Locking Plate With or Without Cerclage Augmentation Versus Hook Plate for Neer Type II Distal Clavicle Fractures: A...

Area of Science:

• Orthopedic surgery
• Traumatology
• Skeletal fixation devices

Background:

• Unstable distal clavicle fractures (Neer type II) present a high nonunion risk, often necessitating surgical intervention.
• Hook plates are common for distal clavicle fractures, especially with small or comminuted fragments, but risk subacromial irritation and wear.
• Distal locking plates with cerclage augmentation offer an alternative fixation method potentially reducing implant-related complications.

Purpose of the Study:

• To compare the clinical and radiographic outcomes of hook plates versus distal locking plates with or without cerclage augmentation for Neer type II distal clavicle fractures.
• To evaluate complication rates, radiographic union, shoulder range of motion, pain, and functional scores between the two fixation methods.

Main Methods:

• A single-center retrospective cohort study reviewed adult patients with Neer type II distal clavicle fractures treated with open reduction and internal fixation.
• Patients were divided into two groups: hook plate fixation (n=16) and distal locking plate with or without cerclage augmentation (n=26).
• Follow-up was at least 6 months, assessing primary outcomes (complications, union, ROM) and secondary outcomes (pain, function scores).

Main Results:

• Both groups demonstrated high radiographic union rates (locking plate: 92.3%, hook plate: 87.5%), with similar complication rates (p=0.612).
• Functional outcomes and shoulder range of motion were comparable between the groups, though forward flexion trended higher in the locking plate group.
• Subacromial wear was observed in 25% of hook plate patients, but not in the locking plate group, with no deep infections or hardware failures reported.

Conclusions:

• Both hook plates and distal locking plates (with or without cerclage) achieve high union rates and satisfactory function for Neer type II distal clavicle fractures.
• Distal locking plates avoid subacromial complications associated with hook plates, making them a reliable first-line option when feasible.
• Hook plates should be reserved for cases with minimal distal bone stock or complex comminution where locking plate purchase is not possible.