Locking plate fixation with coracoclavicular augmentation through cannulated locking screws for unstable distal...

PurposeTo describe a hybrid fixation technique combining a superior distal clavicle locking plate with coracoclavicular (CC) augmentation through cannulated locking screws and to report its radiological and clinical outcomes.MethodsWe retrospectively reviewed a consecutive surgical cohort treated between March 2022 and March 2025. Of 26 patients who underwent the procedure, 4 were excluded because of follow-up of less than 12 months or loss to follow-up, leaving 22 patients for analysis. Two 2.4-mm × 8.5-mm suture anchors were placed at the conoid and trapezoid footprints of the coracoid base, and the sutures were shuttled from the anteroinferior aspect of the clavicle through cannulated locking screw lumens. Outcomes included union, maintenance of reduction, complications, pain, function, and shoulder motion.ResultsAll 22 fractures united at a mean of 12.8 ± 2.5 weeks. The final CC distance ratio was 1.05 ± 0.10. The mean visual analogue scale and QuickDASH scores were 0.6 ± 0.8 and 5.4 ± 2.1, respectively. No coracoid cortical breach, neurovascular injury, implant failure, loss of reduction, or implant removal occurred. Three patients developed transient supraclavicular nerve irritation, which resolved spontaneously.ConclusionThis technique provided reliable union, maintained reduction, and favorable short-term clinical outcomes. It may provide an anatomically oriented option for supplementary CC stabilization, although comparative and biomechanical studies are required.