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Plate Fixation with and without Suture Endobutton Augmentation of the CoracoClavicular Ligament in displaced Lateral
Alona Katzir1, Craig E Klinger1, Robert Bilodeau2
1Hospital for Special Surgery, New York, NY.
Objectives:
To compare the clinical outcomes of plate fixation with and without coracoclavicular (CC) suture Endobutton augmentation in the management of displaced lateral clavicle fractures.
Methods:
Design: Retrospective study.
Setting:
Tertiary referral hospital.
Patient Selection Criteria:
Included were adult patients with displaced lateral clavicle fractures (OTA/AO 15.3) who underwent plate fixation between June 2021 and April 2024. The Augmentation group received adjunctive suture Endobutton fixation, while the Control group did not.
Outcome Measures And Comparisons:
Clinical outcomes including union, coracoclavicular (CC) distance, infection, re-operation, and self-reported functional outcomes consisting of the Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and numerical rating scale for pain (NRSP) were evaluated and compared between the two groups. To normalize for magnification, the ratio of CC distance to midclavicular width (CCD/MCW) was used to compare the CC distance over time.
Results:
Forty-nine patients were included, 21 in the Augmentation group (76.2% male, mean age 47.5 years) and 28 in the Control group (75% male, mean age 46.6 years). In the Augmentation group, 15 patients (71.4%) underwent dual plating and 6 (28.6%) underwent single plate fixation. In the Control group, 15 patients (53.6%) underwent dual plating, 10 (35.7%) underwent single plate fixation, and 3 (10.7%) underwent hook plate fixation. The mean study follow-up was 33.7 months (range 4.2-118.6). Union was achieved in all patients (100%) in the Augmentation group, compared to 92.8% in the Control group (p = 0.19). Preoperative CCD/MCW ratios were 2.6 for the Augmentation group and 2.3 for the Control group (p = 0.12). Intraoperative ratios were reduced to 1.4 in both groups (p = 0.6), and maintained at 1.4 during follow-up (p = 0.3). There were no infections. Two patients (9.5%) in the Augmentation group and 7 patients (25%) in the control underwent hardware removal. The median QuickDASH score was 2.3 in both groups (p=0.7), and the median NRSP score was 0.0 in the Augmentation group and 0.5 in the control (p=0.3).
Conclusions:
In displaced lateral clavicle fractures, plate fixation with CC ligament suture Endobutton Augmentation achieved a 100% union rate, long-term CC stability, and excellent functional results. With the numbers available in the study, the lower (92.8%) healing rate in the control group without Endobutton Augmentation did not reach statistical significance.
Level Of Evidence:
A level IV therapeutic retrospective cohort study.
