A RETROSPECTIVE STUDY OF LATERAL END CLAVICULER FIXATION WITH HOOK PLATE Waleed Mohamed Amrhassaen Mohammad Salah Abdelaal AL Helal Hospital , Cairo

Introduction Unstable fractures of the lateral end of the clavicle (Neer type 2) are a treatment dilemma. Very high risk of delayed union, malunion and non-union (22–35%) and a risk of AC joint arthritis with conservative management. We report our experience with the use of hook plate fixation in unstable fractures of the lateral third of the clavicle.

Goals of Treatment Achieve bony union with minimal morbidity Minimal loss of function Minimal residual deformity

Modalities of Operative Treatment of Distal Clavicle Fractures K wires inserted into the distal fragment Dorsal plate fixation CC screw fixation Tension-band wire or suture Transfer of coracoid process to the clavicle Clavicular Hook Plate

For most techniques of clavicular fixation, coracoclavicular fixation is needed to prevent redisplacement of the medial clavicle.

Hook Plate fixation Our Objectives is to asses functional outcome ,union rate, rate of complication in lateral end clavicular fracture Neer type II.

Patient and Methods Retrospective study 21 patients with unstable fractures of the lateral end of the clavicle stabilised in EL HELAL HOSPITAL between 2005 and 2011 by the use of a hook plate. more than a 6-month follow-up after surgery. shoulder function was assessed using the Constant score , patient satisfaction with the shoulder and VAS pain score.

Preoperative assessment Surgical technique History, Physical Examination and Radiological evaluation Surgical technique supine beach-chair position full exposure of the proximal and distal fragments which are held with reduction forceps, and the clavicle is realigned. in some cases, reduction is held by using a temporary K- wire and then stabilised with the hook plate .

Postoperative : The arms were held in a sling for six weeks . Passive movements were allowed. After six weeks the sling was removed, and active mobility encouraged In all patients, the plate was not removed until at least three months in order to ensure adequate union.

Results

Follow up period (months) 1-Demographic data of the study Demographic data Number Percentage Sex Male 14 66.0% Female 7 34.0% Age(years) Mean±SD 41.0 ± 2.45 Range 22 to 62 2-Mean value and range different parameters Parameter Mean Range Hospital stay(days) 4.6 3 to 7 Follow up period (months) 26 6 to 48

3-complications: Two cases non-unions: (10%) one due to a deep infection requiring removal of the plate progressed to a painful non-union; one patient had a fracture of the clavicle due to second injury and treated conservatively. Five patients demonstrated asymptomatic acromial osteolysis on X-rays (23%)

Other statistics Plates were removed in 17 patients at an average of five months The average Constant shoulder score achieved in the fractured side was 88.5 as compared to 100 in the uninjured side. The average pain in the shoulder at rest was 1 (range 0–4), and the average pain on abduction was 2.2 (range 0–5). Patients were asked to grade their shoulder; 5 patients said it was back to normal (23%) , 15 said it was nearly normal (71%) and one said it was abnormal (4%).

Case 1 male patient 30 years old injured by falling on OSH ,the fracture was closed.

After 2 monts

After 5 months after removal of plate

Case 2 Male patient 22 years old with h/o of RTA. Closed isolated fracture of left clavicle.

Intra operative

1st day post operative

At 4 months after removal of plate

Conclusion Hook plate fixation is a useful method of treating unstable fractures of the lateral end of the clavicle. High union rates and good shoulder function are achieved . Plates need to be removed in a second operation once union is achieved in order to avoid progressive acromial osteolysis.

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