THERAPY AND RESULTS FOR LATERAL CLAVICULA R FRACTURES

Fractures of the distal third of the clavicle tend to develop delayed union or nonunion when treated conservatively. Correct diagnosis of fr acture instability and/or associated lesions of the ligamentous struct ures of the acromioclavicular joint is mandatory for adequate fracture treatment. When classical radiographs fail to demonstrate instability stress roentgenographs of both shoulders are indicated. From 1985 to 1994, 66 adult patients with a fracture of the distal clavicle were tr eated at our institution. Fracture classification was performed accord ing to Jager/Breitner. Fractures were unstable in 36 cases (54.5%). An associated lesion of the acromioclavicular joint was present in 8 pat ients presenting with an unstable fracture. Fracture instability was d ue to an associated fracture of the coracoid process in two cases. Sta ble fractures were treated conservatively. Thirty-three unstable fract ures were treated surgically. Plate fixation was performed when at lea st three screws could be placed in the distal fragment. When the dista l fragment was small or associated with acromioclavicular joint involv ement, it was stabilized by PDS banding of the clavicle to the coracoi d process and reconstruction of the ligaments. Results were evaluated retrospectively by questionnaire, clinically and by radiological exami nation. Fifty patients (76%) were reexamined, The outcome was good or excellent in 96% of unstable fractures that had been treated surgicall y. Results after conservative treatment of unstable fractures (n=3) we re poor. Conservative treatment of stable fractures resulted in all ca ses in a good-to-excellent result. For fractures of the distal clavicl e, good results can be achieved when the instability is recognized and adequately treated. The association of a distal clavicular fracture a nd an acromioclavicular ligament disruption should be added as a separ ate subtype in the existing classification of distal clavicular fractu res. PDS banding is a valuable alternative for fractures with small pe ripheral fragment or associated acromioclavicular disruption.