To determine the outcome of Clavicle Hook Plate fixation in terms of level of function achieved, healing of the fracture and the need for removal of the hook plate. Review of patient records and radiographs of all the fractured clavicles and acromioclavicular dislocations that were surgically treated with a Clavicle Hook Plate. The study population was identified using the operating theatre data. A total of 24 patients (19 lateral third-Neer type II-fractures and 5 type III acromioclavicular dislocations) were treated from January 1998 to December 2003. Eighteen of the 24 plates (75%) had been removed at the time of the study. In 72% restriction of the range of movement and pain due to plate impingement were the main causes for removal of the plate. Two of the plates (11%) were removed due to ‘mechanical failure’; the plate being levered off the bone or eroding the acromion. Mechanical failure of the plate was significantly associated with an older age group (P=0.01). At the time of discharge from the clinic 57% had more than 50% of their shoulder movements, while 55.5% had minimal or no pain. We suggest that Clavicle Hook Plates should be routinely removed as they cause impingement symptoms and they be used with caution (if at all) in the older age group given the tendency for the plate to lever off the bone

Clavicular hook plates have been used over the last decade in the treatment of lateral clavicular fractures with good rates of union reported throughout the literature. Fewer studies have reported the functional outcome of these patients and some have reported potential soft tissue damage post plate removal. We aimed to review the functional outcomes alongside union rates in patients treated with hook plates for lateral clavicular fractures. In this retrospective case series, 21 patients with traumatic lateral third clavicular fractures were included. 15 had Neer type II fractures, 4 Neer type III fractures, 1 patient had a Neer type I fracture and 1 radiograph was not able to be classified. All patients were treated with clavicular hook plates at the same district general hospital by five experienced surgeons between March 2010 and February 2015 adhering to the same surgical protocol. All patients had standard physiotherapy and post operative follow up. Plates were removed when radiological union was achieved in all but one patient who had the plate removed before union was achieved due to prolonged non-union. Patients were followed up post plate removal and evaluated clinically using the Oxford Shoulder Score. Their post plate radiographs were assessed by an independent radiologist and bony union documented. 21 patients were included. Mean age was 40 (range 14–63) with a male:female ratio of 17:4. Mean follow up was 5 months post injury (1–26 months). The hook plate remained in situ for a mean time of 4.3 months (2–16 months). One patient developed a post-operative wound infection treated with antibiotics, 2 patients developed adhesive capsulitis, one patient had not achieved bony union prior to hook plate removal at 16 months, however did achieve union 2 months post plate removal, two patients required revision plating. All patients achieved bony union eventually with good alignment and no displacement of the acromioclavicular joint seen on the most recent post operative radiographs. Post plate removal Oxford Shoulder Scores indicated good shoulder function with a mean score of 41.5 (maximum score possible 48 and the range of scores for our cohort was 30–47). Our data would support the use of hook plates in the treatment of lateral clavicular fractures. All patients achieved union eventually with good alignment and this was reflected in the good functional outcome scores. This study is limited in its small cohort and short-term follow up. More research is required to examine the long term consequences of hook plate surgery in a larger patient population

A prospective study was carried out over a period of 4 years. 31 patients with a mean age of 49 years were treated using the clavicular hook plate. The mean follow up was 28.34 months. 23 patients were operated primarily and 8 patients were operated for symptomatic non-union. All the patients achieved clinical and radiological union in a mean 12.71 weeks. According to Constant scoring the mean was 94. According to HSS (Hospital for Special Surgery) scoring 9 patients had excellent, 21 had good. The clinical results of the clavicular hook plate were good leading to good shoulder girdle function

The aim of our study was to assess the use of the Clavicular Hook Plate in treating acromio–clavicular joint dislocations and fractures of the distal clavicle. The prospective study was carried out at two hospitals- a teaching hospital and a district general hospital. Between 2001 and 2004 a total of 37 patients with AC joint injuries and distal clavicle fractures were treated surgically with this device. Four of the patients had sustained a Neers Type 2 fracture of the distal clavicle, while 33 patients had acromio-clavicular joint dislocation (Rockwood Type 3 or higher). Mean age of the study group was 35.2 years. Post operatively, shoulder pendulum exercises were commenced on the second day and all patients discharged within 48 hours. During the first few weeks, we restricted shoulder abduction to 90 degrees. At the first postoperative follow up appointment at 2 weeks, average shoulder abduction was 30 degrees and forward elevation −40 degrees. This improved at 6 weeks to 85 degrees and 105 degrees respectively. The plates were removed at an average time interval of 11 weeks for the ACJ dislocations (range 8–12 weeks) and 15 weeks for the clavicle fractures (range 12–16 weeks). At three months after plate removal, we evaluated patients to measure the Visual Analogue Score(VAS) and Constant Score. The mean VAS was 1.4 (range 0–6) and the mean Constant score was 92 (range 72 to 98). Wound healing problems occurred in two patients, while two had a stress riser clavicle fracture. These had to be subsequently fixed with a Dynamic Compression Plate. One patient developed a superficial wound infection. Seven patients had problems due to impingement between the hook and the under surface of the acromion. A 45 year old female patient developed ACJ instability after plate removal. Radiographs revealed widening of the AC joint and some osteophyte formation. She went on to develop frozen shoulder which was treated with intensive physiotherapy. The AO hook plate represents an improvement over previous implants in treating injuries around the AC Joint. However, the need for a second operation to remove the plate remains a significant problem. Complications resulting from impingement were common in our patients and represent a major drawback of this implant

This prospective evaluation of early experience using this technique. Patients with fracture of the distal clavicle were surgically treated with clavicular hook plate fixation. They were reviewed clinically and radiographically by one observer. 12 patients, 7 male, 5 female, were treated in our unit. Mean age (34.7) range 25–60 years. 10 were the results of low velocity injury. 9 were treated within one week of injury. 3 were treated at 13, 14 and 16 weeks post injury. Mean hospital stay 2.7 range 2–5 days. All patients healed, 10 within 12 weeks. All resumed full activity by 24 weeks. 2 had superficial wound infection, treated successfully with oral antibiotics without implant removal. One had a seroma, which resolved spontaneously. One patient developed limitation of movement at 20 weeks ultrasound confirmed impingement. Plate was removed and patient regained full range of movement after six weeks. No implant fracture or loosening was observed. Based on experience to date the clavicular hook plate is a safe and reliable method of fixation. Relatively simple implant with good results. Allows early mobilisation and has little complication

Introduction and Aims: Acromioclavicular dislocations and fractures of the distal clavicle present a challenging problem for the treating surgeon. The use of a new specifically designed implant was investigated. A hooked-shaped plate with fixation to the distal clavicle and ‘hook’ placement under the posterior acromion was used.

Method: The procedure was carried out on eight patients. In five patients the injury was a fractured distal clavicle. In three cases an acromioclavicular dislocation was treated. In all cases the time to returning to a functional capacity was analysed. The eventual functional result was indexed from the time of fracture union or complete stabilisation of the dislocations.

Results: All five fractures went on to anatomical union. The three dislocations were all stabilised with no instability or subluxation. In two cases patients complained of impingement symptoms with decreased overhead functional capacity. In both cases the patients regained a full and pain-free range of movement after removal of the implant.

Conclusion: This new implant provides an acceptable alternative in the management of distal clavicle fractures and acromioclavicular dislocations. The complication of impingement is encountered, but this appears to be treatable by removal of the implant after fracture union or joint stabilisation.

Acromioclavicular (AC) joint dislocations and fractures of the distal clavicle present challenging problems for the treating surgeon. We treated eight patients using a hook-shaped plate fixed to the distal clavicle and ‘hooked’ under the posterior acromion.

In five patients the injury was a fractured distal clavicle and in three an AC joint dislocation. We analysed the time taken to achieve a functional capacity. The eventual functional result was indexed from the time of fracture union or complete stabilisation of the dislocations.

All five fractures went on to anatomical union. The three dislocations were all stabilised with no instability or sub-luxation. Two patients complained of impingement symptoms and decreased overhead functional capacity. After the implant was removed, both patients regained a full range of pain-free movement.

This is a small study with limited follow-up. However, the results suggest that this new implant provides an acceptable alternative in the management of distal clavicle fractures and AC joint dislocations. The complication of impingement can be treated by removal of the implant after union or stabilisation has been achieved.

Aims. Distal third clavicle (DTC) fractures are increasing in incidence. Due to their instability and nonunion risk, they prove difficult to treat. Several different operative options for DTC fixation are reported but current evidence suggests variability in operative fixation. Given the lack of consensus, our objective was to determine the current epidemiological trends in DTC as well as their management within the UK. Methods. A multicentre retrospective cohort collaborative study was conducted. All patients over the age of 18 with an isolated DTC fracture in 2019 were included. Demographic variables were recorded: age; sex; side of injury; mechanism of injury; modified Neer classification grading; operative technique; fracture union; complications; and subsequent procedures. Baseline characteristics were described for demographic variables. Categorical variables were expressed as frequencies and percentages. Results. A total of 859 patients from 18 different NHS trusts (15 trauma units and three major trauma centres) were included. The mean age was 57 years (18 to 99). Overall, 56% of patients (n = 481) were male. The most common mechanisms of injury were simple fall (57%; n = 487) and high-energy fall (29%; n = 248); 87% (n = 748) were treated conservatively and 54% (n = 463) were Neer type I fractures. Overall, 32% of fractures (n = 275) were type II (22% type IIa (n = 192); 10% type IIb (n = 83)). With regards to operative management, 89% of patients (n = 748) who underwent an operation were under the age of 60. The main fixation methods were: hook plate (n = 47); locking plate (n = 34); tightrope (n = 5); and locking plate and tight rope (n = 7). Conclusion. Our study is the largest epidemiological review of DTC fractures in the UK. It is also the first to review the practice of DTC fixation. Most fractures are being treated nonoperatively. However, younger patients, suffering a higher-energy mechanism of injury, are more likely to undergo surgery. Hook plates are the predominantly used fixation method followed by locking plate. The literature is sparse on the best method of fixation for optimal outcomes for these patients. To answer this, a pragmatic RCT to determine optimal fixation method is required. Cite this article: Bone Jt Open 2022;3(12):953–959

Abstract. Aim. The aim of this study was to present the results of treatment of displaced lateral clavicle fractures by an arthroscopically inserted tightrope device (‘Dogbone’, Arthrex). Methods. We performed a retrospective series of our patients treated with this technique between 2015 and 2019. Patients were identified using the ‘CRS Millennium’ software package and operation notes/clinic letters were analysed. We performed an Oxford Shoulder Score (OSS) on all the patients at final follow-up. Our electronic ‘PACS’ system was used to evaluate union in the post-operative radiographs. Results. We treated 26 patients with displaced lateral clavicle fractures between 2015 and 2019. There were 4 patients who were treated with a ‘dogbone’ and supplementary plate fixation and the remaining 22 were treated with a ‘dogbone’ alone. Radiological union was seen in 22 (84%) patients. The mean Oxford Shoulder Score (OSS) was 46. Apart from one patient who required removal of the superior endobutton and knot under local anaesthetic there was no other secondary surgery. There were no cases of infection, nerve injury or frozen shoulder. Conclusions. Arthroscopic ‘dogbone’ treatment of lateral clavicle fractures is a safe, cosmetically friendly technique with promising high rates of fracture union and return to normal function. We recommend its use over the more conventional treatment of a hook plate

Neer type 2 fractures of the distal third of the clavicle have a non union rate of 22-35% after conservative treatment. Open reduction and internal fixation has been recommended by most authors but there is no consensus about the best method of internal fixation. We retrospectively assessed the union and shoulder function following Hook plate fixation in 18 patients with Neer type 2 fractures of lateral end clavicle with more then a six month follow up after surgery. There were 14 males with a mean follow-up of 25.89 months (6-48 months) and the average age was 40.33 years (22-62 range). Fifteen had acute fractures and the rest were non unions. Complications included two non unions, one following a deep infection. There were no iatrogenic fractures. Acromial osteolysis was seen in five patients who had their plates in situ. The average pain score at rest was 1 (0-4) and the average pain score on abduction was 2.2 (0-5). The average Constant score was 88.5 (63-100). Patients were asked to rate their shoulder function; three said their shoulder was normal, eleven said it was nearly normal and one rated it as not normal. Hook plate fixation appears to be a valuable method of stabilising Neer type 2 fractures of the clavicle resulting in high union rates and good shoulder function. These plates need to be removed after union to prevent acromial osteolysis

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

Introduction: Primary operative stabilisation of Grade III injuries of the acromio-clavicular (AC) joint remains controversial, with recent literature providing support for conservative management. The aim of this research was to compare the clinical and radiological outcome of operative and non-operative treatment of this injury. Materials and Methods: 56 patients (51 men, 5 women, aged 18 – 78 years) with an acromio-clavicular dislocation Tossy III were recruited into the study. 28 were managed surgically with a hook plate, and 28 were treated non-operatively with a sling until they were pain-free after a few days. The mean follow-up time was 23 months (8 – 31 months). At follow-up the patients were either examined clinically and radiologically or they were surveyed by phone. Clinical results were expressed in the Constant score and the subjective satisfaction of each patient was recorded. Results: Eleven patients were lost to follow-up. Five patients were operated at their home hospital after initial treatment at our clinic, and four non-surgical patients were later treated with a modified Weaver-Dunn procedure. Of the remaining 36 patients, 25 were examined clinically and radiologically and 11 were surveyed by telephone. The clinical outcome showed a mean Constant score of 87 in the operative group and 96 in the non-operative group. 30 of 36 patients were highly satisfied or satisfied (19 in the operative group, 11 in the non-operative group), 5 were mostly satisfied (operative group), 1 was unsatisfied (operative group). Radiologically, all of the operated patients showed changes of the AC-joint including widening of the joint, redislocation of the distal clavicle, and degenerative changes. In the non-operative group, three patients showed a decreasing clavicular elevation. Conclusion: Clinical outcomes were comparable between operative and non-operative treatment of AC-dislocations grade III. Some conservatively treated patients did, however, require a secondary stabilisation. The hook plate was observed to cause additional local injury to the AC-joint, and must be removed after recovery to prevent rotator cuff damage. This procedure incurs high risk of loss of reduction. In our opinion, it is disputable to operate twice on the AC-joint to achieve similar results as those obtained with conservative treatment. We prefer a secondary anatomical reconstruction in cases of failed conservative treatment

Purpose:. To review the union rates, outcomes and complications of angular stable plating of lateral third clavicle fractures. Method:. Between 2007 and 2010 angular stable plates were used in the fixation for seventeen patients with displaced lateral third clavicle fractures (Allman Group II, Type 2). These were identified from surgical log books and operation codes. The surgical and clinical notes as well as X-rays were reviewed. The patients were contacted telephonically. An Oxford Shoulder Score and questions relating to plate removal, scar pain and return to activities were asked. Three patients were not contactable. Results:. There were 16 males. The average age was 44. The average time to union was 3 months (range 2 to 4). There were no complications. The average Oxford Shoulder Score was 13 (range 12–19). No plates have required removal but 2 patients have requested removal for discomfort. All but 3 patients have returned to full activity. Conclusion:. The use of angular stable plates for fixation of type 2 lateral end of clavicle fractures results in excellent union rates by 3 months with only 3 patients requesting elective plate removal. This is in contrast to hook plates which require mandatory removal. No other complication was encountered

Chronic instability of the acromioclavicular joint is relatively common and normally occurs following a fall onto the point of the shoulder. Reconstruction of the joint (Weaver-Dunn procedure) is often required in service personnel, and numerous methods of fixation have been used, including vicryl tape, PDS loops and the use of a hook plate. Many of these operative methods require a second operation to remove the plates and/or screws, and are associated with a failure rate of up to 30%. The ‘Surgilig’ was designed as a method of revision for failed Weaver-Dunn procedures. However this study evaluates its use in the primary operation. We prospectively followed up the Modified Weaver Dunn procedures using surgilig. The post-operative x-rays were reviewed at six weeks, 3 months and then 6 months when the patients were discharged to assess the radiological success of the procedure. We have performed this procedure in 11 patients. Of the eight patients that have reached the six month postoperative time so far, at which they would be discharged from clinic follow-up, none have had radiological failure of the fixation. One patient even had weight-bearing x-rays taken at 6 weeks, with no detrimental effect. Even though a small study, the initial results for primary fixation of acromioclavicular joint disruption with surgilig are extremely encouraging. The study suggests that surgilig should continue to be used in its current role. As patient numbers increase, a follow-up study should be conducted to evaluate these preliminary findings

In the UK we have many surgeon inventors – surgeons who innovate and create new ways of doing things, who invent operations, who design new instruments to facilitate surgery or design new implants for using in patients. However truly successful surgeon inventors are a rare breed and they need to develop additional knowledge and skills during their career in order to push forward their devices and innovations. This article reviews my own experiences as a surgeon inventor and the highs and lows over the whole of my surgical career.