title: [Distal clavicle fracture].
abstract: OBJECTIVE
  Reposition and fixation of unstable distal clavicle fractures with a low profile locking plate (Acumed, Hempshire, UK) in conjunction with a button/suture augmentation cerclage (DogBone/FibreTape, Arthrex, Naples, FL, USA).
  
  
  METHODS
  Unstable fractures of the distal clavicle (Jäger and Breitner IIA) in adults. Unstable fractures of the distal clavicle (Jäger and Breitner IV) in children. Distal clavicle fractures (Jäger and Breitner I, IIB or III) with marked dislocation, injury of nerves and vessels, or high functional demand.
  
  
  METHODS
  Patients in poor general condition. Fractures of the distal clavicle (Jäger and Breitner I, IIB or III) without marked dislocation or vertical instability. Local soft-tissue infection.
  
  
  METHODS
  Combination procedure: Initially the lateral part of the clavicle is exposed by a 4 cm skin incision. After reduction of the fracture, stabilization is performed with a low profile locking distal clavicle plate. Using a special guiding device, a transclavicular-transcoracoidal hole is drilled under arthroscopic view. Additional vertical stabilization is arthroscopically achieved by shuttling the DogBone/FibreTape cerclage from the lateral portal cranially through the clavicular plate. The two ends of the FibreTape cerclage are brought cranially via adjacent holes of the locking plate while the DogBone button is placed under the coracoid process. Thus, plate bridging is achieved. Finally reduction is performed and the cerclage is secured by surgical knotting.
  
  
  METHODS
  Use of an arm sling for 6 weeks.
  
  
  RESULTS
  Due to the fact that the described technique is a relatively new procedure, long-term results are lacking. In the short term, patients postoperatively report high subjective satisfaction without persistent pain.
authors.affiliation: Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81657, München, Deutschland.
authors.forename: G
authors.initials: G
authors.lastname: Seppel
authors.forename: A
authors.initials: A
authors.lastname: Lenich
authors.forename: A B
authors.initials: AB
authors.lastname: Imhoff
mesh_terms: D001860:Bone Plates; D002968:Clavicle / Q000293:injuries* / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods* / Q000534:rehabilitation; D017102:Fracture Healing; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D011474:Prosthesis Design; D013537:Sutures; D016896:Treatment Outcome