Comparing hook plates and Kirschner tension band wiring for unstable lateral clavicle fractures

The purpose of this study was to compare outcomes and complications of clavicular hook plate and Kirschner tension band wiring for fixation of unstable lateral clavicle fractures. The surgical outcomes of 92 consecutive patients (mean age, 49.30 ± 15.54 years) with unstable fractures of the lateral clavicle treated using AO clavicle hook plates were compared with those of 24 patients (mean age, 50.67 ± 17.58 years) treated using K-wire tension banding. Patients in the hook plate and K-wire groups were followed up for 22.76 ± 2.22 and 25.67 ± 2.75 months, respectively (P<.001). The time to hardware removal was significantly shorter (P<.001) in the hook plate group (5.20 ± 1.93 months) compared with the K-wire group (7.58 ± 2.00 months), whereas the Constant-Murley score was significantly higher (P<.001) in the hook plate group (90.43 ± 4.78) compared with the K-wire group (85.63 ± 5.38) at final follow-up. There were 12 complications in the hook plate group and 7 in the K-wire group (P=.069). Complications in the hook plate group included 7 periprosthetic fractures, 4 plate removals, and 1 plate malposition. Complications in the K-wire group included 3 K-wire migrations, 3 losses of reduction, and 1 wire breakage. We found that hook plate fixation of unstable lateral clavicle fractures was associated with statistically better shoulder function and earlier implant removal than K-wire tension band fixation, with an equivalent rate of complications. Our findings suggest that hook plates are useful for treating unstable lateral clavicular fractures.