Interfragmentary suture fixation for displaced acute type II distal clavicle fractures.
OBJECTIVE
Stable fixation of displaced type II distal clavicle fractures presents a challenge to the surgeon because of distal fragment comminution and the large deforming forces created by the weight of the arm. We hypothesized that suture fixation around the coracoid and interfragmentary suture fixation would adequately counteract these forces and lead to a high rate of union and restoration of function.


METHODS
This is a retrospective study of 20 sequential patients treated between 1997 and 2009.


METHODS
In-patient operating room followed by the clinic.


METHODS
All patients presenting with acute displaced distal clavicle fractures to 2 surgeons were included. All patients completed the study without loss to follow-up.


METHODS
Open repair was performed by placing two #5 Fiberwire sutures around the coracoid and through drill holes in the clavicular shaft. Interfragmentary fixation was performed with figure-of-eight #2 Fiberwire sutures.


METHODS
Patients evaluation included the American Shoulder and Elbow Surgeons scale, range of motion, radiographic evaluation, and patient satisfaction.


RESULTS
All fractures healed without loss of reduction at an average of 2.6 months, and all patients were satisfied. American Shoulder and Elbow Surgeons score was 98.5 out of 100. Average follow-up was 7.1 years (range, 3.1-14.3 years). One postoperative wound hematoma and one superficial wound infection were treated nonoperatively.


CONCLUSIONS
Interfragmentary and coracoclavicular suture fixation for displaced acute distal clavicle fractures is a safe and effective treatment with an excellent union rate, low complication rate, and high patient satisfaction.


METHODS
Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.
Peachtree Orthopaedic Clinic, Atlanta, GA.
Xavier A
XA
Duralde
Scott D
SD
Pennington
Douglas H
DH
Murray
D000328:Adult; D000368:Aged; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D017759:Fractures, Malunited / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D016896:Treatment Outcome