Locked Cerclage Wiring for Distal Clavicle Fractures: Surgical Technique and Clinical Outcomes in 11 Patients

Background: Cerclage wiring (CW) is a surgical option in distal clavicular fractures with small bone fragments; however, complications associated with pin backout are occasionally observed. Therefore, we introduced a locked CW system integrating the pin and sleeve and evaluated its clinical outcomes. Methods: This case series included 11 patients who underwent locked CW fixation (age, 57.5 ± 20.0 years; eight men, three women). Postoperatively, shoulder range of motion exercises were commenced at two weeks based on pain tolerance. The primary outcomes were the range of forward elevation, the Constant and American Shoulder and Elbow Surgeons (ASES) scores at six months, bone union rates, pin backout distances, and postoperative complications. Results: The range of forward elevation was 176.7 ± 22.2° at six weeks and 180 ± 0° at six months postoperatively. The Constant and ASES scores were 100 (95-100) and 95 (95-100), respectively. Bone union was achieved in all cases. Compared with immediately after surgery, the pin backout distance was 0.9 mm (-0.2 to 1.2 mm). One patient developed a surgical site infection. Two patients had subcutaneous pin prominence that required implant removal. Discussion: Locked CW showed excellent early recovery of shoulder motion after surgery. This outcome may be attributed to stable fixation even in small distal fragments, minimal pin backout, and the ability to initiate range-of-motion exercises at an early stage. Conclusion: Locked CW appears to be a useful and reliable option for distal clavicular fractures. Further comparative and multicenter studies are needed to validate these results.