Anatomical ligament reconstruction for Neer type IIB distal clavicular fractures using suture buttons without...

Coracoclavicular (CC) ligament reconstruction has been reported as an option for distal clavicle fractures with ligament injuries. However, most of the reported techniques use single-bundle reconstruction which is not fully anatomical and sometimes associated with complications such as nonunion, coracoid fractures, or discomfort on the clavicle due to large-diameter drill holes and bulky implants. We therefore developed an anatomical double-bundle reconstruction of the CC ligaments for distal clavicle fractures. The conoid ligament is reconstructed using a suture button, while the trapezoid ligament is reconstructed using either a suture button or transosseous suturing. We used ankle syndesmosis suture-button, which requires smaller drill holes than suture buttons for acromioclavicular joint reduction. No temporary fixation of the acromioclavicular joint was performed. The purpose of our study was to describe this surgical technique and evaluate clinical and radiographic outcomes of double-ligament reconstruction without temporary wire fixation.

Twenty-three patients with distal clavicle fractures who underwent surgery at our institution were retrospectively enrolled. Twelve patients were treated with double suture buttons for CC ligament reconstruction (double-button group) and 11 were treated with a single suture button (for the conoid ligament) plus transosseous suturing of the trapezoid ligament fragment (single-button group). Sequential radiographs were taken over a 1-year postoperative period to evaluate time to bone union and displacement of the CC distance. These parameters were compared between the single- and double-button groups. Clinical outcomes were assessed using the Constant-Murley score at 1 year postoperatively.

Clinical scores were satisfactory in both groups (single-button group: 97.0 ± 2.2; double-button group: 95.4 ± 2.9; P = .18). All patients except 1 in double-button group achieved bone union. One patient in the double-button group experienced suture-button pull-out from the coracoid process. Radiographs showed a slight increase in CC displacement from 1 to 3 months postoperatively in both groups. At 1 year, the average displacement relative to the intact side was 2.4 ± 2.8 mm in the single-button group and 4.4 ± 2.7 mm in the double-button group, with no significant difference (P = .11). No patients required implant removal or additional surgery.

Double-bundle reconstruction of the CC ligaments for distal clavicle fractures resulted in satisfactory outcomes. Transosseous suturing of the trapezoid ligament fragment provided comparable outcomes to suture-button fixation.