Under Coracoid-through Clavicle Suture Fixation in Type 2 Distal Clavicle Fracture

INTRODUCTION: Surgical management of Neer type 2 distal clavicle fractures may include tension band wiring, pre-contoured plate, hook plate or indirect fixation of coracoclavicular space by Endobutton, suture anchors, or Tightrope devices. We present our technique of suture and Mersilene tape fixation by passing them through the clavicle and under the coracoid which is a form of indirect fixation. TECHNIQUE: The fracture and the coracoid are exposed through a horizontal skin incision. The Mersilene tape and Ethibond suture are looped under the coracoid and then one limb of each is passed through the medial hole and then through the lateral hole to exit inferiorly and then tied underneath the clavicle, while the fracture is reduced. CONCLUSION: Direct fixation by means of plate has good outcomes though high complication rate. Indirect fixation by means of Endobutton and Tightrope devices has shown successful outcome with less side effects. Our method of fixation by Ethibond suture and Mersilene tape is inexpensive while having the same principles of internal fixating the clavicle to the coracoid while the fracture heals.