3-Year results of arthroscopic management of lateral clavicle fractures: Case series and literature review

In 18% of clavicular fractures, the lateral part is affected. Recently, a variety of surgical techniques have been discussed. This study aimed to analyze clinical and radiological results of a consecutive case series with arthroscopy-only coracoclavicular stabilization in unstable lateral clavicle fractures of Neer type IIB, utilizing a double-button fixation technique. Between 2013 and 2015 we followed up ten patients who exclusively had an arthroscopically assisted augmentation of the coracoclavicular ligaments using a double-button fixation (Dog Bone, Arthrex, Naples, FL, USA). Radiological scores and functional outcome measures were evaluated: Subjective Shoulder Value (SSV), Constant–Murley Score (CMS), Taft Score (TF), ASES Score (ASES), Nottingham Clavicle Score (NCS), and a Visual Analogous Scale (VAS). Eight of ten patients (5 males, 3 females; 80%) had follow-ups 37 ± 14 months postoperatively. The mean age was 32.4 ± 11.6 years and the mean operation time was 53 ± 21 min. Clinical examination showed a CMS of 91.9 ± 7.9 points (pt), a TF of 10.5 ± 1.1 pt, and an NCS of 76.5 ± 15.3 pt. The VAS score was 0.7 ± 1.5 pt with an average SSV of 83.1 ± 13.4 pt and an ASES of 87.0 ± 12.5 pt. In three cases (37.5%) a concomitant intra-articular pathology was found. Radiological analysis showed a preoperative CC distance of 19.7 ± 3.3 mm, a postoperative distance of 6.9 ± 3.0 mm and 12.0 ± 4.9 mm at follow-up. The clavicular drill hole widened from 3.0 ± 0.4 mm postoperatively to 6.0 ± 1.5 mm at follow-up; 50% of cases had radiological signs of bony non-union, two of which were symptomatic and received revision surgery. The solely arthroscopic double-button technique shows good clinical results. Although not symptomatic in all cases, the non-union rate is quite high. Thus, this technique should be reserved for special cases with small lateral fragments where anchoring techniques are not an option.