Two Methods Distal Clavicle (neer ¢ò) Fracture Analysis

ObjectiveTo Compare the Clavicular hook plate fixation and Kirschner wire (K-wire) fixation in the treatment the distal clavicle (NeerII) fracture and analyse the effect of clavicular hook plate fixation. Patients and methodsDuring 2001.9-2004.12 40 unstable fractures of the distal clavicle (Neerll) were operated on in Hubei TCM hospital and Wuhan general hospital of PLA. K-wire fixation was used in 22 cases and a clavicular hook plate in 18.Case records and radiographs were reviewed retrospectively and complications and reoperations recorded. Clavicular hook plate fixationThere were 18 patients (12 male) with a mean age of 34.3 (18~64) years. There are 12 patients in I1A and 6 patients in IIB. After the fracture was reduced, a tunnel was made in the subacromial space behind the AC joint. The plate was apply to superior surface of the bone and was fixed using dynamic compression, if possible. Gentle mobilization of the hand and the elbow was allowed from the first postoperative day. And mobilization of the shoulder was allowed from the first postoperative week. Full range of motion was usually achieved after 3~4 weeks. Heavy manual work was not allowed until the fracture healed. K-wire fixationThere were 22 patients (15 male) with a mean age of 32.8 (17~61) years. There are 14 patients in IIA and 8 patients in IIB. Kirschner pin must be strongly and stiffly tempered to withstand the unsupported weight of the upper extremity without bending or breaking. Its lateral end should be bent 90 degrees to prevent its migration medially toward vital structures. 2 Kirschner pins must pass through the AC joint, the lateral fragment and the medial fragment parallelly for a distance of 3 ~ 4 cm . The arm was supported with a sling, usually for 3~4 weeks, and after that gentle mobilization of the shoulder was started. A full range of motion was allowed only after the K-wire had been removed(6~8weeks). ResultAll patients were followed up. Mean follow up was 8 (6-24) months. Shoulder function was evaluated with the JO A scoring system.There are no significant difference in mean age, the type of sex and fracture, operation duration, clinical healing duration and bleeding amount in both groups (P > 0.05).In the first postoperative week the score of the clavicular hook plate fixation group and the K-wire fixation group were similar in the aspect of the pain, the activity and function of the shoulder joint (P > 0.05).In the 2,4,12 week the score of the clavicular hook plate fixation group were higher than the K-wire fixation group in the aspect of the pain, the activity and function of the shoulder joint (P <0.05). Conclusion1. the clavicular hook plate were better in the respect of function restored and the pain than the K-wire in the treatment of the distal clavicle(NeerII) fracture and it is therefore recommended.2. The clavicular hook plate may decrease the subacromial space. As a result it may induce the subacromial impingement syndrome, functional impairment and pain.