Comparative Evaluation of Arthroscopically Assisted Coracoclavicular Fixation Versus Hook Plate Fixation for Unstable Distal Clavicle Fractures: A Minimum 2-Year Follow-up Study

Abstract

Background: Neer type 2 distal clavicular fractures are associated with poor outcomes after nonoperative management. Surgical management is preferred, and various fixation methods have been studied. Purpose: To assess the clinical and radiological outcomes in patients with unstable distal-end clavicular fractures that were treated with hook plate (HP) or arthroscopically assisted coracoclavicular (AAC) fixation. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively compared the clinical and radiological results of HP versus AAC fixation in patients who had unstable lateral-end clavicular fractures and at least 2 years of follow-up. The recorded postoperative Constant score, American Shoulder and Elbow Surgeons score, and shoulder forward flexion were compared between treatment groups using the independent t test. Fracture union was evaluated on routine shoulder radiographs. Results: This study included 34 patients (17 with HP fixation, 17 with AAC fixation) with a mean ± SD age of 36.4 ± 8.3 years for the HP group and 37.2 ± 6.9 years for the AAC group. The mean follow-up period was 30.8 ± 2.8 months for the HP group and 28.8 ± 3.01 months for the AAC group. No statistically significant difference between groups was observed regarding postoperative Constant score (89.7 vs 92.5; P =.07), American Shoulder and Elbow Surgeons score (88.2 vs 91.1; P =.12), or mean time to union (10.1 vs 9.3 weeks; P =.16). Postoperative shoulder forward flexion was better in the AAC group (168.2° ± 4.3°) versus the HP group (161.9° ± 6.6°; P =.002), and the complication rate was lower in the AAC group (5.8% vs 41.1%; P =.03). Conclusion: Both the AAC and HP fixation methods were effective in the surgical fixation of unstable Neer type 2 lateral-third clavicle fractures, with successful functional and radiological outcomes. However, AAC fixation provided an earlier return to work with fewer complications.