Abstract
Introduction: Distal third fractures of the clavicle account for approximately 10–15% of clavicle fractures. Non union rates following conservative management can be as high as 30%. Many techniques have been described, including external fixation, k-wire fixation, and most recently, hook plate fixation. Non-absorbable sutures, and slings have also been utilised. All of these techniques are associated with complications. In addition, Hook plates require a second operation to remove the plate. This study reports the results of a simple technique using a PDS loop in the fixation of Neer type 2 fractures of the clavicle, performed in our institution.
Methods: Twelve patients with Neer type 2 fractures operated by a single surgeon over three years were included in the study. The mean age was 45 (14 to 63). There were 7 male and 5 female patients. Standard postoperative protocols were followed in all patients. A 1.5 PDS cord looped around the coracoid was used to hold the reduced medial clavicular shaft fragment. Patients were followed up postoperatively at two, six and twelve weeks. Final outcomes were assessed using radiographs and the Oxford and DASH scoring systems at twelve months.
Results: Ten fractures united within twelve weeks. All of these patients returned to their pre-injury activity level. There were two non unions, both in non compliant patients. One of these non unions remained asymptomatic and one patient was lost to follow up. The mean Oxford score at 12 months was 14.25 (range 12 to 16) and the mean DASH score was 5 (4–7).
Conclusion: We conclude that this technique is safe, simple and cost effective. It achieves high rates of union without the need for implant removal. As with other techniques, proper patient selection is essential. We recommend this technique as an excellent treatment option when dealing with these notoriously difficult fractures.
The abstracts were prepared by Mr Matt Costa and Mr Ben Ollivere. Correspondence should be addressed to Mr Costa at Clinical Sciences Research Institute, University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK.
