Treatment of acute unstable distal clavicle fractures with single coracoclavicular suture fixation

Distal clavicular fractures are less common than fractures involving the middle third of the clavicle. For Neer type IIb distal clavicular unstable fractures associated with disruption of the coracoclavicular ligament, surgical treatment is indicated because of the high risk of nonunion. Various surgical methods can be found in the literature, but no gold standard has been established. We treated 29 consecutive adult patients with unstable distal clavicular fracture with single coracoclavicular suture fixation by using single Mersilene tape (Ethicon, Somerville, New Jersey) and without repair of the torn coracoclavicular ligament or hardware implantation.Twenty-eight patients were followed for at least 46 months (mean, 57.3 months). All fractures healed without further treatment, with a mean time to union of 14.3 weeks. There was no major morbidity, but 2 minor complications occurred. One patient experienced a frozen shoulder on the treated side postoperatively. After adequate rehabilitation, the symptom resolved without any complications at final follow-up. Another patient reported uncomfortable skin tenting due to subcutaneous protrusion of the suture node of the Mersilene tape. After simple subcutaneous surgical removal of the node under local anesthesia, the discomfort resolved. Mean University of California Los Angeles shoulder rating score was 34 (range, 29-35). Twenty patients had excellent results and 8 had good results. All patients resumed their previous levels of activity.