title: Displaced Neer Type IIB distal-third clavicle fractures-Long-term clinical outcome after plate fixation and additional screw augmentation for coracoclavicular instability.
abstract: Unstable Neer Type IIB fractures require meticulous surgical treatment. Thus, the aim of this study was to present long-term outcomes after plate fixation and minimally invasive coracoclavicular (CC) stabilization using screw fixation.
  
  
  
  A consecutive series of patients with unstable Neer Type IIB displaced clavicle fractures, treated by open reduction and internal fixation (ORIF) with a plate and additional screw fixation for coracoclavicular ligament instability, was reviewed in order to determine long-term clinical and radiological outcome.
  
  
  
  Seven patients, six males and one female, with a mean age of 37 ± 8 years (median: 36 years; range, 28-51 years), were evaluated. At latest follow-up, after a mean of 67 months (range, 11-117 months), patients presented with the following mean scores: DASH: 0.57, ASES: 98.81, UCLA: 34.29, VAS: 0.43, Simple Shoulder Test: 11.57. However, two complications were observed: one case of implant loosening and one non-union. There were no differences observed between the CC distances comparing postoperative X-rays to those in final follow-up. In 25% of our patients early postoperative complications occurred. In all patients reoperation was necessary to remove the implanted screw.
  
  
  
  The results of the present study indicate that the treatment of Neer Type IIB lateral clavicle fractures with ORIF using a plate and additional CC screw fixation, leads to satisfying clinical and radiological outcomes in the long-term. However, considering an early postoperative complication rate of 25% and a 100% rate of secondary surgery due to removal of the CC screw does not seem to justify this technique anymore.
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria. thomas.tiefenboeck@meduniwien.ac.at.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Tiefenboeck
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria.
authors.forename: Sandra
authors.initials: S
authors.lastname: Boesmueller
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria.
authors.forename: Harald
authors.initials: H
authors.lastname: Binder
authors.affiliation: Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Adam
authors.initials: A
authors.lastname: Bukaty
authors.affiliation: Department of Orthopaedics, Hospital of sacred Heart of Jesus, Vienna, Austria.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Tiefenboeck
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria.
authors.forename: Julian
authors.initials: J
authors.lastname: Joestl
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria.
authors.forename: Marcus
authors.initials: M
authors.lastname: Hofbauer
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria.
authors.forename: Roman C
authors.initials: RC
authors.lastname: Ostermann
mesh_terms: D000328:Adult; D001860:Bone Plates / Q000639:trends; D001863:Bone Screws / Q000639:trends; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000639:trends; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Displaced distal-third clavicle fractures; Long-term outcome; Retrospective study; Screw fixation