Arthroscopic stabilization for Neer type 2 fracture of the distal clavicle fracture

The distal clavicle fractures are divided into three types according to Neer's classification. Types 1 and 3 fractures are treated with a sling to immobilize the upper extremity. However, the treatment of type 2 fractures is controversial. We paid attention to the anatomic basis of type 2 fractures that the disruptions of the conoid ligament lead to the distraction between the two bony fragments. In this study, we describe the arthroscopic procedure to reconstruct the disrupted ligament and stabilize the fracture as a minimally invasive method. The subjects were seven patients with the distal clavicle fractures. According to Neer's or Rockwood's classification on plain radiographs, all seven patients were evaluated as type 2 or 2B, respectively. Our surgical procedure was performed with the patient in the beach chair position. We have used the artificial ligament with an EndoButton (Smith & Nephew Endoscopy, Andover, MA) as the substitute ligament to reconstruct the disrupted conoid ligament. The mean duration of postoperative follow-up was 2 years and 5 months. The bony union was achieved in all patients at a final follow-up. When concerning the range of motion at final examinations, mean forward flexion was 171A degrees, mean abduction was 165A degrees, mean internal rotation was Th11, and mean horizontal adduction was 132A degrees. It is possible to treat the distal clavicle fractures by a minimally invasive arthroscopic procedure without opening the fracture site of clavicle.