Characteristics of Lateral Clavicle Fractures Treated With Coracoclavicular Ligament Repair or Reconstruction in a...

Lateral clavicle fractures comprise a minority of all clavicle fractures and are associated with high rates of nonunion when managed nonoperatively. Various fixation methods have been described, including augmentation with coracoclavicular (CC) ligament repair or reconstruction. Outcomes following the surgical treatment of lateral clavicle fractures are limited to small case series and systematic reviews, and the literature within physically demanding populations remains sparse. We sought to describe the characteristics and complications of operative lateral clavicle fractures treated with CC ligament repair or reconstruction within the Military Health System.

We queried the U.S. Military Health System Data Repository for patients with a lateral clavicle fracture treated with CC ligament repair or reconstruction between October 2013 and March 2020. We reviewed electronic health records, including patient demographics, radiographs, operative reports, and clinical notes, to assess injury characteristics, surgical constructs, postoperative complications, and functional outcomes.

A total of 40 patients underwent CC ligament repair (n = 20, 50%) or reconstruction (n = 20, 50%) for treatment of lateral clavicle fractures during the study period. Twenty-two (55%) patients underwent surgery within 6 weeks of injury, and 40% (n = 18) required concomitant open reduction and internal fixation. Complications included adhesive capsulitis (n = 3, 7.5%), unplanned return to the operating room (n = 4, 10%), and loss of CC reduction (n = 10, 25%). Twenty-six (65%) patients achieved a full, pain-free range of motion. There was a statistically significant association between postoperative complications and shoulder pain or diminished range of motion (P = .026). Seven of 32 (21.9%) active-duty service members required medical separation from military service. Female sex (P = .04) and distal clavicle plate fixation increase the risk of unplanned return to the operating room (P = .01). Nicotine use was predictive of eventual military separation (P = .004).

In this case, a series of lateral clavicle fractures treated with CC ligament repair or reconstruction, all patients achieved fracture union and the majority of patients regained full, pain-free range of motion. Complications were common and portended a poor functional outcome. At the conclusion of their fracture care, 1 in 5 active-duty patients necessitated medical separation from military service.