Which Technique is the Optimal Option for the Treatment of Displaced Far-Lateral (Cho Type IIC) Distal Clavicle...

As achieving stable fixation in unstable far-lateral distal clavicle fractures is challenging, the optimal surgical treatment remains controversial. The aim of this study was to compare the clinical and radiological results of coracoclavicular fixation (CCF) versus anatomical locking plate fixation (ALPF) in patients with Cho type IIC fractures.

Thirty-eight patients who underwent surgical treatment for Cho type IIC fracture were included. Open CCF using a suture button device was performed in 25 patients and ALPF was performed in 13 patients. The mean follow-up period was 35.7 months (range, 12-132 months). Radiographic results were evaluated using serial plain radiographs. Clinical results were evaluated using the University of California, Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) score, and Subjective Shoulder Value (SSV).

No significant differences were observed between the CCF and ALPF groups in terms of UCLA score (32.0 vs. 32.1), ASES score (90.6 vs. 91.0), and SSV (90.6% vs. 89.6%). Although significant differences between the 2 groups were observed in the mean coracoclavicular (CC) distance of the affected side at the immediate postoperative period (5.2 mm vs. 9.0 mm) and final follow-up (5.7 mm vs. 9.1 mm), the CC distances between the immediate postoperative period and final follow-up in each group were maintained without significant loss of reduction. In the CCF group, complications occurred in 4 of 25 cases (16.0%) including skin irritation caused by a superior button or knot in 2 cases, nonunion in 1 case, and shoulder stiffness in 1 case. In the ALPF group, complications occurred in 2 of 13 cases (15.4%) including screw pull-out in 1 case and shoulder stiffness in 1 case.

Both CCF using a suture button device and ALPF without CC augmentation for type IIC fractures showed satisfactory clinical and radiological results. Both techniques can be recommended as the optimal option that can provide sufficient vertical stability for solid union.