Arthroscopic-assisted stabilization of distal clavicle fractures with coracoclavicular ligament injury: does it restore anatomy and function?

Background
Fractures of the lateral-third clavicle are less common than the mid-shaft. However, these lateral thirds are associated with disruption of coracoclavicular (CC) ligaments requiring surgical management for optimal fracture healing and functional outcome. Many surgical techniques have been developed to manage these fractures; however, high failure rates and implant-related complications were reported. This study aims to assess the radiological and functional outcomes of arthroscopic-assisted stabilization of the distal end clavicle in terms of union rate, complications, and shoulder function.
Patients and methods
A prospective study of 32 patients with distal displaced clavicle fracture combined with CC ligament injury (Neer type IIB, V) who underwent surgery within the first 2 weeks of injury between January 2017 and February 2020. Clinical evaluation was employed postoperatively using the Constant–Murley score. The stability of the acromioclavicular joint in the horizontal and vertical planes was evaluated by the cross-arm test and manual dislocation. Radiological assessment was reviewed by an independent observer who was not a surgical team member at 1 and 2 months postoperatively.
Results
A series of 32 patients (24 men and eight women) were included. Their mean age was 36 years. Based on the radiological imaging, 20 patients had Neer type-IIB fractures, while 12 showed type-V fractures. Their average union time was 6.12 ± 1.26 weeks (ranged 5–9 weeks), with a mean Constant–Murley score that was 96.1 ± 3.76 (range, 89–100). An average of 6.62 ± 1.82 weeks was needed before returning to prior activities. There were no complications reported.
Conclusions
Arthroscopic-assisted fixation of the distal end clavicle provides excellent fixation results and restores the native anatomy by reconstructing the torn CC ligament without complications or the need for removal of the implant.