title: Arthroscopic-Assisted Management of Unstable Distal-Third Clavicle Fractures: Conoid Ligament Reconstruction and Fracture Cerclage With Sutures.
abstract: Surgical treatment is usually indicated for the management of Neer type IIB fractures of the distal third of the clavicle. These unstable injuries have shown a rate of nonunion that oscillates around 30% to 45% when managed conservatively, and surgical strategies often require a second operation for implant removal. We describe an arthroscopic-assisted technique for the treatment of Neer type IIB unstable distal-third clavicle fractures that overcomes the issues related to open surgery, metal hardware, and implant irritation. This technique increases the load to failure of the construct by means of adding a synthetic conoid ligament reconstruction with a nonrigid suspension device, and it allows the diagnosis and treatment of associated glenohumeral injuries. Our technique incorporates a fracture interfragmentary fixation with sutures, thus avoiding a second operation for implant removal.
authors: Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Hospital General de Catalunya, Sant Cugat del Vallés, Spain.
authors: Luis Natera
authors: LN
authors: Cisneros
authors: Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Hospital Quirón Teknon, Barcelona, Spain.
authors: Juan Sarasquete
authors: JS
authors: Reiriz