Surgical treatment of distal clavicle fractures using the clavicular hook plate

From 1999 to 2003, 34 patients with unstable distal clavicular fractures (Neer Type 2) had surgery using the acromioclavicular titanium hook plate. To investigate the reliability of clavicular hook plate fixation and the effects of hook plates in the subacromial space, we retrospectively reviewed clinical results for pain, shoulder function, range of motion, and radiographic results. The Japanese Orthopaedic Association scores for shoulder disorders indicated good clinical results (mean, 98.3 points). All patients had radiographic bony union. Complications included plate displacement in one patient, acromion fracture caused by widening of the hook hole in one patient, and a rotator cuff tear caused by hook subacromial impingement in one patient. This plate fixation method is useful for treating unstable distal clavicular fracture. However, careful operative planning and familiarity with the technique are necessary to prevent complications including subacromial impingement, rotator cuff damage, acromion fracture, and hook cut-out. Care must be used when establishing the position of the hook hole, and it is best to remove the plate after bony union.