In Neer type II (Robinson type 3B) fractures
of the distal clavicle the medial fragment is detached from the coracoclavicular
ligaments and displaced upwards, whereas the lateral fragment, which
is usually small, maintains its position. Several fixation techniques
have been suggested to treat this fracture. The aim of this study
was to assess the outcome of patients with type II distal clavicle
fractures treated with coracoclavicular suture fixation using three
loops of Ethibond. This prospective study included 14 patients with
Neer type II fractures treated with open reduction and coracoclavicular
fixation. Ethibond sutures were passed under the coracoid and around
the clavicle (UCAC loop) without making any drill holes in the proximal
or distal fragments. There were 11 men and three women with a mean
age of 34.57 years (29 to 41). Patients were followed for a mean
of 24.64 months (14 to 31) and evaluated radiologically and clinically
using the Constant score. Fracture union was obtained in 13 patients at
a mean of 18.23 weeks (13 to 23) and the mean Constant score was
96.07 (91 to 100). One patient developed an asymptomatic fibrous
nonunion at one year. This study suggests that open reduction and
internal fixation of unstable distal clavicle fractures using UCAC
loops can provide rigid fixation and lead to bony union. This technique avoids
using metal hardware, preserves the acromioclavicular joint and
provides adequate stability with excellent results. Cite this article:
Ununited fractures of the scaphoid with extensive bone resorption are usually treated by bone grafting and internal fixation, using either an open or a minimally invasive technique. We studied the feasibility of percutaneous fixation without bone grafting in a consecutive series of 27 patients with established nonunion of an undisplaced fracture of the scaphoid and extensive local resorption of bone. They were treated by a single surgeon with rigid fixation alone, using a headless cannulated screw inserted through a volar percutaneous technique. Clinical examination, standard radiographs and CT confirmed that the fracture had united in all patients at a mean of 11.6 weeks (8 to 16), and that their functional scores had improved. We concluded that extensive resorption at the fracture site is not an absolute indication for bone grafting, and that percutaneous fixation alone will eventually produce healing of ununited undisplaced fractures of the scaphoid regardless of the size of the gap.
