Treatment of distal clavicle fractures using an arthroscopic technique (original) (raw)

2008, Journal of Shoulder and Elbow Surgery

Whenever indicated, distal clavicle fractures can be treated with a double loop of a nonabsorbable, #5 suture around the clavicle and under the coracoid. We developed an all arthroscopic technique to perform this procedure. From January to September 2004, 7 patients were treated. The mean age was 46 years. The coracoid is identified through the rotator interval. Using a special needle, a double #5 suture is passed around the coracoid. A hole is created at the clavicle and, through another guide wire, is sent to the anterior portal. The double #5 suture is transported to the clavicle. After the reduction of the fracture the sutures are tightened. All 7 cases have healed. The surgical treatment of these fractures is well established, and with the aid of arthroscopy, the morbidity can be decreased. The technique has been shown to be safe with no complications. (J Shoulder Elbow Surg 2008;17:395-398.) Fractures of the clavicle comprise about 4% of all fractures of the human body. Because of the S shape of the clavicle, the great majority of fractures of this bone (80%) are in the middle third. Distal clavicle fractures (DCF) account for approximately 15% of the remaining fractures of the clavicle. The muscles of the shoulder girdle contribute to the dynamic stability of the upper limb; 12,13,16 however, stability of the lateral cavicle is provided mostly by the acromioclavicular and coracoclavicular ligaments. 1,3,6,7,18 These ligaments have statistically been proven to enhance stability, especially the superior acromioclavicular ligament, which is responsible for the vertical stability (suspensory mechanism) of the shoulder girdle.