Unstable distal clavicle fractures: Outcomes of internal fixation of clavicle and coracoclavicular stabilization

Abstract

Background

This study evaluates outcomes following internal fixation of unstable distal clavicle fractures (DCFs) with or without coracoclavicular (CC) stabilization.

Methods

A retrospective review was conducted for patients who underwent open repair of unstable DCFs at a single institution from 2017 to 2024. Fixation techniques included locking plate alone (P) or plate with CC stabilization [transcoracoid suture button (P + B), coracoid anchor (P + A)]. Collected variables included demographics, clinical details, patient-reported outcome measurement information system (PROMIS) scores, American Shoulder and Elbow Surgeons (ASES) scores, and Visual Analog Scale (VAS) Pain.

Results

Seventeen patients with DCFs (17 shoulders;11 males, 6 females; mean age 45 [23–78] years) were followed for an average of 32.0 (3.4–69.3) months. Fixation groups included P (6), P + B (8), and P + A (3). Neer types included IIA (4), IIB (6), and V (7). Mean outcome scores were PROMIS upper extremity 49.2 ± 10.5, pain interference 47.0 ± 7.2, pain intensity 39.3 ± 7.0, ASES 89.3 ± 14.3, and VAS 1.5 ± 2.2. Three patients (18%) experienced postoperative issues: plate prominence (2) and shoulder stiffness (1); none required reoperation.

Discussion

The addition of CC stabilization to locking plate fixation in high-risk unstable DCFs results in favorable outcomes and predictable healing rates.

Level of evidence

IV, case series.