title: Modified tension band for displaced type 2 lateral end clavicle fractures.
abstract: OBJECTIVE
  Displaced type 2 lateral end clavicle fractures have a tendency to delayed union or non-union. Various methods of stabilisation of the displaced lateral end fractures are described. The increasing use of implants to fix such fractures also necessitates extensive dissection for implant retrieval. Adequate reduction and minimal tissue trauma during implant placement and removal would be ideal modalities for fixation of such fractures.
  
  
  METHODS
  All displaced type 2 lateral end clavicle fractures fulfilling our inclusion criteria were reduced with a small anterosuperior incision. Anteroposterior drill holes were made in both the fragments and a nonabsorabable polyester suture was passed through. The fracture was reduced and fixed with transacromial smooth Kirshner wires. The suture was tied with the knot superiorly in a figure-eight manner. The arm was supported in an arm pouch for six weeks. The Kirshner wire was routinely removed after six weeks in an out-patient department. Clinico-radiological outcome was studied at six weeks, and monthly intervals thereafter until union.
  
  
  RESULTS
  All 16 fractures united. The mean average age of patients was 36.25 years with a SD of 11.35. There was no loss of reduction even after removal of Kirshner wires at six weeks. The mean average time of union was 10.75 weeks with a SD of 3.92. All patients regained near normal range of motion, and the mean average constant score at the end of one year was 98.37 with a SD of 2.87. All patients returned to preinjury level by the one-year follow-up. The range of motion remained the same in those who were followed up in successive years. Skin impingement with bent Kirshner wires were noted in four cases. Kirshner wires backed out in one case before six weeks but there was no loss of reduction. Infection and Kirshner wire breakage were not noted in our series.
  
  
  CONCLUSIONS
  The clinico-radiological outcomes with our modified tension band fixation for displaced type 2 lateral end clavicle fractures were encouraging and comparable with earlier studies.
authors.affiliation: Department of Orthopaedics, Civil Service Hospital, Minbhawan, Kathmandu, Nepal. laxmanrijal@gmail.com
authors.forename: Laxman
authors.initials: L
authors.lastname: Rijal
authors.forename: Gopal
authors.initials: G
authors.lastname: Sagar
authors.forename: Anshumala
authors.initials: A
authors.lastname: Joshi
authors.forename: Khima Nand
authors.initials: KN
authors.lastname: Joshi
mesh_terms: D000293:Adolescent; D000328:Adult; D017760:Bone Malalignment / Q000534:rehabilitation / Q000601:surgery*; D001864:Bone Wires; D002968:Clavicle / Q000293:injuries*; D020878:Device Removal; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing; D050723:Fractures, Bone / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011446:Prospective Studies; D020127:Recovery of Function; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome