title: Evaluation of the results from surgical treatment of fractures of the lateral extremity of the clavicle, using the double ligature technique.
abstract: OBJECTIVE
  To evaluate the incidence of consolidation in surgical treatment of fractures of the lateral extremity of the clavicle using the double subcoracoid ligature technique, with nonabsorbable No. 5 thread.
  
  
  METHODS
  Between May 1993 and June 2013, the Shoulder and Elbow Group of our service surgically treated 116 patients (116 shoulders) with fractures of the lateral extremity of the clavicle. Among these, we were able to reassess 65 cases. The surgical technique used consisted of double subcoracoid ligature with two nonabsorbable threads. In two patients classified as type III, we had to combine this technique with use of an interfragmentary screw for fixation of the intra-articular portion of the acromioclavicular joint.
  
  
  RESULTS
  We achieved fracture consolidation in 90%. Fourteen cases (21%) evolved with major complications: four cases of pseudarthrosis, five of adhesive capsulitis, two of delayed consolidation and three of loss of reduction. Two cases (3%) evolved with minor complications of skin granuloma.
  
  
  CONCLUSIONS
  The double ligature technique for fractures of the lateral extremity of the clavicle promotes the stabilization needed for consolidation to take place, without the need for synthesis using metal components. It avoids reoperation for the synthesis material to be removed. Moreover, it is a low-cost procedure with good reproducibility and preservation of the acromioclavicular joint.
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
authors.forename: Alberto Naoki
authors.initials: AN
authors.lastname: Miyazaki
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
authors.forename: Luciana Andrade
authors.initials: LA
authors.lastname: da Silva
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
authors.forename: Guilhermel
authors.initials: G
authors.lastname: do Val Sella
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
authors.forename: Sergio Luiz
authors.initials: SL
authors.lastname: Checchia
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
authors.forename: Sílvia Helena Cavadinha
authors.initials: SH
authors.lastname: Cândido Dos Santos
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
authors.forename: Vitor Schneider
authors.initials: VS
authors.lastname: Chadud
keywords: Acromioclavicular joint; Bone fractures; Clavicle