Surgical treatment for distal clavicle fracture with coracoclavicular ligament disruption

Surgical reconstruction is usually indicated for distal clavicle fractures with coracoclavicular ligament disruption due to a high rate of nonunion and delayed union. We report the outcome of a surgical technique for this type of fracture.

The procedures consist of coracoclavicular reconstruction with a Mersilene tape, repair of torn coracoclavicular ligament, and wire fixation of the fracture fragments. From 1993 through 1998, this technique has been used on 13 patients with distal clavicle fracture and associated coracoclavicular ligament disruption. Eleven patients with at least 18 months of complete postoperative follow-up were included for functional and radiographic evaluation.

After 18 to 48 months' follow-up, the clinical outcome has been encouraging. Solid union of the fracture could be achieved at 3 months after operation in 10 patients. The remaining one fracture achieved bony union at 6 months. Ten patients could return to the same or a higher level of preinjury activity. Good and excellent results were obtained in 10 patients.

The advantages of this technique include that the disrupted coracoclavicular articulation is rigidly restored and then the fracture site can be easily reduced and fixed with a wire. This technique allows for stable fixation with early mobilization and early return to work and sports.