1. Conflict of interests
The speaker has the following to disclose related directly or indirectly to the subject of this presentation (period: past three years).
Companies, I worked for in the last 3 years: OKMEYDANI TRAİNİNG AND RESEARCH HOSP

2. Okmeydanı Training and Research Hospital, Istanbul, Turkey
Results of minimal invasive coracoclavicular fixation by double button lift-up system in Neer type II distal clavicle fractures
Suleyman Semih Dedeoglu, Yunus Imren, Haluk Cabuk, Murat Cakar, Samet Murat Arslan, and Cem Zeki Esenyel
Okmeydanı Training and Research Hospital, Istanbul, Turkey

3. Süleyman Semih Dedeoğlu 01.06.2017 - 2033
Background
Neer Type 2 fractures – “unstable”
Deforming forces
Various fixation methods:
- K wire, screw, Knowles pin
- plate (low profile, hook)
- Tension band, anchor, CC lig. reconstruction
- Endobutton
Gold Standard ?
Süleyman Semih Dedeoğlu

4. Süleyman Semih Dedeoğlu 01.06.2017 - 2033
Purpose
Evaluate clinical and functional outcome of indirect fracture reduction performed by coracoclavicular fixation with minimal invasive double button lift-up system in Neer type IIa unstable fractures of distal clavicle.
Süleyman Semih Dedeoğlu

5. Süleyman Semih Dedeoğlu 01.06.2017 - 2033
Materials and Method
22 patients (M/F: 19/3)
Displaced Neer type IIa distal clavicle fracture
Mean age: 39 (21-60)
Dominant extremity affected in 14 cases
Traffic accident (n: 14), falls (n: 6), sports injury (n: 2)
Mean time to surgery : 5 days (3-8)
Süleyman Semih Dedeoğlu

6. Süleyman Semih Dedeoğlu 01.06.2017 - 2033
Materials and Method
Same surgeon
Indirect reduction and osteosynthesis by coracoclavicular fixation with minimal invasive double button lift-up system (TightRope™ system, Arthrex) under fluoroscopy
Standard sling for 3 weeks, pandular exercises on postop day 1.
Active ROM and muscle strengthening at 6 weeks
X-rays, ASES and Constant scores were obtained.
Süleyman Semih Dedeoğlu

7. Surgical technique Beach chair position under fluoroscopy
Haluk Çabuk

8. Süleyman Semih Dedeoğlu 01.06.2017 - 2033
Results
Mean duration of surgery: 40 min. (30-55)
Mean union time: 14 weeks (7-21)
Mean ASES and Constant scores: 79.9 (66.9–88.3) and (71–100), respectively.
Return to daily activity: 4.5 months
20 patients had complete recovery and pain relief
at first year.
Two cases had prolonged shoulder pain
Süleyman Semih Dedeoğlu

9. Süleyman Semih Dedeoğlu 01.06.2017 - 2033
Results No
- Wound problems
- Loss of reduction
- AC joint arthrosis
- Osteolysis, impingement
- Clavicular shortening
at the end of first year.
Süleyman Semih Dedeoğlu

10. Süleyman Semih Dedeoğlu 01.06.2017 - 2033
Limitations
Results of single centre, single surgeon
Low number of cases with short term follow-up
May not be appropriate for comminuted fractures
Clear definition for the extent of the tension of the rope
Süleyman Semih Dedeoğlu

11. Süleyman Semih Dedeoğlu 01.06.2017 - 2033
Conclusions
Indirect osteosynthesis by coracoclavicular fixation with tightrope had successful clinical, radiological, and functional outcomes for treatment of unstable Neer type IIa fractures of the distal clavicle.
Probably no need for implant removal
Satisfactory cosmetic view
Süleyman Semih Dedeoğlu

12. Thank you for your attention
Haluk Çabuk