Treating unstable distal clavicle fractures with arthroscopy results in good functional outcomes compared to open techniques, but with less complications, a new study finds.
Arthroscopy for Unstable Clavicle Fractures Has Good Outcomes
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Secondary#arthroscopy#opentechnique#unstabledistalclavicle
Distal clavicle fractures represent between 15% and 25% of all clavicle fractures and 25% of them are unstable with a high nonunion rate when treated nonoperatively.
“These unstable fractures classified by Neer as type II or type V, present a unique challenge for surgical fixation because of the small size and comminution of the lateral fragment, the disruption of the coracoclavicular (CC) ligaments, and the large deforming forces on the fracture fragments,” the researchers of “Outcomes of Arthroscopic Fixation of Unstable Distal Clavicle Fractures: A Systematic Review,” wrote. The article was published in the Orthopaedic Journal of Sports Medicine on May 3, 2021.
“Surgical management of unstable distal clavicle fractures remain controversial. Traditional open techniques result in acceptable union rates but are fraught with complications. In response to these limitations, arthroscopic techniques have been developed; however clinical outcome data are limited.”
In their study, they evaluated the clinical and radiographic outcomes of arthroscopic fixation of unstable distal clavicle fractures, and the overall complication rate. The analysis focused on major complications and reoperation rates.
The researchers conducted a systematic review of relevant studies between 2008 and 2019. Data was collected on patient characteristics, fracture type, surgical technique, concomitant injuries, union rates, functional outcomes, and complications.
Analysis was based on 15 studies that included 226 distal clavicle fractures treated arthroscopically. Most of the fractures were classified as Neer type II. A cortical button coracoclavicular stabilization surgical technique was in 97% of the cases.
Overall, bony union occurred in 94.1% of the fracture and most patients reported good to excellent outcomes at the final follow-up.
The pooled mean Constant-Murley score was 93.06 (95% CI, 91.48-94.64). The overall complication rate was 27.4%, but only 12% were major complications. Six percent of the complications were related to hardware and required reoperation.
“Arthroscopic fixation of distal clavicle fractures resulted in good functional outcomes with union rates comparable to those of traditional open techniques. While the overall complication profile was similar to that of other described techniques, there was a much lower incidence of major complications, including hardware-related complications and reoperations,” they wrote.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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