured locking plate and endobutton. Cureus, 2021, 13(1): e12585. doi: 10.7759/cureus.12585.
34.	Salazar BP, Chen MJ, Bishop JA, et al. Outcomes after locking plate fixation of distal clavicle fractures with and without coracoclavicular ligament augmentation. Eur J Orthop Surg Traumatol, 2021, 31(3): 473-479.
35.	Matsumura N, Takada Y, Seto T, et al. Cerclage wiring fixation for the treatment of long oblique fractures of the distal clavicle: A report of 2 cases. JBJS Case Connect, 2019, 9(4): e0085. doi: 10.2106/JBJS.CC.19.00085.
36.	Meyer DC, Bachmann E, L?dermann A, et al. The best knot and suture configurations for high-strength suture material. An in vitro biomechanical study. Orthop Traumatol Surg Res, 2018, 104(8): 1277-1282.
37.	Westberg SE, Acklin YP, Hoxha S, et al. Is suture comparable to wire for cerclage fixation? A biomechanical analysis. Shoulder Elbow, 2019, 11(3): 225-232.
38.	Lee HJ, Kim BK, Ryu HS, et al. Vertical interfragmentary doubled suture for displaced patella fractures: Sequential compressive tightening with Nice knot. Clin Orthop Surg, 2020, 12(3): 413-416.
39.	Wu G, Chen YQ, Chen CY, et al. Clinical outcomes of doubled-suture Nice knot augmented plate fixation in the treatment of comminuted midshaft clavicle fracture. BMC Surg, 2021, 21(1): 270. doi: 10.1186/s12893-021-01274-4.
40.	陳濤, 馬信龍, 馬劍雄, 等. 雙股絲線縫合Nice結固定聯合彈性敷貼牽張治療皮膚軟組織缺損. 中華骨科雜志, 2020, 40(3): 154-159.
41.	Fan XL, Wang J, Zhang DH, et al. The use of Nice knots cerclage to aid reduction and fixation of metacarpal fractures. Plast Reconstr Surg, 2021, 148(2): 338e-339e.
42.	邱耀宇, 王發圣, 藍文彬, 等. 尼斯結技術間接復位治療髕骨橫形骨折. 中國修復重建外科雜志, 2021, 35(6): 710-715.
43.	Laux CJ, Villefort C, El Nashar R, et al. Stand-alone coracoclavicular suture repair achieves very good results in unstable distal clavicle fractures at a minimum follow-up of 1 year. J Shoulder Elbow Surg, 2021, 30(9): 2090-2096.
44.	吳程, 夏亞卿, 王建吉, 等. 關節鏡下TightRope固定與鎖骨鉤鋼板固定治療NeerⅡ型鎖骨遠端骨折的比較. 中國組織工程研究, 2019, 23(32): 5117-5125.
45.	Ying H, Wang J, Sun Y, et al. Treatment of unstable distal clavicle fractures (Neer type Ⅱb): a modified system using a miniature locking plate with a single button. J Int Med Res, 2021, 49(6): 3000605211022505. doi: 10.1177/03000605211022505.
46.	馬滾韶, 羅裕強, 徐勤. 穿梭導線小隧道Endobutton技術治療Rockwood Ⅲ型急性肩鎖關節脫位的療效分析. 中華創傷骨科雜志, 2021, 23(6): 535-538.
47.	Seo JB, Lee DH, Kim KB, et al. Coracoid clavicular tunnel angle is related with loss of reduction in a single-tunnel coracoclavicular fixation using a dog bone button in acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc, 2019, 27(12): 3835-3843.

1. Robinson CM, Cairns DA. Primary nonoperative treatment of displaced lateral fractures of the clavicle. J Bone Joint Surg (Am), 2004, 86(4): 778-782.
2. van der Meijden OA, Gaskill TR, Millett PJ. Treatment of clavicle fractures: current concepts review. J Shoulder Elbow Surg, 2012, 21(3): 423-429.
3. Kahn LA, Bradnock TJ, Scott C, et al. Fractures of the clavicle. J Bone Joint Surg (Am), 2009, 91(2): 447-460.
4. Kim DW, Kim DH, Kim BS, et al. Current concepts for classification and treatment of distal clavicle fractures. Clin Orthop Surg, 2020, 12(2): 135-144.
5. Oh JH, Kim SH, Lee JH, et al. Treatment of distal clavicle fracture: a systematic review of treatment modalities in 425 fractures. Arch Orthop Trauma Surg, 2011, 131(4): 525-533.
6. Boonard M, Sumanont S, Arirachakaran A, et al. Fixation method for treatment of unstable distal clavicle fracture: systematic review and network meta-analysis. Eur J Orthop Surg Traumatol, 2018, 28(6): 1065-1078.
7. Sharma V, Modi A, Armstrong A, et al. The management of distal clavicle fractures-A survey of UK shoulder and elbow surgeons. Cureus, 2021, 13(8): e17305. doi: 10.7759/cureus.17305.
8. 韋永安, 周繼輝, 陳文瑤, 等. 鎖骨遠端骨折治療及內置物的選擇. 中國組織工程研究, 2021, 25(30): 4877-4882.
9. 林浩東, 周軍, 李瀟, 等. 鎖骨遠端不穩定性骨折治療需重視喙鎖韌帶的修復. 中國骨與關節雜志, 2019, 8(11): 801-803.
10. 吳劍宏, 吳曉明, 韓志華, 等. 喙鎖韌帶重建結合鋼板固定治療伴喙鎖韌帶鎖骨止點撕脫的鎖骨遠端骨折. 中華骨科雜志, 2020, 40(1): 17-22.
11. 吳雙, 陳家磊, 張潔, 等. 鎖骨鉤鋼板聯合縫合錨釘重建喙鎖韌帶治療不穩定鎖骨遠端骨折. 中國修復重建外科雜志, 2021, 35(8): 978-983.
12. Hislop P, Sakata K, Ackland DC, et al. Acromioclavicular joint stabilization: A biomechanical study of bidirectional stability and strength. Orthop J Sports Med, 2019, 7(4): 2325967119836751. doi: 10.1177/2325967119836751.
13. Yagnik GP, Brady PC, Zimmerman JP, et al. A biomechanical comparison of new techniques for distal clavicular fracture repair versus locked plating. J Shoulder Elbow Surg, 2019, 28(5): 982-988.
14. Fox HM, Ramsey DC, Thompson AR, et al. Neer type-Ⅱ distal clavicle fractures: A cost-effectiveness analysis of fixation techniques. J Bone Joint Surg (Am), 2020, 102(3): 254-261.
15. Kapicioglu M, Erden T, Bilgin E, et al. All arthroscopic coracoclavicular button fixation is efficient for Neer type Ⅱ distal clavicle fractures. Knee Surg Sports Traumatol Arthrosc, 2021, 29(7): 2064-2069.
16. Erden T, Kapicioglu M, Ersen A, et al. Arthroscopic coracoclavicular button fixation versus anatomic locking plate fixation for unstable distal clavicular fractures. JSES Int, 2021, 5(5): 835-839.
17. Singh B, Mohanlal P, Bawale R. Early failure of coracoclavicular ligament reconstruction using TightRope system. Acta Orthop Belg, 2016, 82(1): 119-123.
18. Vannabouathong C, Chiu J, Patel R, et al. An evaluation of treatment options for medial, midshaft, and distal clavicle fractures: a systematic review and meta-analysis. JSES Int, 2020, 4(2): 256-271.
19. Souza Vilela JC, de Andrade RP, Jacques Gon?alves LB, et al. Fractures of the distal clavicle: comparison between two surgical treatment methods. Rev Bras Ortop, 2015, 50(2): 136-141.
20. Reghine éL, Cirino CCI, Neto AA, et al. Clavicle Kirschner wire migration into left lung: A case report. Am J Case Rep, 2018, 19: 325-328.
21. Lyons FA, Rockwood CA. Migration of pins used in operations on the shoulder. J Bone Joint Surg (Am), 1990, 72(8): 1262-1267.
22. Boileau P, Alami G, Rumian A, et al. The doubled-suture Nice knot. Orthopedics, 2017, 40(2): e382-e386.
23. Craig EV. Fractures of the clavicle//Rockwood CA Jr, Matsen FA 3rd. The shoulder. Philadelphia: WB Saunders, 1990: 367-401.
24. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res, 1987, (214): 160-164.
25. Gordon JE, Kelly-Hahn J, Carpenter CJ, et al. Pin site care during external fixation in children: results of a nihilistic approach. J Pediatr Orthop, 2000, 20(2): 163-165.
26. Seo JB, Kwak KY, Yoo JS. Comparative analysis of a locking plate with an all-suture anchor versus hook plate fixation of Neer Ⅱb distal clavicle fractures. J Orthop Surg (Hong Kong), 2020, 28(3): 2309499020962260. doi: 10.1177/2309499020962260.
27. Wu K, Su X, Roche SJL, et al. Relationship between the lateral acromion angle and postoperative persistent pain of distal clavicle fracture treated with clavicle hook plate. J Orthop Surg Res, 2020, 15(1): 217. doi: 10.1186/s13018-020-01737-z.
28. Lopiz Y, Checa P, García-Fernández C, et al. Complications with the clavicle hook plate after fixation of Neer type Ⅱ clavicle fractures. Int Orthop, 2019, 43(7): 1701-1708.
29. Asadollahi S, Bucknill A. Hook plate fixation for acute unstable distal clavicle fracture: A systematic review and meta-analysis. J Orthop Trauma, 2019, 33(8): 417-422.
30. Furuhata R, Matsumura N, Udagawa K, et al. Residual coracoclavicular separation after plate fixation for distal clavicle fractures: comparison between fracture patterns. JSES Int, 2021, 5(5): 840-845.
31. Perskin CR, Tejwani NC, Jazrawi LM, et al. Clinical outcomes of a combined osteoligamentous reconstruction technique of Neer type ⅡB distal clavicle fractures. J Orthop, 2021, 25: 134-139.
32. Xie Z, Song M, Zhou J, et al. Precontoured locking compression plate with titanium alloy cable system: In treatment of Neer type Ⅱb distal clavicle fracture. Orthop Surg, 2021, 13(2): 451-457.
33. Vikas V, Bhatia N, Jalan D, et al. Clinical outcome of Neer type Ⅱ lateral end clavicle fractures with coracoclavicular ligament disruption treated with pre-contoured locking plate and endobutton. Cureus, 2021, 13(1): e12585. doi: 10.7759/cureus.12585.
34. Salazar BP, Chen MJ, Bishop JA, et al. Outcomes after locking plate fixation of distal clavicle fractures with and without coracoclavicular ligament augmentation. Eur J Orthop Surg Traumatol, 2021, 31(3): 473-479.
35. Matsumura N, Takada Y, Seto T, et al. Cerclage wiring fixation for the treatment of long oblique fractures of the distal clavicle: A report of 2 cases. JBJS Case Connect, 2019, 9(4): e0085. doi: 10.2106/JBJS.CC.19.00085.
36. Meyer DC, Bachmann E, L?dermann A, et al. The best knot and suture configurations for high-strength suture material. An in vitro biomechanical study. Orthop Traumatol Surg Res, 2018, 104(8): 1277-1282.
37. Westberg SE, Acklin YP, Hoxha S, et al. Is suture comparable to wire for cerclage fixation? A biomechanical analysis. Shoulder Elbow, 2019, 11(3): 225-232.
38. Lee HJ, Kim BK, Ryu HS, et al. Vertical interfragmentary doubled suture for displaced patella fractures: Sequential compressive tightening with Nice knot. Clin Orthop Surg, 2020, 12(3): 413-416.
39. Wu G, Chen YQ, Chen CY, et al. Clinical outcomes of doubled-suture Nice knot augmented plate fixation in the treatment of comminuted midshaft clavicle fracture. BMC Surg, 2021, 21(1): 270. doi: 10.1186/s12893-021-01274-4.
40. 陳濤, 馬信龍, 馬劍雄, 等. 雙股絲線縫合Nice結固定聯合彈性敷貼牽張治療皮膚軟組織缺損. 中華骨科雜志, 2020, 40(3): 154-159.
41. Fan XL, Wang J, Zhang DH, et al. The use of Nice knots cerclage to aid reduction and fixation of metacarpal fractures. Plast Reconstr Surg, 2021, 148(2): 338e-339e.
42. 邱耀宇, 王發圣, 藍文彬, 等. 尼斯結技術間接復位治療髕骨橫形骨折. 中國修復重建外科雜志, 2021, 35(6): 710-715.
43. Laux CJ, Villefort C, El Nashar R, et al. Stand-alone coracoclavicular suture repair achieves very good results in unstable distal clavicle fractures at a minimum follow-up of 1 year. J Shoulder Elbow Surg, 2021, 30(9): 2090-2096.
44. 吳程, 夏亞卿, 王建吉, 等. 關節鏡下TightRope固定與鎖骨鉤鋼板固定治療NeerⅡ型鎖骨遠端骨折的比較. 中國組織工程研究, 2019, 23(32): 5117-5125.
45. Ying H, Wang J, Sun Y, et al. Treatment of unstable distal clavicle fractures (Neer type Ⅱb): a modified system using a miniature locking plate with a single button. J Int Med Res, 2021, 49(6): 3000605211022505. doi: 10.1177/03000605211022505.
46. 馬滾韶, 羅裕強, 徐勤. 穿梭導線小隧道Endobutton技術治療Rockwood Ⅲ型急性肩鎖關節脫位的療效分析. 中華創傷骨科雜志, 2021, 23(6): 535-538.
47. Seo JB, Lee DH, Kim KB, et al. Coracoid clavicular tunnel angle is related with loss of reduction in a single-tunnel coracoclavicular fixation using a dog bone button in acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc, 2019, 27(12): 3835-3843.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicle fractures

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