Lateral Clavicle Fractures with Coracoclavicular Ligament Disruption (Neer's Type IIB): Review of Literature and a New Technique for All-Suture Fixation

BACKGROUND: All-suture fixation for the treatment of Neer's Type IIB lateral clavicle fractures by coracoclavicular (CC) ligament reconstruction has become popular in the past decade. Results of modified under-coracoid-around-clavicle (UCAC) technique are reported in this paper. METHODOLOGY AND RESULTS: Nineteen consecutive patients with minimum 6-month followup (FU) were identified. Average FU was 23 months (6–47 m), mean age was 38 years (16–81), and male-to-female ratio was 2:1. The time to surgery varied from 4 days to 12 weeks. Two patients had primary lateral end excision; of the rest, all but one healed fully. Average time to regain full range of motion was 4 weeks; postoperative Oxford Shoulder Score at 6 months was 43. All the patients returned to their previous occupation. One patient showed mild osteolysis on the last X-rays. There were no cases with infections or stiffness. DISCUSSION: CC ligament reconstruction converts the unstable Type IIB fracture into stable Type I; therefore, it is unnecessary to fix the distal fragment separately. Standard plating procedures are technically challenging due to small lateral fragment and frequently require a second operation for implant removal. The cost of commercially available implants vary from ≤750 to ≤1450. This technique is quick, easy to perform, provides good primary stability, and comparable union rates with other techniques at an implant cost of <£120. CONCLUSION: This is a reproducible and efficient technique that provides comparable results with other established procedures at a fraction of the cost of the next cheapest implant. It is recommended for the treatment of displaced Type II clavicle fractures. LEVEL OF EVIDENCE: Level IV.