title: Surgical treatment of vertically unstable lateral clavicle fractures (Neer 2b) with locked plate fixation and coracoclavicular ligament reconstruction.
abstract: BACKGROUND
  The present study evaluates the outcome of patients treated with a combination of locked plate fixation and minimal-invasive coracoclavicular (CC) ligament reconstruction for unstable lateral clavicle fractures type IIb according to Neer.
  
  
  METHODS
  Fourteen patients with an unstable lateral clavicle fracture were treated with a combination of locked plate fixation and a minimal-invasive CC ligament reconstruction. At a mean follow-up of 38 months, patients were re-evaluated using the Constant-Murley score, the Acromioclavicular (AC) joint instability score and the TAFT score. Furthermore, anterior-posterior (ap) stress radiographs and axillary views were performed in order to detect any recurrent instability.
  
  
  RESULTS
  Bony union was achieved in all cases within 6-10 weeks. The mean Constant-Murley score of the affected shoulder was 93.5 points compared to 97.2 of the contralateral unaffected shoulder. The mean Taft score was 11.2 points and the mean AC joint instability score was 92 points in comparison to 96 points on the unaffected side. The mean CC distance at the time of the injury was 21 mm compared to 8.5 mm after surgery and 12 mm a the final follow-up examination. The CC distance did not differ between the postoperative X-rays and those at the time of follow-up (p = 0.068). Three plates had to be removed because of implant irritation.
  
  
  CONCLUSIONS
  A combination of locked plate fixation and CC ligament augmentation in a minimal-invasive manner can be regarded as suitable for the treatment of vertically unstable lateral clavicle fractures and is associated with excellent clinical and radiological outcomes and a low complication rate.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149 Münster, Germany. benedikt.schliemann@gmail.com
authors.forename: Benedikt
authors.initials: B
authors.lastname: Schliemann
authors.forename: Steffen B
authors.initials: SB
authors.lastname: Roßlenbroich
authors.forename: Kristian N
authors.initials: KN
authors.lastname: Schneider
authors.forename: Wolf
authors.initials: W
authors.lastname: Petersen
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Raschke
authors.forename: Andre
authors.initials: A
authors.lastname: Weimann
mesh_terms: D000328:Adult; D001860:Bone Plates; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D013536:Suture Techniques; D016896:Treatment Outcome