J Korean Fract Soc.  2014 Apr;27(2):127-135. 10.12671/jkfs.2014.27.2.127.

Tension Band Wiring for Distal Clavicle Fracture: Radiologic Analysis and Clinical Outcome

• Moon SC
• Lee CH
• Baek JH
• Cho NS
• Rhee YG

• KMID: 1703111
• DOI: http://doi.org/10.12671/jkfs.2014.27.2.127

Abstract

PURPOSE
The purpose of this study is to evaluate the radiologic and clinical outcomes after tension band wire fixation of Neer type II distal clavicle fractures.
MATERIALS AND METHODS
Twenty-six patients with Neer type II distal clavicle fractures who underwent tension band wire fixation from March 2002 to May 2011 were included in the study. Fifteen cases were classified as Neer type IIa and 11 cases as type IIb. The postoperative mean follow-up period was 14.3 months. Clinical and radiologic evaluation was performed at two weeks, six weeks, three months, six months, and 12 months postoperatively.
RESULTS
Bony union on X-rays was observed at an average of 11.7 weeks (range 8-20 weeks) postoperatively. The overall visual analogue scale score for pain was 1.23+/-2.75 postoperatively. The overall postoperative University of California at Los Angeles score increased to 33.5+/-2.15 from the preoperative score of 21.6+/-1.91 (p<0.05).
CONCLUSION
Among various methods of treatment for Neer type II distal clavicle fracture, K-wire and tension band fixation was used and relatively satisfactory radiological and clinical results were obtained. This surgical method yields excellent clinical results, owing to its relatively easy technique, fewer complications, and allowance of early rehabilitation.

Keyword

Clavicle fracture; Coracoclavicular ligament; Acromioclavicular ligament; Tension band wiring

MeSH Terms

California
Clavicle*
Follow-Up Studies
Humans
Rehabilitation

Figure

• 

  Fig. 1 (A) Neer and Rockwood classification of distal clavicle fracture IIa: both the conoid and the trapezoid ligaments remain attached to the distal fragment. (B) Neer and Rockwood classification of distal clavicle fracture IIb: medial fragment instability is a result of disruption of the conoid ligament.

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  Fig. 2 (A) Preoperative radiologic analysis. a: acromioclavicular distance (ACD), b: coracoclavicular distance (CCD), c: acromioclavicular interval (ACI). (B) Postoperative radiologic analysis. a: ACD, b: CCD, c: ACI after K-wire insertion. ACI is increased. But, CCD is decreased.

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  Fig. 3 A 47-year-old women injured by traffic accident. Type IIa. (A) The radiograph shows a type IIa distal clavicle fracture of the left shoulder. Coracoclavicular (CC) distance b increased. (B) Postoperative radiograph shows a distal clavicle fracture fixed with tension band wiring. CC distance b was decreased, acromioclavicular (AC) interval c was increased. (C) After removal of wires at postoperative one year, AC interval c was reduced as compared with immediate postoperative radiograph.

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  Fig. 4 A 24-year-old man injured by falling down. Type IIb. (A) The radiograph shows a type IIb distal clavicle fracture of the left shoulder. Coracoclavicular (CC) distance b increased. (B) Postoperative radiograph shows a distal clavicle fracture fixed with tension band wiring. CC distance b was decreased, acromioclavicular (AC) interval c was increased. (C) After removal of wires at postoperative one year, AC interval c was reduced as compared with immediate postoperative radiograph.

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