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

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 clavic...

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Autores principales: Fahmy, Fahmy Samir, ElAttar, Mohammed, Abulsoud, Mohamed, Mohammed, Ahmed Saied, Elhalawany, Mohamed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9706069/
https://www.ncbi.nlm.nih.gov/pubmed/36458107
http://dx.doi.org/10.1177/23259671221137337
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author Fahmy, Fahmy Samir
ElAttar, Mohammed
Abulsoud, Mohamed
Mohammed, Ahmed Saied
Elhalawany, Mohamed
author_facet Fahmy, Fahmy Samir
ElAttar, Mohammed
Abulsoud, Mohamed
Mohammed, Ahmed Saied
Elhalawany, Mohamed
author_sort Fahmy, Fahmy Samir
collection PubMed
description 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.
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spelling pubmed-97060692022-11-30 Comparative Evaluation of Arthroscopically Assisted Coracoclavicular Fixation Versus Hook Plate Fixation for Unstable Distal Clavicle Fractures: A Minimum 2-Year Follow-up Study Fahmy, Fahmy Samir ElAttar, Mohammed Abulsoud, Mohamed Mohammed, Ahmed Saied Elhalawany, Mohamed Orthop J Sports Med Article 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. SAGE Publications 2022-11-21 /pmc/articles/PMC9706069/ /pubmed/36458107 http://dx.doi.org/10.1177/23259671221137337 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Fahmy, Fahmy Samir
ElAttar, Mohammed
Abulsoud, Mohamed
Mohammed, Ahmed Saied
Elhalawany, Mohamed
Comparative Evaluation of Arthroscopically Assisted Coracoclavicular Fixation Versus Hook Plate Fixation for Unstable Distal Clavicle Fractures: A Minimum 2-Year Follow-up Study
title Comparative Evaluation of Arthroscopically Assisted Coracoclavicular Fixation Versus Hook Plate Fixation for Unstable Distal Clavicle Fractures: A Minimum 2-Year Follow-up Study
title_full Comparative Evaluation of Arthroscopically Assisted Coracoclavicular Fixation Versus Hook Plate Fixation for Unstable Distal Clavicle Fractures: A Minimum 2-Year Follow-up Study
title_fullStr Comparative Evaluation of Arthroscopically Assisted Coracoclavicular Fixation Versus Hook Plate Fixation for Unstable Distal Clavicle Fractures: A Minimum 2-Year Follow-up Study
title_full_unstemmed Comparative Evaluation of Arthroscopically Assisted Coracoclavicular Fixation Versus Hook Plate Fixation for Unstable Distal Clavicle Fractures: A Minimum 2-Year Follow-up Study
title_short Comparative Evaluation of Arthroscopically Assisted Coracoclavicular Fixation Versus Hook Plate Fixation for Unstable Distal Clavicle Fractures: A Minimum 2-Year Follow-up Study
title_sort comparative evaluation of arthroscopically assisted coracoclavicular fixation versus hook plate fixation for unstable distal clavicle fractures: a minimum 2-year follow-up study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9706069/
https://www.ncbi.nlm.nih.gov/pubmed/36458107
http://dx.doi.org/10.1177/23259671221137337
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