Augmented Fixation of Distal Clavicle Fractures: High Union, Moderate Complications

Introduction Unstable lateral clavicle fractures (Neer type II) present significant surgical challenges. Combined fixation using a locking clavicular plate and suture-button (e.g., TightRope (Arthrex, Inc., Naples, FL)) augmentation is a biomechanically appealing technique designed to provide both anatomical stability and coracoclavicular (CC) reconstruction. This study reports the early clinical and radiological outcomes of this combined approach in a representative NHS patient cohort. Materials and methods A retrospective case series was conducted of 18 consecutive patients (mean age 48.5 years, 12 males). All patients received a pre-contoured locking plate (Arthrex/Synthes) combined with a suture-button construct for CC augmentation (knotless/knotted TightRope, FiberTape (Arthrex, Inc., Naples, FL) or EndoButton (Smith+Nephew, Watford, UK)). Primary outcomes were radiographic union and complications. Secondary outcomes included range of motion (ROM) and patient-reported outcome measures (PROMs) (Visual Analogue Scale (VAS), QuickDASH, Oxford Shoulder Score). Results Among the 18 patients with documented radiological follow-up, the mean time to union was 23.9 weeks (range 17.4-34.8 weeks). At a mean follow-up of 13.2 months, functional ROM was achieved in 15 patients (84%). Preliminary PROMs from a subset of patients (n = 10) showed a mean Visual Analogue Scale (VAS) pain score of 1.1, mean QuickDASH of 20.1 and mean Oxford Shoulder Score of 52.5. The overall complication rate was 16.7% (3/18), with one patient experiencing two complications. Complications included one implant failure (TightRope construct rupture) requiring revision surgery, one deep wound infection requiring debridement and implant removal, one case of frozen shoulder and one instance of transient neurological symptoms. No cases of plate failure or non-union were observed, although two patients (11.1%) required re-operation (implant removal for infection in one and a planned secondary ligament reconstruction for the failed TightRope construct in the other). Conclusion and significance Combined locking plate and suture-button augmentation for unstable lateral clavicle fractures results in reliable bony union and good early functional outcomes in an NHS setting. While the complication rate reflects the complexity of these injuries and the learning curve associated with the technique, the absence of catastrophic implant failure or non-union is encouraging. This dual-construct technique offers a viable and effective alternative to traditional hook plate fixation.