title: Technical tip: tightrope fixation of neer type II distal clavicle fracture supported by a case series.
abstract: BACKGROUND
  We present a case series of 3 patients who underwent a novel technique of tight rope fixation for Neer type II distal clavicle fracture.
  
  
  METHODS
  2-3 cm incision was made lateral to the fracture site moving inferomedially. Part of the distal end of clavicle was exposed close to fracture site and further dissection was carried out to reveal the coracoid process. Tight rope fixation of the distal ends of clavicle and coracoid was performed to achieve satisfactory fracture reduction on x-ray.
  
  
  RESULTS
  4 weeks of sling with gentle pendulum movement were followed by active shoulder movement exercises. Radiographic union was reached at 6 weeks' time, while the patients achieved proper shoulder functionality 3 months following the operation.
  
  
  CONCLUSIONS
  Neer type II distal clavicle fractures are characterized by disruption of the coracoclavicular ligament with wide proximal fragment displacement. Overall, type II distal clavicle fractures have a 20-30% nonunion rate if treated non-surgically. Various techniques have been described for the treatment of these fractures, including hook plate and nailing. Tight rope fixation provides proper apposition of the fracture fragments for union by maintaining a reduced coracoclavicular interval.
authors.affiliation: Department of Trauma and Orthopaedics, Kettering General Hospital NHS Trust, Kettering, United Kingdom.
authors.forename: Syed
authors.initials: S
authors.lastname: Haque
authors.affiliation: Department of Trauma and Orthopaedics, Luton and Dunstable University Hospital NHS Trust, Luton, United Kingdom.
authors.forename: Anwar
authors.initials: A
authors.lastname: Khan
authors.affiliation: Department of Trauma and Orthopaedics, Luton and Dunstable University Hospital NHS Trust, Luton, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Trauma and Orthopaedics, Luton and Dunstabe University Hospital NHS Trust, Luton, United Kingdom.
authors.forename: Sabapathy
authors.initials: S
authors.lastname: Sundararajan
mesh_terms: D001860:Bone Plates; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D008023:Ligaments, Articular / Q000000981:diagnostic imaging; D008297:Male; D011859:Radiography; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology