Suture Button Fixation and Nice Knot Cerclage for Neer Type V Distal Clavicle Fractures

Neer type V distal clavicle fractures are challenging injuries to treat. The fracture morphology includes a small distal clavicle fracture fragment attached to the acromion by the acromioclavicular ligaments and a separate inferior fracture fragment attached to the coracoclavicular ligaments. This fracture pattern is functionally equivalent to a complete acromioclavicular joint dislocation. Plate fixation is not an ideal operative strategy, as the distal fracture fragment is too small to obtain adequate screw fixation; therefore, suture button or suture anchor fixation is an alternative that has been described and used. These techniques use the coracoid as an anchor to reduce the clavicle indirectly to the inferior fracture fragment and small lateral distal fragment to achieve bony union. The purpose of this Technical Note is to describe a technique for open suture button fixation and Nice knot suture cerclage for Neer type V distal clavicle fractures.