title: Treatment of unstable distal clavicle fractures using two suture anchors and suture tension bands.
abstract: OBJECTIVE
  The study presents a surgical technique using two suture anchors combined with two non-absorbable suture tension bands and the clinical and radiological results obtained in patients with acute distal clavicle fractures associated with coracoclavicular ligaments disruption.
  
  
  METHODS
  Nineteen patients with distal clavicle fractures were included with a mean follow-up of 25 months. All patients had type IIb fractures according to the Neer classification. Coracoclavicular ligaments were reconstructed using two suture anchors to maintain distal clavicle in an anatomical position, and supplementary interfragmentary fixation was performed using two non-absorbable suture tension bands in figure-of-eight configurations. Functional outcomes were assessed at final follow-up visits using the Constant score.
  
  
  RESULTS
  The numbers of lateral fragments averaged 1.4. Seventeen patients maintained the same vertical coracoclavicular distance between both shoulders. However, in two patients, the coracoclavicular distance of the injured shoulder increased by 50% compared with that of the contralateral shoulder. Fracture union was obtained in 18 patients at a mean 4.8 months postoperatively. One patient had symptomatic nonunion until 9 months postoperatively, and subsequently, distal clavicle resection was performed. Two patients showed delayed union and achieved fracture union at 9 and 10 months postoperatively, respectively. Clavicular erosion was found in two patients. The lateral fragment of one patient united in an upward angulated position caused by over-tightening of the medial clavicle. The average Constant score improved to 94.
  
  
  CONCLUSIONS
  Coracoclavicular reconstruction using two suture anchors and supplementary interfragmentary fixation using two non-absorbable suture tension bands for acute distal clavicle fracture are reliable techniques for restoring stability in patients with acute distal clavicle fracture.
authors.affiliation: Department of Orthopaedic Surgery, Ewha Womans University, School of Medicine, 911-1, Mok-Dong, Yangcheon-Ku, 158-710 Seoul, Republic of Korea. sjshin622@ewha.ac.k
authors.forename: Sang-Jin
authors.initials: SJ
authors.lastname: Shin
authors.forename: Kwon Jae
authors.initials: KJ
authors.lastname: Roh
authors.forename: Jong Oh
authors.initials: JO
authors.lastname: Kim
authors.forename: Hoon-Sang
authors.initials: HS
authors.lastname: Sohn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001864:Bone Wires; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000601:surgery*; D005599:Fractures, Ununited / Q000601:surgery; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008023:Ligaments, Articular / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012086:Reoperation; D053441:Suture Anchors; D013536:Suture Techniques / Q000009:adverse effects; D013537:Sutures / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult