Treatment for Displaced Medial-End Clavicle Fractures with hook plate: A Retrospective Study

AbstractObjective:To retrospectively evaluate the radiological and clinical efficiency of internal fixation using CanSHS-hook plate for treatment of unstable displaced medial-end clavicle fractures.Methods:From July 2014 to August 2019, 11 patients who underwent open reduction and internal CanSHS-hook plate fixation for medial-end clavicle fractures were included in the present study. There were 9 male and 2 female patients, with the average age of 35.5±11.3 years (aging from 22 to 58 years old). All the patients received routine x-rays and computed tomogra­phy examinations to evaluate the fractures before CanSHS-hook plate fixation. During the operation, a standard anterior approach across the sternoclavicular joint to the clavicle was made. After the reduction, the fracture was fixed by CanSHS-hook plate provided by Canwell Corporation under a series of operation procedures. Postoperative follow-up including physical examination and x-ray evaluation was performed in order to evaluate both the radiological and clinical efficiency of the treatment. Exercises were introduced to patients after initial postoperative immobilization. Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires were used to evaluate the shoulder function postoperatively. Complications of any patients were noted to evaluate the disadvantages of the hook plate.Results:All patients were followed up, with the average follow up period of 14.0±3.3 months (8-20 months). All the 11 cases were unilateral injuries. None of them were pathological fractures or open fractures. No intraoperative complications occurred during the operation. The mean DASH scores were 36.9±17.8, 11.7±5.4, and 7.6±5.0 at 1 month, 3 months postoperatively and the final follow up. There were no neurovascular injuries, mal-union or internal fixation failures. No wound hematoma or infection was obtained during follow up. All the fractures got bony union at the final follow up. The average time of bone union was 13.2±2.7 weeks (10-20 weeks). Postoperative complications included 2 patients complained of implant related discomfort during shoulder motion which disappeared after implant removal, and one delayed union which was healed after electromagnetic stimulation and oral administration of traditional Chinese Medicine. All patients were satisfied with their treatment outcome at the final follow-up.Conclusions:Although the procedures of planting the CanSHS-hook plate were more complicated than other implants, the fixation of hook plate seemed to be an effective and relatively safe method for patients with medial end clavicle fractures. We recommend this CanSHS-hook plate for tiny and/or comminuted medial end segments because its unique design.