Objective To investigate the cl inical efficacy, compl ications and necessity of removing internal fixation in treatment of fresh Tossy type III acromioclavicular joint dislocations and Neer type II distal clavicle fractures with clavicularhook plate. Methods From June 2005 to June 2008, 24 patients with fresh Tossy type III acromioclavicular joint dislocations and 20 patients with fresh Neer type II distal clavicle fractures were treated. There were 32 males and 12 females with an agerange of 18-66 years (38.5 years on average), involving 18 left shoulders and 26 right shoulders. The injury was caused bytraffic accident in 31 cases and by fall ing in 13 cases. The mean time from injury to operation was 4 days (range, 2-8 days). All patients were treated by reduction with clavicular hook plate fixation. The coracoclavicular l igaments were not sutured. The shoulder functions were evaluated according to University of Cal ifornia-Los Angeles (UCLA) score system and analysed before and after removing internal fixation. Results Wound infection occurred in 2 cases 1 week after operation and healed after symptomatic managment, the other incisions healed by first intention. One case accepted hook plate fixation again because of loosening hooking-up 1 week after operation. One case accepted hook plate removal and Kirschner wire fixation because of severe shoulder’s pain on the postoperative third day. Thirty-eight patients were followed up for 8-32 months (18 months on average), there was no plate breakage. Clavicle fractures got bony union after 3-6 months (4.2 months on average). At last followup (before plate removal), according to UCLA shoulder function score system, the results were excellent in 11 cases, good in 22 cases, and fair in 5 cases; the excellent and good rate was 86.8%. Because of shoulder’s pain, plates were removed in 20 patients 3-16 months (10 months on average) after operation. The cases were followed up 3-8 months (5 months on average) after removing plate. No dislocation and fracture occurred again. There was statistically significant difference (P lt; 0.01) in the functional scores of shoulder between before (30.55 ± 4.00) and after removing internal fixation (33.85 ± 1.95). Conclusion Clavicular hook plate fixation is an effective treatment for fresh Tossy type III acromioclavicular joint dislocations and Neer type II distal claviclefractures. Normative operating, correct plate moulding, functional rehabil itation after operation are key factors in preventingcompl ications and reaching good cl inical efficacy. For the patients with postoperative symptoms, the plate should be removed to improve the shoulder’s function.
ObjectiveTo 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. ResultsAll 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. ConclusionFor 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.
