Arthroscopic fixation of a type II-variant, unstable distal clavicle fracture

This article describes a case of a patient with a type II-variant, unstable distal clavicle fracture that was successfully treated with a novel arthroscopic technique using the Tightrope system (Arthrex, Naples, Florida). The arthroscope was placed into the anterolateral portal after a bursectomy was performed. An anterior portal was made lateral to the coracoid using superficial landmarks and arthroscopic visualization. A radiofrequency device was inserted through the anterior portal. Following the coracoacromial ligament medially, the radiofrequency device was used to first tactilely then visually identify the coracoid base. An anterior cruciate ligament guide was inserted through the anterior portal and placed inferior to the base of the coracoid. The guide pin sleeve was placed medial to the fractured clavicle perpendicular to the coracoid. A small incision was made and a guide pin was drilled through the clavicle and through the coracoid under arthroscopic visualization. A cannulated drill was used to drill a hole through the clavicle into the base of the coracoid. A looped guide wire was inserted through the cannulated drill, passed out of the hole drilled in the coracoid, and retrieved through the anterior cannula. The drill was removed, leaving the guide wire in place. The Tightrope was inserted into the looped guide wire and pulled first through the clavicle and then the coracoid. Once the inferior button was pulled out of the coracoid drill hole, the button was deployed to anchor it under the inferior coracoid. With the fracture held reduced, the Tightrope was tied down over the superior clavicle, obtaining reduction and fixation of the distal clavicle fracture. Fracture consolidation was confirmed at 3 months, and the patient returned to painless, unrestricted activity at 5 months.