Complications with the clavicle hook plate after fixation of Neer type II clavicle fractures

There is no consensus on the optimal surgical procedure for treating Neer type-2 distal clavicle fractures. Hook plates provide better stability than other fixation methods for small fragments but have been related to multiple complications.

Retrospective study on patients operated for Neer type-2 fractures using a hook plate. At the time of the study, we performed functional (UCLA and Constant scales) and radiographic (coracoclavicular distance CCD) evaluation and ultrasound assessments of the condition of the rotator cuff.

Twenty-four patients were included in the study, with a mean age of 43 years (18-81) and a mean follow-up of 40.4 months (22-67). All the fractures healed, except one. The plate was removed at a mean of five  months (3-13). The Constant score was 85.7 and the UCLA score was 32. The mean increase in CCD at final follow-up was 9.6% ± 7.2% (range 1.9-54.3%) compared with the uninjured side. Nine patients showed acromioclavicular arthrosis (only one case was symptomatic), and 12% showed subacromial osteolysis. No acromion fractures were recorded. The implant failed in three cases due to medial movement of the material, and we found one peri-plate fracture.

The use of hook plates in this particular type of fracture provides high consolidation rates and good functional outcomes, irrespective of the fracture subtype. However, it is essential to select the correct length and depth of the hook to prevent complications such as medial movement of the implant. Ultrasound assessment showed that rotator cuff injury is not a common complication if the implant is removed as soon as the fracture has consolidated.