Effectiveness of Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor in treatment of Cho type <b>Ⅱ</b>C distal clavicle fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Shijun , LI Xiang , ZHANG Wei , ZHAO Jiabang , ZENG Zhaofeng ,  WANG Aiguo

Department of Minimally Invasive Orthopedics, Zhengzhou Orthopaedic Hospital, Zhengzhou Henan, 450052, P. R. China;

Corresponding?author：

WANG Aiguo, Email: wag0726@163.com

Keywords：

Distal clavicle fracture; coracoclavicular ligament; Kirschner wire; suture anchor; internal fixation

DOI：

10.7507/1002-1892.202308008

Video：

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Objective To evaluate the effectiveness of Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor in the treatment of Cho type ⅡC distal clavicle fractures. Methods The data of 17 patients with Cho type ⅡC distal clavicular fractures, who were treated with Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor between June 2019 and June 2021, was retrospectively analyzed. There were 11 males and 6 females with an average age of 38.7 years (range, 19-72 years). The fractures were caused by falling in 12 cases and traffic accident in 5 cases. All patients had fresh closed fractures. The interval from injury to operation was 1-5 days (mean, 2.6 days). The preoperative injury severity score (ISS) was 6-27 (mean, 10.2). The operation time, intraoperative blood loss, hospital stay, fracture healing, and postoperative complications were analyzed. The shoulder joint function was evaluated by disabilities of the arm, shoulder, and hand (DASH) score and Constant score at last follow-up. Results All operations were completed successfully. The operation time was 20-50 minutes (mean, 31.6 minutes). The intraoperative blood loss was 30-100 mL (mean, 50.6 mL). The hospital stay was 4-9 days (mean, 5.3 days). All incisions healed by first intention. All patients were followed up 12-16 months (mean, 13 months). All clavicle fractures healed, and the healing time was 8-15 weeks (mean, 11 weeks). No complications such as fracture displacement or nonunion caused by internal fixation failure occurred. During the follow-up, skin irritation caused by the Kirschner wire withdrawal occurred in 3 cases. The Kirschner wires were removed after fracture healing in 17 patients. At last follow-up, the Constant score of shoulder joint was 90-100 (mean, 98.2). The DASH score was 0-10 (mean, 1.5). Conclusion Kirschner wire fixation combined with coracoclavicular ligament reconstruction with suture anchor in the treatment of Cho type ⅡC distal clavicle fractures has less postoperative complications and slight complications. It is convenient to remove the internal fixator. The Kirschner wire does not fix the distal clavicle fracture through the acromion, which has little effect on shoulder joint function and can obtain good effectiveness.

Citation： ZHAO Shijun, LI Xiang, ZHANG Wei, ZHAO Jiabang, ZENG Zhaofeng, WANG Aiguo. Effectiveness of Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor in treatment of Cho type ⅡC distal clavicle fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(11): 1370-1374. doi: 10.7507/1002-1892.202308008 Copy

1.	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.
2.	Sambandam B, Gupta R, Kumar S, et al. Fracture of distal end clavicle: A review. J Clin Orthop Trauma, 2014, 5(2): 65-73.
3.	Neer CS 2nd. Fractures of the distal third of the clavicle. Clin Orthop Relat Res, 1968, 58: 43-50.
4.	Craig EV. Fractures of the clavicle//Rockwood CA, Matsen FA, Harryman DT. The shoulder. Philadelphia: WB Saunders, 1990: 373.
5.	Cho CH, Kim BS, Kim DH, et al. Distal clavicle fractures: A new classification system. Orthop Traumatol Surg Res, 2018, 104(8): 1231-1235.
6.	Serpico M, Tomberg S. The emergency medicine management of clavicle fractures. Am J Emerg Med, 2021, 49: 315-325.
7.	Banffy MB, van Eck CF, Stanton M, et al. A single-tunnel technique for coracoclavicular and acromioclavicular ligament reconstruction. Arthrosc Tech, 2017, 6(3): e769-e775.
8.	Seo JB, Kim SJ, Ham HJ, et al. Comparison between hook plate fixation with and without coracoclavicular ligament suture for acute acromioclavicular joint dislocations. J Orthop Surg (Hong Kong), 2020, 28(1): 2309499020905058.
9.	Xu H, Chen WJ, Zhi XC, et al. Comparison of the efficacy of a distal clavicular locking plate with and without a suture anchor in the treatment of Neer Ⅱb distal clavicle fractures. BMC Musculoskelet Disord, 2019, 20(1): 503.
10.	Vrotsou K, ávila M, Machón M, et al. Constant-Murley Score: systematic review and standardized evaluation in different shoulder pathologies. Qual Life Res, 2018, 27(9): 2217-2226.
11.	Franchignoni F, Vercelli S, Giordano A, et al. Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH). J Orthop Sports Phys Ther, 2014, 44(1): 30-39.
12.	Renger RJ, Roukema GR, Reurings JC, et al. The clavicle hook plate for Neer type Ⅱ lateral clavicle fractures. J Orthop Trauma, 2009, 23(8): 570-574.
13.	Li L, Wu H, Jiang P, et al. Comparison of four different internal fixation methods in the treatment of distal clavicle fractures. Exp Ther Med, 2020, 19(1): 451-458.
14.	鄭興國, 薛騁, 李翔, 等. 喙鎖韌帶解剖重建與鉤鋼板治療鎖骨遠端NeerⅡb型骨折的療效比較. 中華創傷骨科雜志, 2022, 24(5): 421-428.
15.	Sarda P. Lateral clavicle fractures with coracoclavicular ligament disruption (Neer’s type ⅡB): Review of literature and a new technique for all-suture fixation. Indian J Orthop, 2019, 53(3): 465-471.
16.	金翔赟, 沈一凡, 李廣翼, 等. 帶錨鈦纜重建喙鎖韌帶的生物力學研究. 國際骨科學雜志, 2019, 40(3): 187-190.
17.	Manohara R, Reid JT. Percutaneous endobutton fixation of acute acromioclavicular joint injuries and lateral clavicle fractures. J Clin Orthop Trauma, 2019, 10(3): 492-496.
18.	Dan J, Kim BK, Lee HJ, et al. Supplementary technique for unstable clavicle shaft fractures: interfragmentary wiring and temporary axial K-wire pinning. Clin Orthop Surg, 2018, 10(2): 142-148.
19.	Fan J, Zhang Y, Huang Q, et al. Comparison of treatment of acute unstable distal clavicle fractures using anatomical locking plates with versus without additional suture anchor fixation. Med Sci Monit, 2017, 23: 5455-5461.
20.	Argekar HG, Sahu D. Under coracoid-through clavicle suture fixation in type 2 distal clavicle fracture. J Orthop Case Rep, 2020, 10(2): 13-16.
21.	Jeon YM, Ko BS, Park JW. Distal clavicle fracture treated with a titanium elastic nail (TEN). Trauma Case Rep, 2019, 19: 11-14.
22.	姜濟世, 翟云雷, 黃徐兵, 等. Endobutton鋼板聯合高強度縫線Nice結固定治療鎖骨遠端骨折療效分析. 中國修復重建外科雜志, 2022, 36(2): 155-162.

1. 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.
2. Sambandam B, Gupta R, Kumar S, et al. Fracture of distal end clavicle: A review. J Clin Orthop Trauma, 2014, 5(2): 65-73.
3. Neer CS 2nd. Fractures of the distal third of the clavicle. Clin Orthop Relat Res, 1968, 58: 43-50.
4. Craig EV. Fractures of the clavicle//Rockwood CA, Matsen FA, Harryman DT. The shoulder. Philadelphia: WB Saunders, 1990: 373.
5. Cho CH, Kim BS, Kim DH, et al. Distal clavicle fractures: A new classification system. Orthop Traumatol Surg Res, 2018, 104(8): 1231-1235.
6. Serpico M, Tomberg S. The emergency medicine management of clavicle fractures. Am J Emerg Med, 2021, 49: 315-325.
7. Banffy MB, van Eck CF, Stanton M, et al. A single-tunnel technique for coracoclavicular and acromioclavicular ligament reconstruction. Arthrosc Tech, 2017, 6(3): e769-e775.
8. Seo JB, Kim SJ, Ham HJ, et al. Comparison between hook plate fixation with and without coracoclavicular ligament suture for acute acromioclavicular joint dislocations. J Orthop Surg (Hong Kong), 2020, 28(1): 2309499020905058.
9. Xu H, Chen WJ, Zhi XC, et al. Comparison of the efficacy of a distal clavicular locking plate with and without a suture anchor in the treatment of Neer Ⅱb distal clavicle fractures. BMC Musculoskelet Disord, 2019, 20(1): 503.
10. Vrotsou K, ávila M, Machón M, et al. Constant-Murley Score: systematic review and standardized evaluation in different shoulder pathologies. Qual Life Res, 2018, 27(9): 2217-2226.
11. Franchignoni F, Vercelli S, Giordano A, et al. Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH). J Orthop Sports Phys Ther, 2014, 44(1): 30-39.
12. Renger RJ, Roukema GR, Reurings JC, et al. The clavicle hook plate for Neer type Ⅱ lateral clavicle fractures. J Orthop Trauma, 2009, 23(8): 570-574.
13. Li L, Wu H, Jiang P, et al. Comparison of four different internal fixation methods in the treatment of distal clavicle fractures. Exp Ther Med, 2020, 19(1): 451-458.
14. 鄭興國, 薛騁, 李翔, 等. 喙鎖韌帶解剖重建與鉤鋼板治療鎖骨遠端NeerⅡb型骨折的療效比較. 中華創傷骨科雜志, 2022, 24(5): 421-428.
15. Sarda P. Lateral clavicle fractures with coracoclavicular ligament disruption (Neer’s type ⅡB): Review of literature and a new technique for all-suture fixation. Indian J Orthop, 2019, 53(3): 465-471.
16. 金翔赟, 沈一凡, 李廣翼, 等. 帶錨鈦纜重建喙鎖韌帶的生物力學研究. 國際骨科學雜志, 2019, 40(3): 187-190.
17. Manohara R, Reid JT. Percutaneous endobutton fixation of acute acromioclavicular joint injuries and lateral clavicle fractures. J Clin Orthop Trauma, 2019, 10(3): 492-496.
18. Dan J, Kim BK, Lee HJ, et al. Supplementary technique for unstable clavicle shaft fractures: interfragmentary wiring and temporary axial K-wire pinning. Clin Orthop Surg, 2018, 10(2): 142-148.
19. Fan J, Zhang Y, Huang Q, et al. Comparison of treatment of acute unstable distal clavicle fractures using anatomical locking plates with versus without additional suture anchor fixation. Med Sci Monit, 2017, 23: 5455-5461.
20. Argekar HG, Sahu D. Under coracoid-through clavicle suture fixation in type 2 distal clavicle fracture. J Orthop Case Rep, 2020, 10(2): 13-16.
21. Jeon YM, Ko BS, Park JW. Distal clavicle fracture treated with a titanium elastic nail (TEN). Trauma Case Rep, 2019, 19: 11-14.
22. 姜濟世, 翟云雷, 黃徐兵, 等. Endobutton鋼板聯合高強度縫線Nice結固定治療鎖骨遠端骨折療效分析. 中國修復重建外科雜志, 2022, 36(2): 155-162.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor in treatment of Cho type ⅡC distal clavicle fractures

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