title: Use of plate fixation without coracoclavicular ligament augmentation for unstable distal clavicle fractures.
abstract: BACKGROUND
  The purpose of this study was to evaluate the clinical and radiologic outcomes of unstable distal clavicle fractures treated with anatomic plate fixation without coracoclavicular ligament augmentation and to compare the outcome of Neer type IIA with that of type IIB.
  
  
  METHODS
  Twenty-five patients with unstable distal clavicle fractures who underwent anatomic plate fixation without coracoclavicular ligament augmentation were enrolled prospectively, including 9 patients of Neer type IIA and 16 patients of Neer type IIB. Clinical outcomes were evaluated using Constant and University of California-Los Angeles (UCLA) scores. Coracoclavicular distance was measured on plain radiographs.
  
  
  RESULTS
  Bone union was achieved in all patients. Satisfactory clinical and radiologic outcomes were obtained regardless of fracture type. After operation, the mean coracoclavicular distance on the injured side was increased by 10% compared with the uninjured side. However, between the patients who showed an increased coracoclavicular distance >10% (Constant score, 89.4 ± 3.7; UCLA score, 32.6 ± 3) and the patients with increased coracoclavicular distance <10% of the uninjured side (Constant score, 88.7 ± 3.6; UCLA score, 31.9 ± 3), there was no statistically significant difference in clinical outcomes of Constant score (P = .934) and UCLA score (P = .598).
  
  
  CONCLUSIONS
  In unstable distal clavicle fractures, precontoured anatomic plate fixation without coracoclavicular ligament augmentation showed satisfactory clinical outcomes and high union rates even with a small lateral fragment. Patients who had increased coracoclavicular distance also demonstrated satisfactory shoulder functional outcomes regardless of the fracture type. Therefore, anatomic plate fixation without additional coracoclavicular ligament augmentation can be considered one of the treatment options for unstable distal clavicle fracture.
  
  
  METHODS
  Level IV; Case Series; Treatment Study.
authors.affiliation: Department of Orthopedic Surgery, School of Medicine, Ewha Womans University, Seoul, Republic of Korea. Electronic address: sjshin622@ewha.ac.kr.
authors.forename: Sang-Jin
authors.initials: SJ
authors.lastname: Shin
authors.affiliation: Department of Orthopedic Surgery, School of Medicine, Ewha Womans University, Seoul, Republic of Korea.
authors.forename: Young-Won
authors.initials: YW
authors.lastname: Ko
authors.affiliation: Department of Orthopedic Surgery, School of Medicine, Ewha Womans University, Seoul, Republic of Korea.
authors.forename: Juyeob
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, School of Medicine, Ewha Womans University, Seoul, Republic of Korea.
authors.forename: Min-Gyue
authors.initials: MG
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D016896:Treatment Outcome
keywords: Distal clavicle fracture; anatomic plate; coracoclavicular distance; coracoclavicular ligament augmentation; neer type; plate fixation