J Korean Fract Soc.  2016 Apr;29(2):107-113. 10.12671/jkfs.2016.29.2.107.

Usefulness of the Additional K-Wire Fixation and Suture for Reinforce the Treatment of Distal Clavicle Fracture Using Modified Tension Band Wiring

• Chae SB
• Choi CH
• Kim DY

• KMID: 2162012
• DOI: http://doi.org/10.12671/jkfs.2016.29.2.107

Abstract

PURPOSE
We attempted to evaluate the clinical results of modified tension band wiring (MTBW) with additional K-wire fixation and suture for distal clavicle fracture.
MATERIALS AND METHODS
Fifty-nine patients with a distal clavicle fracture from May 2009 to December 2013 treated with MTBW were enrolled in this study. Their fracture types were type 2, 12; and type 3, 33; type 4, 8; and type 5, 6 according to Craig classification group II; average age was 47.2 years with a mean follow-up period of 27.9 months. The operations were performed within a mean of 3.1 days a fter t rauma. The c linical results were evaluated u sing University of California at Los Angeles scores (UCLA), American Shoulder and Elbow Surgeons scores (ASES) and Korean Shoulder Society scores (KSS) at 1 year after surgery.
RESULTS
Radiographic bone union was achieved at a mean of 3.7 months after the operation. In the last observation, their range of motion was forward flexion 159.0°, external rotation 59.8°, and internal rotation 4.3 points, and there were 2 cases of nonunion. Each average functional score was UCLA 31.3 points, KSS 91.6 points, and ASES 93.0 points.
CONCLUSION
For the surgical treatment of distal clavicle fractures, MTBW with additional K-wire fixation and suture is a useful technique allowing early range of motion exercises, minimizing soft tissue damage, and preserving the acromio-clavicular joint.

Keyword

Clavicle; Distal clavicle fracture; Modified tension band wiring

MeSH Terms

California
Classification
Clavicle*
Elbow
Exercise
Follow-Up Studies
Humans
Joints
Range of Motion, Articular
Shoulder
Sutures*

Figure

• 

  Fig. 1 (A) A 46-year-old male sustained a Neer type IIb right distal clavicle fracture. (B) The fracture was reduced with modified tension band wiring. (C) The last follow-up (postoperative day 4 months) radiograph shows solid union.

• 

  Fig. 2 (A) A 16-year-old male sustained a Neer type IIb left distal clavicle fracture. (B) The fracture was reduced with modified tension band wiring (MTBW). Ahead of MTBW, K-wire fixation on the displaced bone fragment (arrow). (C) The last follow-up (postoperative day 5 months) radiograph shows solid union. (D) K-wire fixation on the displaced bone fragment (arrow), which affords additional stability maintaining reduction of the displaced fracture segment.

• 

  Fig. 3 Small bone fragment fixation with non-absorbable suture material (arrow), which affords stability of the fracture site as well as soft tissue healing.

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