Distal clavicle fractures with "superior intact cortical bone": minimally invasive surgery

Distal clavicle fractures represent 12%-26% of all clavicle fractures. For unstable cases, surgical fixation is the preferred method of treatment. To date, there is still controversy regarding the best fixation method with a high reoperation and complication rate reported. The purpose of this article is to describe a minimally invasive method for reduction and stabilization of displaced distal clavicle fractures, using cortical buttons.

After standard preoperative preparation, a 3-cm incision is made at the coracoclavicular area. Using both coracoid and clavicle tunnels, fracture reduction and fixation is obtained using a cortical fixation button. Standard postoperative care is given.

A total of 21 patients (19 men) with a mean age of 34.7 years were treated using this technique. The follow-up was between 6 and 41 months, with an average of 23.4 months. The mean simple shoulder test score was 79.4 (range 66-91.7), and the QuickDASH score was 11 (range 6.8-15.9). Consolidation of the fracture was confirmed at the 12-week follow-up radiography, with no cases of nonunion or malunion identified. No patients presented infection or complications at the surgical site. Implant removal was not needed in this series. All the patients returned to work.

Minimally invasive button fixation of unstable distal clavicle fractures is a safe and reliable alternative treatment. The initial outcome report is promising with excellent clinical and radiological results and no complications or implant removals.