Abstract
Objective
Objective:To study the characteristics and classifications of the fractures of the distal third of the clavicle with coracoclavicular ligament disruption, and to define the adequate treatments of the fracture and its complications.
Method(s):
Methods:These are 31 patients who were suffered from the fractures of the distal third of the clavicle with coracoclavicular ligament disruption referred to our department of orthopaedic from July 2012 to July 2015. According the the clavicle fracture Rockwood classification, these fractures are Neer type IIb fractures. The injury mechanism: automobile accident(accident of bicycle and car13 patients; accident of pedestrian and car4 patients)17patients; fall injury 11 patients; athletic injury 2 patients; the other 1 patient. Fractures of the distal third of the clavicle with coracoclavicular ligament disruption have been associated with delayed union or nonunion, because the fracture is obvious displacement and instability. These patients were treated operatively in one week, a combined surgical technique for the fracture fixation and ligament repair for acute fractures was developed. The technique includes the TightRope device placement between the coracoid process and clavicle, and the lateral clavicle plate-screw fixation and repairing the coracoclavicular ligament with absorbable suture. The results of this combined technique were evaluated.
Result(s):
Results
patients who were treated with surgery were followed up 1 ~ 4 years, averaging 2.6 years. Main outcome measurements: The patients were evaluated by the Constant scores and Modified Shoulder Rating Scale. Measurements included pain 15 points, daily activities 20 points, the range of motion 40 points, and the physical strength 25 points, full score 100 points, indicating the best shoulder function; the excellent﹥90 points, good 80~90 points, fair 70~79 points, poor﹤70 points. The mean Constant score was 96.6 points in the last follow-up. Twenty nine patients（94%） had excellent results, 1 patient（3%） had a good result, and 1 patient（3%） had a fair result using the Modified Shoulder Rating Scale. The rates of the excellent and good were 97%. The group of patients don’t infected; there are no injures of nerve and blood vessel ; 1 patients suffer from the partly limitation of anterior flexion and rise of shoulder because the acromioclavicular joint subluxation after taking away the internal fixation. There is 1 patient skin necrosis of apex of the incision developed.
Conclusion(s):
Conclusions
The operation combined surgical technique of the TightRope device placement between the coracoid process and clavicle, the lateral clavicle plate-screw fixation and repairing the coracoclavicular ligament disruption with absorbable suture is a reliable technique with encouraging results for treating displaced distal third clavicle fractures with coracoclavicular ligament disruption.