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

2. 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.

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

4. 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

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

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

7. 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.

8. 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 .

9. 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.

10. Results

11. 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

12. 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%)

13. 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%).

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

17. After 2 monts

19. After 5 months after removal of plate

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

22. Intra operative

23. 1st day post operative

24. At 4 months after removal of plate

25. 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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