Noncomminuted lateral end clavicle fractures associated with coracoclavicular ligament disruption: Technical considerations for optimal anatomic fixation and stability

Distal clavicle fractures associated with coracoclavicular ligament disruption are potentially unstable and necessitate surgical treatment. Current fixation techniques are nonanatomic and do not address relevant aspects of the pathoanatomy. We have developed a technique that uses a unique combination of implants; this permits minimally invasive fixation and stable reduction with a lateral fragment size as small as 5 mm. The surgical technique consists of (1) neutralization of muscular forces on the proximal fragment using a minimally invasive ligament repair device (TightRope™, Arthrex, FL, USA) and (2) internal fixation using a contour-matched locking plate (2.4 mm LCP(®) Distal radius plates, Synthes, USA). Technical tips to optimize this new procedure are discussed. The technique can be extended to an “arthroscopic-assisted” method involving arthroscopic coracoclavicular fixation followed by a mini-open plate fixation of the clavicular fragments.