Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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The Radiologic Comparison of Operative Treatment Using a Hook Plate versus a Distal Clavicle Locking Plate of Distal Clavicle Fracture

  • Yoon, Byungil (Department of Orthopaedic Surgery, Chung-Ang University College of Medicine) ;
  • Kim, Jae Yoon (Department of Orthopaedic Surgery, Chung-Ang University College of Medicine) ;
  • Lee, Jae-Sung (Department of Orthopaedic Surgery, Chung-Ang University College of Medicine) ;
  • Jung, Hyoung Seok (Department of Orthopaedic Surgery, Chung-Ang University College of Medicine)
  • Received : 2018.06.15
  • Accepted : 2018.09.21
  • Published : 2018.12.01
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Abstract

Background: The purpose of this study was to compare the radiologic results of patients who underwent surgery with a hook plate and a locking plate in distal clavicle fractures. Methods: Sixty patients underwent surgical treatment for Neer type IIa, IIb, III, and V distal clavicle fracture. Twenty-eight patients underwent fracture fixation with a hook plate and 32 with a locking plate. Coracoclavicular distance was measured on standard anteroposterior radiographs before and after the surgery, and union was confirmed by radiograph or computed tomography taken at 6 months postoperatively. Other radiologic complications like osteolysis was also checked. Results: Bony union was confirmed in 59 patients out of 60 patients, and 1 patient in the hook plate group showed delayed union. Coracoclavicular distance was decreased more in the hook plate group after surgery (p<0.01). After 6 weeks of the hook plate removal, the coracoclavicular distance was increased a little compared to before metal removal, but there was no difference compared to the contralateral shoulder. Eleven out of 28 patients (39.3%) showed osteolysis on the acromial undersurface in the hook plate group. Conclusions: Both the hook plate group and the locking plate group showed satisfactory radiologic results in distal clavicle fractures. Both hook plate and locking plate could be a good treatment option if it is used in proper indication in distal clavicle fracture with acromioclavicular subluxation or dislocation.

Keywords

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Fig. 1. (A) A 30-year-old male sustained a Neer type IIa left distal clavicle fracture. (B) The fracture was reduced with locking plate. (C) The last follow-up radiograph after implant removal shows solid union.

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Fig. 2. (A) A 27-year-old male sustained a Neer type IIb left distal clavicle fracture. (B) The fracture was reduced and fixed with hook plate. (C) The last follow-up radiograph after implant removal shows solid union.

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Fig. 3. (A) A 37-year-old male sustained a Neer type V right distal clavicle fracture with acromioclavicular joint subluxation. (B) The fracture-dislocation was reduced and fixed with hook plate and wiring.

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Fig. 4. (A) A 52-year-old male sustained a Neer type V right distal clavicle fracture. (B) Immediate postoperative radiograph shows fracture site reduced with hook plate. (C) Hook was moving toward to acromion on follow-up radiograph taken at 6 months postoperatively. (D) Partial union was observed on computcom tomography image taken at 6 months postoperatively. (E) Pelvic bone graft was done on nonunion site during implant removal and union was found on 3 months later.

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Fig. 5. (A) The immediate postoperative radiograph of a 30-year-old male sustained a Neer type V left distal clavicle fracture reduced with hook plate. (B) The last followup radiograph before implant removal shows osteolysis on acromion (white arrow).

Table 1. Patient Demographic Data

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Table 2. Neer Classification between Hook Plate and Locking Plate

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Table 3. Overall Radiologic Outcomes (Unit: mm)

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Table 4. Radiologic Outcome of Hook Plate in Postoperative and Postremoval (Unit: mm)

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Cited by

  1. Biomechanical Analysis of Clavicle Hook Plates with a Range of Posterior Hook Offsets Implanted at Different Acromion Positions in the Acromioclavicular Joint: A Finite Element Analysis Study vol.11, pp.23, 2018, https://doi.org/10.3390/app112311105