Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA, 94063-6342, USA.
Eur J Orthop Surg Traumatol. 2021 Apr;31(3):473-479. doi: 10.1007/s00590-020-02797-x. Epub 2020 Sep 19.
The need for coracoclavicular (CC) ligament augmentation when performing locking plate fixation of unstable distal clavicle fractures is controversial. The purpose of this study was to compare the results after locking plate fixation for treatment of Neer type-II and type-V distal clavicle fractures with and without suture suspensory augmentation of the CC ligaments.
This was a retrospective case series of all Neer type-II and type-V distal clavicle fractures treated with locking plates at a single Level I trauma center. Patients were separated into locking plate-only and locking plate with CC ligament augmentation groups. Postoperative complications and fracture healing rates were recorded. Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores were recorded as functional outcomes during follow-up phone interviews. Standard descriptive statistics were performed.
Sixteen patients were treated with locking plate fixation-only, and seven patients were treated with additional CC ligament augmentation. There was a similar distribution of Neer fracture types with each group. All fractures in both groups went onto union without loss of reduction or implant failure. There were no cases of infection or wound complications in either group. QuickDASH scores were comparable between locking plate-only fixation (mean 4.1 ± 3.9) and additional suspensory suture fixation (mean 4.5 ± 3.6).
This comparative study of Neer type-II and type-V distal clavicle fractures demonstrated comparable outcomes after locking plate fixation with and without CC ligament augmentation. CC ligament augmentation may not be necessary when treating unstable distal clavicle fractures if locking plate fixation is used.
在不稳定型锁骨远端骨折行锁定钢板固定时，是否需要行喙锁韧带（CC）增强存在争议。本研究旨在比较使用锁定钢板治疗 Neer Ⅱ型和Ⅴ型锁骨远端骨折时，是否联合 CC 韧带缝合悬吊增强的疗效。
这是一项单中心Ⅰ级创伤的回顾性病例系列研究，纳入所有接受锁定钢板治疗的 Neer Ⅱ型和Ⅴ型锁骨远端骨折患者。将患者分为仅行锁定钢板固定组和联合 CC 韧带增强组。记录术后并发症和骨折愈合率。通过随访电话访谈记录简易上肢功能评分（QuickDASH）作为功能结果。采用标准描述性统计分析。
16 例患者仅行锁定钢板固定，7 例患者联合 CC 韧带增强。两组 Neer 骨折类型分布相似。两组所有骨折均愈合，无复位丢失或内固定失败。两组均无感染或伤口并发症。仅行锁定钢板固定组（平均 4.1±3.9）和联合行悬吊缝合固定组（平均 4.5±3.6）的 QuickDASH 评分相似。
本研究对 Neer Ⅱ型和Ⅴ型锁骨远端骨折的比较表明，在使用锁定钢板固定时，联合或不联合 CC 韧带增强的疗效相似。如果使用锁定钢板固定不稳定型锁骨远端骨折，CC 韧带增强可能不是必需的。
