An Alternative Fixation Technique for the Treatment of Comminuted Intra-Articular Distal Clavicle Fractures Using Contoured Reconstruction Bridging Plate

Background: Comminuted intra-articular distal end clavicular fractures are rare type fractures, which cannot be fixed with standard fixation methods. This work aimed to study an alternative fixation technique for the treatment of comminuted intra-articular distal clavicle fractures using the contoured reconstruction bridging plate. Methods: The prospective study was conducted from August 2017 and March 2023 on 17 patients with highly comminuted intra-articular distal end clavicular fractures (Robinson type 3B2), managed by ORIF using a contoured reconstruction plate with coracoclavicular screws augmentation through the plate, bridging the AC joint in the age group of 18 to 50 years. Functional outcomes were evaluated at the final follow-up 12 months after plate removal, which was done after the full union of the fracture, using the modified shoulder score for distal clavicle fractures. Results: Time until the achievement of radiologic union ranged from 6 to 20 weeks (mean=15.8). Postoperative complications were superficial infection in 5.88% of patients and hardware symptoms in 5.88% of patients. Satisfactory results were excellent in 58.82% of patients and good in 41.18% of patients. The mean modified shoulder score was 16.2 at the final follow-up of 12 months after plate removal. Conclusion: In comminuted intra-articular distal end clavicular fractures which are not amenable for fixation with the standard methods, we recommend using a low-profile contoured reconstruction plate bridging the AC joint, with coracoclavicular screws augmentation as an alternative method of fixation with satisfactory results to restore normal anatomy, preserve AC joint motion, and reduce arthritic changes.