J Korean Orthop Assoc.  2014 Oct;49(5):374-380. 10.4055/jkoa.2014.49.5.374.

Analysis of Treatment Results of Unstable Distal Clavicle Fractures Using Hook Plate

• Jeon HS
• Woo YK
• Hwang SH
• Suh SP
• Kang SG
• Lee JK

• KMID: 2185173
• DOI: http://doi.org/10.4055/jkoa.2014.49.5.374

Abstract

PURPOSE
The purpose of this study is to analyze the treatment results and complications in unstable distal clavicle fractures which were treated with a Hook plate, and, in particular, to compare the functional results before and after removal of the Hook plate.
MATERIALS AND METHODS
We examined 20 cases in 20 patients who underwent removal of Hook plates after bony union was obtained in an unstable fracture of the distal clavicle (Neer type II) from March 2009 to December 2012. The average follow-up period after initial surgery was 12 months (8-20 months). Plates were removed at 18 weeks (ranged from 10-36 weeks) after initial fixation. University of California at Los Angeles (UCLA) and Korean Shoulder Scoring System (KSS) scores were used for clinical functional evaluation, and plain radiographs were used for radiological evaluation.
RESULTS
In radiological evaluation, bony union was obtained at an average of 11.4 weeks (ranged from 8-14 weeks) in all of the 20 patients. All of the 20 patients showed limited range of motion, mild pain, and discomfort of the shoulder before removal of the Hook plate, and all of the 20 patients showed better results in UCLA and KSS score after removal of the plate, when compared to before removal. Stress fracture as a major complication, was united completely with a 'figure of 8' bandage and deep wound infection was resolved after repeated debridement and antibiotic treatment with satisfactory functional results.
CONCLUSION
Hook plate in treatment of unstable fracture of the distal clavicle is considered to be a useful method because rigid fixation can be obtained. However, there are some complications, such as limited range of motion, pain, and discomfort of the shoulder joint, before removal of the Hook plate. Therefore, we think that removal of the Hook plate as soon as possible if bony union is obtained would be desirable.

Keyword

clavicle; unstable fracture; Hook plate

MeSH Terms

Bandages
California
Clavicle*
Debridement
Follow-Up Studies
Fractures, Stress
Humans
Range of Motion, Articular
Shoulder
Shoulder Joint
Wound Infection

Figure

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  Figure 1 (A) Neer type IIB fracture of the clavicle in a 53-year-old man is seen. (B) The distal clavicular fracture is stabilized with a Hook plate. (C) At postoperative three months, radiograph shows union of the fracture.

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  Figure 2 (A) Neer type IIA fracture of the distal clavicle in a 68-yearold man is seen. (B) Immediate postoperative radiograph shows normal cortical surface of acromion. (C) At postoperative three months, radiograph shows subacromial erosion around the tip of the Hook plate.

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  Figure 3 University of California at Los Angeles (UCLA) score. SD: standard deviation.

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  Figure 4 Korean Shoulder Scoring System (KSS) score. SD: standard deviation.

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  Figure 5 (A) Fracture of the clavicle through the most medial screw hole of the Hook plate is seen. (B) At six months of follow-up, union of the fracture is seen.

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