The Treatment Of Distal Clavicle Fracture With AO Clavicular Hook-plate

The treatment of unstable fractures of the distal clavicle with detachment of the coracoclavicular ligaments(Neer typeⅡ)has been still thought as a controversial problem by most authors. Some authors insisted that conservative management with short-term sling immobilization can result in healing and a good outcome. But others recommended open reduction. Because the rate of nonunion observed in distal calvicle fractures can approach 30%,and higher incidence of local complication, and residual shoulder dysfunction in using conservative methods. By now, hundreds of methods for the fixation of clavicle fracture have been described. However all have been associated with problems and there is no consensus regarding the best method to provide the best clinical results. The clavicular hook-plate is a new small fragment AO plate with a hook engaging below the acromion. Recently more and more reports demonstrate that the hook-plate fixation resulte in a good union rate ,good shoulder function and patient satisfaction. But the difference between the affected and control sides in pain and the subjective part of the JOA score was small.Objective:To evaluate the clinical outcomes after treatment of with AO clavicular hook-plate.method: From January 2003 to January 2006. 18 patients with the distal clavicle fractures(Neer typeⅡ)were treated with AO clavicular hook-plate under general anaesthesia. All of the patients were open reduction and the broken coracoclavicular ligaments were sutured in operation.The arm was kept in a sling for 2 weeks postoperatively,and pendulum exercises were performed by the patient from the first postoperative day, Patients were instructed to avoid forward flexion or abduction greater than 90°and internal rotation of the shoulder behind the back until the plate was removed. Active and passive ROM exercises were started 2 weeks postoperatively. The patients had the AO hook plate removed after bony union was observed on radiographs. Rang from 10 to 18 months(mean 12.75months). all the patients were divided into two groups ,according weather accepted physiotherapy with rehabilitation physician or not. Shoulder symptoms and functions were assessed using the 100-point Japanese Orthopaedic Association (JOA) scoring system for therapeutic effects on shoulder disorders. Including pain(30-point),strength of forward abduction (by manual muscle testing), activities of daily life(20-point), ROM(30-point), radio- graphic evaluation(5-point), and joint stability(15-point).their shoulder functions before and after taking out of the internal fixation were compared . Result:All the cases got reduction and fixation, 14 patients were followed up from 3~31months(mean 13.2months). The patients postoperative shoulder pain and release of ROM. 1 patient developed impingment of the shoulder because of unsatisfactory preliminary flexion but the joint function was not affected after plate removal.1 patient'coraco-claviclular screw loosening, there were no infection and refracture. The mean JOA score was 79.6 point, The JOA score of those who accepted physiotherapy were better than those not accepted(p<0.05). the scores of shoulder joint function were 83.00±4.11 and 97.63±1.41(p<0.05)before and after removing internal fixations. After the clavicular hook-plate removed, the shoulder joint function had obviously change especially in sleeping, also ROM of daily activities improved. Conclusion: The AO clavicular hook-plate is useful for treating unstable distal clavicular fracture. this plate promises stable postoperative outcomes,allows early mobilization and easy to handle with lower complications, Systematic rehabilitation training could improved the shoulder joint function. Also we recommend that the clavicular hook-plate device should be routinely removed to get better shoulder joint function and relieve the pain.