Abstract
Introduction
The treatment of Neer type 2 lateral end clavicle fractures presents a difficult problem due to the high incidence of non-union, delayed union, shoulder girdle instability and the need for implant removal. We report our experience in 10 patients with acute fractures treated with a simple modified tension band suturing technique.
Surgical technique
Following accurate reduction of the fracture, antero-posterior holes are drilled through both fracture fragments. Ethibond suture (number 5) is passed through the drill holes and tied in a ‘figure of 8’ on the superior side. This is reinforced with an identical second tension band suture. As the coracoclavicular ligaments remain attached to the lateral fragment, the principle of the surgery is to maintain the approximation of the fracture fragments with the tension band until fracture union, thereby resuming shoulder girdle stability.
Methods
The patients (8 male and 2 female, age range 15 to 72 years) were operated on by the senior author between May 2003 and Jan 2005. Assessment was performed with clinical evaluation, the Constant score and radiologically. Mean length of follow-up was 13 months.
Results
The fractures all united clinically and radiologically without complication. None of the patients reported pain or instability and all had returned to their occupations and recreational activities. Equivalent Constant scores were obtained with the uninjured shoulder. Excellent results can be achieved using this tension band suturing technique, which provides stable permanent fracture fixation and avoids the need of reconstruction of the coracoclavicular ligaments or an implant removal.
