J Korean Fract Soc.  2012 Jan;25(1):38-45. 10.12671/jkfs.2012.25.1.38.

Complications of Hook-Plate Fixation for Distal Clavicle Fractures

• An SH
• Kim HC
• Kim KY
• Lee JH
• Yoon SH

• KMID: 1434109
• DOI: http://doi.org/10.12671/jkfs.2012.25.1.38

Abstract

PURPOSE
To report on the complications of hook-plate fixation for distal clavicle fractures.
MATERIALS AND METHODS
Eighteen patients who underwent surgery for distal clavicle fracture with a hook-plate from April 2008 to April 2011 were enrolled with a minimum of 4 months follow-up. The reduction was qualified and evaluated according to the radiologic findings. We analyzed the results by UCLA score, Kona's functional evaluation, and VAS pain score.
RESULTS
By radiologic evaluation, 17 of 18 cases showed anatomical reduction and solid unions. Although satisfactory results were found in the clinical study as shown by the UCLA score, Kona's functional evaluation, and VAS pain score, complications arose in 7 cases, including osteolysis of the acromion in 2 cases, nonunion in 1 case, periprosthetic fracture in 2 cases, subacromial pain in 1 case, and skin irritation in 1 case. 2 cases of all required reoperation.
CONCLUSION
To reduce the complications of the hook-plate, a precise surgical technique and the choice of an appropriate size for the hook-plate are needed. We suggest that early removal of the plate is necessary to decrease the risk of subacromial impingement and erosion in hook-plate fixation.

Keyword

Clavicle; Distal clavicle fracture; Hook plate; Complication

MeSH Terms

Acromion
Clavicle
Follow-Up Studies
Humans
Osteolysis
Periprosthetic Fractures
Skin

Figure

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  Fig. 1 Radiograhs of 52-year-old male. (A) Postoperative radiograph of the right shoulder shows Neer type II distal clavicle fracture. (B) At 2 months follow-up, the radiograph shows osteo-lysis of acromion by the Hook plate. (C) At 4 month follow-up, Hook plate was removed.

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  Fig. 2 The hook of Hook plate can be bent to fit the clavicle anatomy. Bending is required to fit the curve of the acromoclavicular joint, that maximized the area of contact surface with hook of the Hook plate.

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  Fig. 3 Radiographs of 45-year-old female. (A) Preoperative radiograph shows left distal clavicle fracture. (B) Postoperative radiograph. The fracture was reduced and fixed with Hook plate. But the locking screw was being fracture site. (C) At. POD 7 months follow-up, the radiographs shows proximal screw loosening & plate migration, but seen no bony union. (D) At POD 10 months Hook plate was removed, internal fixation and bone graft was done. (E) At POD 14 month follow-up, the union of fracture was deteched, eventually.

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  Fig. 4 Radiographs of 62-year-old female. (A) Preoperative radiograph of the left shoulder shows neer type II distal clavicle fracture. (B) Postoperative radiograph. Satisfactory reduction and Hook plate fixation were seen. (C) At POD 4 weeks follow-up, postoperative radiograph shows clavicle shaft fracture. (D) At 6 months follow-up, bony union was achieved without any complications.

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