Clavicular Hook Plate: A Better Implant Choice for Fixation of Unstable Distal Clavicle Fractures?

Background: The ideal fixation method for unstable distal clavicle fractures is still controversial. Clavicular hook plates (HPs) are an effective option but the clinical efficacy and advantages/disadvantages of this implant compared with the tension band wire technique in treating this fracture have not been determined. Methods: A retrospective study was undertaken over a period of 3 years that included 45 patients, who were divided into two groups based on the treatment method. The clavicle HP group included 25 patients and the K-wire and tension band wire (KTBW) group included 20 patients. Radiographic examinations were taken to assess the adequacy of implant fixation and degree of bony union. Clinical results for pain, shoulder function and range of motion were evaluated using Constant-Murley scores. Results: Two groups of patients were similar in terms of age, sex, injury mechanisms, time to surgery, and time of follow-up. The results showed that the HP group had a significantly higher union rate and lower occurrence of surgical complications (p <0.001). However, 36% of patients in the HP group developed subacromial shoulder impingement syndrome before implant removal, and their functional scores were poorer than their nonimpinged counterparts. Conclusions: Although better surgical results and radiological outcome were achieved by using clavicle HP than KTBW in treating unstable distal clavicle fractures, the mechanical hook impingement imposed on the subacromial structures was remarkable and may have lowered the functional scores of patients receiving HP fixation. The result showed that clavicular HP did not offer more clinical advantages than with KTBW in treating unstable distal clavicle fracture.