Application study of a novel locking anatomical plate in treatment of Neer type <b>Ⅱ</b>b and type <b>Ⅴ</b> distal clavicle fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Jin , XU Duohui , WU Jide ,  PU Yanchuan

Department of Orthopedics, Wuwei People's Hospital, Wuwei Gansu, 733000, P. R. China;

Corresponding?author：

PU Yanchuan, Email: softface007@126.com

Keywords：

Novel locking plate; distal clavicle fracture; open reduction; internal fixation

DOI：

10.7507/1002-1892.202509072

Video：

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Objective To evaluate the feasibility and effectiveness of a novel locking plate designed for the acromial end of the clavicle (hereinafter referred to as the “novel locking plate”) in the treatment of Neer type Ⅱb and type Ⅴ distal clavicle fractures. Methods Between February 2024 and January 2025, a total of 12 patients with Neer type Ⅱb and type Ⅴ distal clavicle fractures resulting from trauma were treated using the novel locking plate. The cohort comprised 7 males and 5 females, with ages ranging from 22 to 65 years (mean, 49.6 years). According to the Neer fracture classification system, 9 cases were classified as type Ⅱb and 3 cases as type Ⅴ. The interval from injury to operation ranged from 2 to 6 days (mean, 3.9 days).After achieving anatomical reduction of the fracture, the novel locking plate was applied for internal fixation, accompanied by anatomical reconstruction of the coracoclavicular ligament. Operative time, intraoperative blood loss, and incision healing were meticulously documented. During follow-up period, the radiographic examinations were taken to assess fracture healing, and was evaluated using the Constant-Murley score criteria was used to evaluate the shoulder joint function. Results All 12 operations were completed. The operative time ranged from 55 to 90 minutes (mean, 74 minutes), and intraoperative blood loss ranged from 50 to 100 mL (mean, 85 mL). All incisions healed by first intention. All patients were followed up 6-18 months (mean, 11.6 months). At last follow-up, the radiographic examination demonstrated that all fractures had achieved bony union; the Constant-Murley score ranged from 92 to 96 (mean, 94.3), all rated as excellent. Conclusion For Neer type Ⅱb and type Ⅴ distal clavicle fractures, the combination of the novel locking plate and anatomical reconstruction of the coracoclavicular ligament provides reliable internal fixation, ensures satisfactory fracture reduction, promotes fracture healing, and yields highly satisfactory effectiveness.

1.	Kim DW, Kim DH, Kim BS, et al. Current concepts for classification and treatment of distal clavicle fracture. Clin Orthop Surg, 2020, 12(2): 135-144.
2.	Neer CS 2nd. Fractures of the distal third of the clavicle. Clin Orthop Relat Res, 1968, 58: 43-50.
3.	Craig EV. Fractures of the clacicle//Rockwood CA, Matsen FA, Harryman DT. The shoulder. Philadelphia: WB Saunders, 1990: 373.
4.	俞云飛, 胡鋼, 嚴松鶴, 等. 兩種術式固定鎖骨遠端Neer Ⅱb型骨折比較. 中國矯形外科雜志, 2023, 31(20): 1836-1841.
5.	Kim DJ, Lee YM, Yoon EJ, et al. Comparison of locking plate fixation and coracoclavicular ligament reconstruction for Neer type 2B distal clavicle fractures. Orthop J Sports Med, 2022, 10(3): 23259671221086673. doi: 10.1177/23259671221086673.
6.	Fox HM, Ramsey DC, Thompson AR, et al. Neer type-Ⅱ distal clavicle fractures: a cost-effectiveness analysis of fixation techniques. J Bone Joint Surg (Am), 2020, 102(3): 254-261.
7.	Boonard M, Sumanont S, Arirachakaran A, et al. Fixation method for treatment of unstable distal clavicle fracture: systematic review and network meta-analysis. Eur J Orthop Surg Traumatol, 2018, 28(6): 1065-1078.
8.	Sharma V, Modi A, Armstrong A, et al. The management of distal clavicle fractures——A survey of UK shoulder and elbow surgeons. Cureus, 2021, 13(8): e17305. doi: 10.7759/cureus.17305.
9.	韋永安, 周繼輝, 陳文瑤, 等. 鎖骨遠端骨折治療及內置物的選擇. 中國組織工程研究, 2021, 25(30): 4877-4882.
10.	Xu D, Luo P, Chen J, et al. Outcomes of surgery for acromioclavicular joint dislocation using different angled hook plates: a prospective study. Int Orthop, 2017, 41(12): 2605-2611.
11.	劉鎮煌, 黃長明, 范華強, 等. 肩鎖關節脫位鉤鋼板固定的并發癥與對策. 中國矯形外科雜志, 2023, 31(2): 111-116.
12.	楊求勇, 李亞偉, 孫飛, 等. NeerⅡ型鎖骨遠端骨折是否修復喙鎖韌帶的薈萃分析. 中國矯形外科雜志, 2022, 30(24): 2241-2245.
13.	鄭興國, 薛騁, 李翔, 等. 喙鎖韌帶解剖重建與鉤鋼板治療鎖骨遠端NeerⅡb型骨折的療效比較. 中華創傷骨科雜志, 2022, 24(5): 421-428.
14.	Edwards DJ, Kavanagh TG, Flannery MC. Fractures of the distal clavicle: a case for fixation. Injury, 1992, 23(1): 44-46.
15.	陳浩, 方加虎, 殷國勇. 喙鎖韌帶不同重建方法治療肩鎖關節脫位的有限元分析. 中國骨傷, 2023, 36(6): 543-549.
16.	潘昭勛, 杜德凱, 孫超, 等. 喙鎖韌帶解剖重建與垂直重建的生物力學對比. 醫用生物力學, 2018, 33(4): 343-347.
17.	Xu J, Liu H, Lu W, et al. A retrospective comparative study of arthroscopic fixation in acute Rockwood type Ⅳ acromioclavicular joint dislocation: single versus double paired Endobutton technique. BMC Musculoskelet Disord, 2018, 19(1): 170. doi: 10.1186/s12891-018-2104-9.
18.	季貴柱, 鄭秋, 汪武祥, 等. 原生喙鎖韌帶及柔性重建后有限元仿真和實驗測試. 中國組織工程研究, 2024, 28(5): 706-711.
19.	馬昌科, 沈憶新, 陽利武. 單純解剖鎖定鋼板內固定與聯合喙鎖韌帶重建治療新鮮和陳舊性NeerⅡb型鎖骨遠端骨折的療效比較. 中華創傷骨科雜志, 2022, 24(2): 120-126.
20.	Xue C, Song LJ, Zhang M, et al. Coracoclavicular ligament attachment regions of the Chinese population: a quantitative anatomic study. Anat Sci Int, 2013, 88(4): 189-194.
21.	Furuhata R, Matsumura N, Udagawa K, et al. Residual coracoclavicular separation after plate fixation for distal clavicle fractures: comparison between fracture patterns. JSES Int, 2021, 5(5): 840-845.
22.	趙士君, 李翔, 張威, 等. 克氏針聯合縫合錨釘重建喙鎖韌帶治療Cho ⅡC型鎖骨遠端骨折. 中國修復重建外科雜志, 2023, 37(11): 1370-1374.
23.	姜濟世, 翟云雷, 黃徐兵, 等. Endobutton鋼板聯合高強度縫線Nice結固定治療鎖骨遠端骨折療效分析. 中國修復重建外科雜志, 2022, 36(2): 155-162.
24.	Ono Y, Woodmass JM, Nelson AA, et al. Knotless anchors with sutures external to the anchor body may be at risk for suture cutting through osteopenic bone. Bone Joint Res, 2016, 5(6): 269-275.
25.	高進濤, 甄珍, 韓丹, 等. 不可吸收帶線錨釘典型功能失效及力學性能研究. 中國醫療器械雜志, 2023, 47(3): 247-251.
26.	Hou Z, Graham J, Zhang Y, et al. Comparison of single and two-tunnel techniques during open treatment of acromioclavicular joint disruption. BMC Surg, 2014, 14: 53. doi: 10.1186/1471-2482-14-53.
27.	劉挺, 周彬, 王冶, 等. 改良TightRope袢鋼板解剖重建喙鎖韌帶治療RockwoodⅢ~Ⅴ型肩鎖關節脫位. 中國骨與關節損傷雜志, 2024, 39(9): 924-927.
28.	吳劍宏, 吳曉明, 韓志華, 等. 喙鎖韌帶重建結合鋼板固定治療伴喙鎖韌帶鎖骨止點撕脫的鎖骨遠端骨折. 中華骨科雜志, 2020, 40(1): 17-22.

1. Kim DW, Kim DH, Kim BS, et al. Current concepts for classification and treatment of distal clavicle fracture. Clin Orthop Surg, 2020, 12(2): 135-144.
2. Neer CS 2nd. Fractures of the distal third of the clavicle. Clin Orthop Relat Res, 1968, 58: 43-50.
3. Craig EV. Fractures of the clacicle//Rockwood CA, Matsen FA, Harryman DT. The shoulder. Philadelphia: WB Saunders, 1990: 373.
4. 俞云飛, 胡鋼, 嚴松鶴, 等. 兩種術式固定鎖骨遠端Neer Ⅱb型骨折比較. 中國矯形外科雜志, 2023, 31(20): 1836-1841.
5. Kim DJ, Lee YM, Yoon EJ, et al. Comparison of locking plate fixation and coracoclavicular ligament reconstruction for Neer type 2B distal clavicle fractures. Orthop J Sports Med, 2022, 10(3): 23259671221086673. doi: 10.1177/23259671221086673.
6. Fox HM, Ramsey DC, Thompson AR, et al. Neer type-Ⅱ distal clavicle fractures: a cost-effectiveness analysis of fixation techniques. J Bone Joint Surg (Am), 2020, 102(3): 254-261.
7. Boonard M, Sumanont S, Arirachakaran A, et al. Fixation method for treatment of unstable distal clavicle fracture: systematic review and network meta-analysis. Eur J Orthop Surg Traumatol, 2018, 28(6): 1065-1078.
8. Sharma V, Modi A, Armstrong A, et al. The management of distal clavicle fractures——A survey of UK shoulder and elbow surgeons. Cureus, 2021, 13(8): e17305. doi: 10.7759/cureus.17305.
9. 韋永安, 周繼輝, 陳文瑤, 等. 鎖骨遠端骨折治療及內置物的選擇. 中國組織工程研究, 2021, 25(30): 4877-4882.
10. Xu D, Luo P, Chen J, et al. Outcomes of surgery for acromioclavicular joint dislocation using different angled hook plates: a prospective study. Int Orthop, 2017, 41(12): 2605-2611.
11. 劉鎮煌, 黃長明, 范華強, 等. 肩鎖關節脫位鉤鋼板固定的并發癥與對策. 中國矯形外科雜志, 2023, 31(2): 111-116.
12. 楊求勇, 李亞偉, 孫飛, 等. NeerⅡ型鎖骨遠端骨折是否修復喙鎖韌帶的薈萃分析. 中國矯形外科雜志, 2022, 30(24): 2241-2245.
13. 鄭興國, 薛騁, 李翔, 等. 喙鎖韌帶解剖重建與鉤鋼板治療鎖骨遠端NeerⅡb型骨折的療效比較. 中華創傷骨科雜志, 2022, 24(5): 421-428.
14. Edwards DJ, Kavanagh TG, Flannery MC. Fractures of the distal clavicle: a case for fixation. Injury, 1992, 23(1): 44-46.
15. 陳浩, 方加虎, 殷國勇. 喙鎖韌帶不同重建方法治療肩鎖關節脫位的有限元分析. 中國骨傷, 2023, 36(6): 543-549.
16. 潘昭勛, 杜德凱, 孫超, 等. 喙鎖韌帶解剖重建與垂直重建的生物力學對比. 醫用生物力學, 2018, 33(4): 343-347.
17. Xu J, Liu H, Lu W, et al. A retrospective comparative study of arthroscopic fixation in acute Rockwood type Ⅳ acromioclavicular joint dislocation: single versus double paired Endobutton technique. BMC Musculoskelet Disord, 2018, 19(1): 170. doi: 10.1186/s12891-018-2104-9.
18. 季貴柱, 鄭秋, 汪武祥, 等. 原生喙鎖韌帶及柔性重建后有限元仿真和實驗測試. 中國組織工程研究, 2024, 28(5): 706-711.
19. 馬昌科, 沈憶新, 陽利武. 單純解剖鎖定鋼板內固定與聯合喙鎖韌帶重建治療新鮮和陳舊性NeerⅡb型鎖骨遠端骨折的療效比較. 中華創傷骨科雜志, 2022, 24(2): 120-126.
20. Xue C, Song LJ, Zhang M, et al. Coracoclavicular ligament attachment regions of the Chinese population: a quantitative anatomic study. Anat Sci Int, 2013, 88(4): 189-194.
21. Furuhata R, Matsumura N, Udagawa K, et al. Residual coracoclavicular separation after plate fixation for distal clavicle fractures: comparison between fracture patterns. JSES Int, 2021, 5(5): 840-845.
22. 趙士君, 李翔, 張威, 等. 克氏針聯合縫合錨釘重建喙鎖韌帶治療Cho ⅡC型鎖骨遠端骨折. 中國修復重建外科雜志, 2023, 37(11): 1370-1374.
23. 姜濟世, 翟云雷, 黃徐兵, 等. Endobutton鋼板聯合高強度縫線Nice結固定治療鎖骨遠端骨折療效分析. 中國修復重建外科雜志, 2022, 36(2): 155-162.
24. Ono Y, Woodmass JM, Nelson AA, et al. Knotless anchors with sutures external to the anchor body may be at risk for suture cutting through osteopenic bone. Bone Joint Res, 2016, 5(6): 269-275.
25. 高進濤, 甄珍, 韓丹, 等. 不可吸收帶線錨釘典型功能失效及力學性能研究. 中國醫療器械雜志, 2023, 47(3): 247-251.
26. Hou Z, Graham J, Zhang Y, et al. Comparison of single and two-tunnel techniques during open treatment of acromioclavicular joint disruption. BMC Surg, 2014, 14: 53. doi: 10.1186/1471-2482-14-53.
27. 劉挺, 周彬, 王冶, 等. 改良TightRope袢鋼板解剖重建喙鎖韌帶治療RockwoodⅢ~Ⅴ型肩鎖關節脫位. 中國骨與關節損傷雜志, 2024, 39(9): 924-927.
28. 吳劍宏, 吳曉明, 韓志華, 等. 喙鎖韌帶重建結合鋼板固定治療伴喙鎖韌帶鎖骨止點撕脫的鎖骨遠端骨折. 中華骨科雜志, 2020, 40(1): 17-22.

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Latest ArticlesApplication study of a novel locking anatomical plate in treatment of Neer type Ⅱb and type Ⅴ distal clavicle fractures

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