Operative management of an extra-lateral distal clavicle fracture pattern: a study of 48 patients and a proposed update to the modified Neer classification

Abstract

Background: The purpose of this study was to determine the efficacy of operative management for the treatment of patients with an extra-lateral distal clavicle fracture pattern. This fracture pattern is not currently included in the modified Neer classification.

Methods: We retrospectively reviewed 48 patients who underwent open reduction and internal fixation of an acute extra-lateral distal clavicle fracture pattern between August 2005 and March 2019. The postoperative clinical outcomes were time to union; active shoulder range of motion; scar size; patient sensation of a "normal" shoulder; and Disabilities of the Arm, Shoulder and Hand score.

Results: Postoperatively, all patients achieved union at an average of 7.9 weeks (range, 4-20 weeks). All patients regained full active shoulder range of motion at an average of 10.1 weeks (range, 5-44 weeks) and had a scar size of 3-4 cm; 93.8% of patients reported that their shoulder felt normal again after union. The mean Disabilities of the Arm, Shoulder and Hand score was 1.7 (range, 0-28) at 12 months postoperatively.

Conclusion: The patients had very good clinical outcomes following operative management of an extra-lateral distal clavicle fracture pattern. We recommend that this fracture pattern be added to the current modified Neer classification as a type IIC fracture.

Keywords: Clavicle; extra-lateral; fracture; modified Neer classification; operative fixation; range of motion.