Different Modalities in management of Fractures & Fracture Dislocations of Distal Clavicle

Abstract

Distal clavicle fractures account for 21% of all clavicle fractures and are most common among middle-aged men. The majority of the injuries are caused by traffic accidents and accidental falls. Acromio-clavicular joint dislocations encompass 9% to 12% of traumatic shoulder lesions and are more prevalent among young and active individuals, particularly athletes involved in contact sports. These dislocations are more common among patients in their third and fourth decades and in males. Stability of the lateral clavicle is provided mostly by the acromioclavicular and coracoclavicular ligaments. These ligaments have statistically been proven to enhance stability, especially the superior acromioclavicular ligament, which is responsible for the vertical stability (suspensory mechanism) of the shoulder girdle. Neer’s classification is widely used to classify the distal clavicle fractures according to their relations to the coracoclavicular ligaments. The Neer type II fractures have Chapter 7 Summary 83 received a clinical concern because of the high nonunion rate in nonsurgical treatment that have been observed (>30%). Rockwood classified ACJ dislocations into 6 grades according to the direction of the dislocation and the integrity of the acromioclavicular and coracoclavicular ligaments. Radiography is usually the first-line imaging modality used to evaluate patients with uncomplicated clavicular and acromio - clavicular joint injury. Computed tomography (CT) is not routinely used for the evaluation of simple, non-displaced clavicle fractures. MRI is extremely helpful to delineate concomitant ligamentous injury with distal clavicular fractures and aid in further subtyping these injuries. Non-union of displaced clavicular fractures can result in orthopaedic, neurovascular, and cosmetic complications. Recent studies demonstrate lower rates of non -union with surgery compared to non -operative treatment. Furthermore, patients nowadays expect improved cosmetic outcomes and earlier resumption of preoperative activity levels, leading surgeons to focus on primary surgical repair of displaced clavicular fractures. Treatment of distal clavicle fractures ranges from nonoperative to operative approaches. Various surgical procedures have been described in the literature [coraco-clavicular Chapter 7 Summary 84 stabilization, hook plate, intramedullary fixation, interfragmentary fixation, K-wire plus tension band wiring (TBW) and arthroscopic fixation] , each with potential complications. For fractures treated operatively, the goal was to maximize stability and functionality with early mobilization and low morbidity. Complications of surgical treatment of distal clavicular fractures are similar to those of midshaft clavicle fractures, including hardware-related complications, loosening and infection, delayed union and nonunion. Unique complications with the hook plate include hook migration, loosening, and osteolysis around the hook, warranting hardware removal. Just like any other joint in the body, once the acromioclavicular joint has been injured, it has tendency for arthritis and pain, with pain in the joint is the most common problem after these injuries.