Arthroscopically assisted stabilization of displaced lateral clavicle fractures with coracoclavicular instability

Lateral clavicle fractures associated with partial or complete injury of the coracoclavicular ligaments have traditionally been treated using a variety of open surgical techniques. The aim of this prospective study was the evaluation of the clinical and radiologic outcome of displaced lateral clavicular fractures with coracoclavicular instability treated in an arthroscopic single TightRope technique including an interfragmentary cerclage. From 2008 to 2010, 23 patients [8 women and 15 men; mean age 38 (24-63) years] who sustained a displaced lateral clavicular fracture type II according to Neer were included in this study. The follow-up consisted of a complete physical examination of the shoulder including range of motion, the constant score (CS), and the subjective shoulder value (SSV). The radiological follow-up included an anteroposterior stress view with 10 kg of axial load and bilateral axillary views to evaluate the coracoclavicular distance, the clavicular implant position, and healing of the fracture. After a mean follow-up of 23.0 (13-38) months, 20 patients (7 women and 13 men; mean age 38.3 (24-53) years) were available for follow-up. On average, patients achieved 95.1 (60-100) % in the SSV, 88.7 (64-99; contralateral side 91.8 points; p > 0.05) points in the CS. Radiologically, 18 of 20 patients (90 %) displayed a bony healing of the fracture. The average coracoclavicular distance of 11.2 (6-14) mm did not differ significantly from the healthy side [9.9 (8-14) mm]. In six cases (30 %), coracoclavicular ossifications appeared. Two of 20 patients had concomitant glenohumeral lesions (10 %). Two patients had secondary surgery [implant removal (N = 1 local implant irritation); plate osteosynthesis (N = 1 early loss of reduction)]. The arthroscopic-assisted and image intensifier-controlled closed reduction and single TightRope fixation with interfragmentary cerclage of displaced lateral clavicular fractures with coracoclavicular instability yields excellent clinical results and is able to recreate stability of the clavicle.