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Beitragstitel All-suture technique for fixation of unstable displaced distal clavicle fractures
Beitragscode P01
Autoren
  1. Gregory Cunningham Centre Epaule Coude la Colline (CEPCO)
  2. Alejandro Culebras Hôpital de La Tour, Genève Vortragender
  3. Morgan Gauthier Service de chirurgie orthopédique et traumatologie de l'appareil locomoteur, Hôpitaux Universitaires de Genève
Präsentationsform Poster
Themengebiete
  • A01 - Schulter/Ellbogen
Abstract Background
Displaced Neer type II and V clavicle fractures are usually treated surgically in active patients. However, distal fragment fixation remains a challenge, and no consensus has been established regarding the optimal surgical treatment. Osteosuture techniques have been popularized over the last decade, and multiple different techniques have been described.
The aim of this study was to describe an all-suture technique in patients with displaced type II and V clavicle fractures and report its outcome in a prospective case series.

Methods
Between 2017 and 2020, 15 patients with displaced acute distal clavicle fractures were treated with an all-suture open technique performed by one shoulder specialized surgeon, with a minimum follow-up of 12 months. Osteosuture repair consisted in a coraco-clavicular cerclage with 4 n°6 Ethibonds and a figure-of-0 and figure-of-8 fracture cerclage with 2 n°2 Suturetapes. Single assessment numerical evaluation (SANE) and adjusted Constant score were recorded at 6 and 12 months. Radiologic union was assessed on plain radiographs.

Results
At 12 months, all patients reported excellent clinical results, with a mean SANE of 98.2 [± 5.2, range 80 to 100] and a mean adjusted Constant score of 99.0 [± 1.9, range 94 to 100]. One patient developed shoulder stiffness that resolved before final follow-up. Fractures consolidated in 93% of the cases, with union happening between 3 and 6 months [range 3 to 12 months]. One patient developed an asymptomatic malunion. No degenerative changes were noted in the acromioclavicular joint at 12 months. Correlation analysis between radiologic union and functional scores showed moderate negative correlation between time to union with 6 months SANE score (r = -0.7, p = 0.003) but none with 1 year SANE or adjusted Constant scores (r = -0.13, p = 0.6 and r =0.35, p = 0.2, respectively).

Conclusion
Excellent clinical and radiological outcomes can be achieved with this minimally invasive all-suture fixation technique for displaced distal clavicle fractures, which allows for an anatomic reduction and stable fixation. This study showed low complications and a high level of union after a minimum follow up of 12 months. Among the numerous advantages are a smaller exposure than for plate fixation, avoidance of hardware-related complications (screw/plate failure, coracoid fracture from drilling, or rotator cuff damage caused by hook-plates) and avoids a reoperation to remove symptomatic hardware.