Outcome following management of unstable lateral end clavicle fractures with locking plate and coracoid anchor augmentation

Karthik Karuppaiah; Ahmad Bilal; Toby Colegate-Stone; Joydeep Sinha; Ramon Tahmassebi; Adel Tavakkolizadeh

doi:10.1177/1758573220981708

Outcome following management of unstable lateral end clavicle fractures with locking plate and coracoid anchor augmentation

Shoulder Elbow. 2022 Apr;14(2):181-188. doi: 10.1177/1758573220981708. Epub 2021 Feb 17.

Authors

Karthik Karuppaiah¹, Ahmad Bilal¹, Toby Colegate-Stone¹, Joydeep Sinha¹, Ramon Tahmassebi¹, Adel Tavakkolizadeh¹

Affiliation

¹ Department of Orthopaedic Surgery, King's College Hospital, London, UK.

Abstract

Background: Management of complex lateral end clavicle fractures with coraco-clavicular ligament disruption can be challenging.

Methods: We prospectively analysed 19 (17 M:2F) patients from January 2014 to June 2016. Six patients had intra-articular fractures (Edinburgh-3B2) and the remaining were extra-articular (3B1). All patients had open reduction internal fixation with lateral end locking plate augmented with a coracoid anchor. All patients were evaluated at the final follow-up by American Shoulder and Elbow Surgeon score (ASES), Disabilities of the Arm, Shoulder and Hand (DASH), Oxford Shoulder Score (OSS), return to work, sports and radiographs.

Results: At a mean follow-up of 54 months (range 37-64), 19 patients were available for analysis. Mean age of patients was 34 years (range 24-65). At final follow-up DASH score was 1.66 (range 0-5); ASES score was 98.14 (93.3-100) and OSS was 46.6 (42-48). There was no difference in the functional outcome between 3B1 and 3B2 fractures (DASH - p(0.51); ASES - p(0.44); OSS - p(0.69)). All patients returned to preinjury level of function, sports and work. Five patients needed implant removal and three developed capsulitis that resolved with conservative treatment.

Conclusion: Locking plate fixation, augmented with coracoid anchor is an effective option in the management of these complex injuries. The need for implant removal is reduced (26%) and there is no difference in the functional outcome between 3B1 and 3B2 fractures.

Keywords: Acusinch; Clavicle fracture; coracoclavicular ligament injury; coracoid anchor; lateral end clavicle fracture; locking plate.