Seong Cheol Moon; Chul Hee Lee; Jong Hoon Baek; Nam Su Cho; Yong Girl Rhee

doi:10.12671/jkfs.2014.27.2.127

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Tension Band Wiring for Distal Clavicle Fracture: Radiologic Analysis and Clinical Outcome: Seong Cheol Moon, M.D., Chul Hee Lee, M.D., Jong Hoon Baek, M.D., Nam Su Cho, M.D., Yong Girl Rhee, M.D.; Journal of the Korean Fracture Society 2014;27(2):127-135.
DOI: https://doi.org/10.12671/jkfs.2014.27.2.127
Published online: April 18, 2014

Department of Orthopaedic Surgery, Kyung Hee University Medical Center, Seoul, Korea.

Address reprint requests to: Yong Girl Rhee, M.D. Department of Orthopaedic Surgery, Kyung Hee University Medical Center, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-872, Korea. Tel: 82-2-958-8360, Fax: 82-2-964-3865, shoulderrhee@hanmail.com

• Received: June 7, 2013 • Revised: September 5, 2013 • Accepted: January 18, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
NOTES
REFERENCES

Abstract

Purpose
The purpose of this study is to evaluate the radiologic and clinical outcomes after tension band wire fixation of Neer type II distal clavicle fractures.
Materials and Methods
Twenty-six patients with Neer type II distal clavicle fractures who underwent tension band wire fixation from March 2002 to May 2011 were included in the study. Fifteen cases were classified as Neer type IIa and 11 cases as type IIb. The postoperative mean follow-up period was 14.3 months. Clinical and radiologic evaluation was performed at two weeks, six weeks, three months, six months, and 12 months postoperatively.
Results
Bony union on X-rays was observed at an average of 11.7 weeks (range 8-20 weeks) postoperatively. The overall visual analogue scale score for pain was 1.23±2.75 postoperatively. The overall postoperative University of California at Los Angeles score increased to 33.5±2.15 from the preoperative score of 21.6±1.91 (p<0.05).
Conclusion
Among various methods of treatment for Neer type II distal clavicle fracture, K-wire and tension band fixation was used and relatively satisfactory radiological and clinical results were obtained. This surgical method yields excellent clinical results, owing to its relatively easy technique, fewer complications, and allowance of early rehabilitation.
Key words: Clavicle fracture, Coracoclavicular ligament, Acromioclavicular ligament, Tension band wiring

Financial support: None.

Conflict of interest: None.

REFERENCES

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Fig. 1

(A) Neer and Rockwood classification of distal clavicle fracture IIa: both the conoid and the trapezoid ligaments remain attached to the distal fragment. (B) Neer and Rockwood classification of distal clavicle fracture IIb: medial fragment instability is a result of disruption of the conoid ligament.

Fig. 2

(A) Preoperative radiologic analysis. a: acromioclavicular distance (ACD), b: coracoclavicular distance (CCD), c: acromioclavicular interval (ACI). (B) Postoperative radiologic analysis. a: ACD, b: CCD, c: ACI after K-wire insertion. ACI is increased. But, CCD is decreased.

Fig. 3

A 47-year-old women injured by traffic accident. Type IIa. (A) The radiograph shows a type IIa distal clavicle fracture of the left shoulder. Coracoclavicular (CC) distance b increased. (B) Postoperative radiograph shows a distal clavicle fracture fixed with tension band wiring. CC distance b was decreased, acromioclavicular (AC) interval c was increased. (C) After removal of wires at postoperative one year, AC interval c was reduced as compared with immediate postoperative radiograph.

Fig. 4

A 24-year-old man injured by falling down. Type IIb. (A) The radiograph shows a type IIb distal clavicle fracture of the left shoulder. Coracoclavicular (CC) distance b increased. (B) Postoperative radiograph shows a distal clavicle fracture fixed with tension band wiring. CC distance b was decreased, acromioclavicular (AC) interval c was increased. (C) After removal of wires at postoperative one year, AC interval c was reduced as compared with immediate postoperative radiograph.

Table 1

Summary of Cases

TBW: Tension band wiring, Circum: Circumferential additional wiring.

Table 2

Radiologic Outcome of Distal Clavicle Fracture Treatment: At Base Line and at the Last Follow-Up

Values are presented as mean±standard deviation. AC: Acromioclavicular, CC: Coracoclavicular. ^*Statistically significant (p<0.05). ^†Difference between affected side and normal side.

Table 3

Preoperative Radiologic Outcome of Distal Clavicle Fracture IIa and IIb

Values are presented as mean±standard deviation. ACD: Acromioclavicular distance, CCD: Coracoclavicular distance, ACI: Acromioclavicular interval. ^*Statistically significant (p<0.05).

Table 4

Immediate Postoperative Radiologic Outcome of Distal Clavicle Fracture IIa and IIb

Values are presented as mean±standard deviation. ACD: Acromioclavicular distance, CCD: Coracoclavicular distance, ACI: Acromioclavicular interval. ^*Statistically significant (p<0.05).

Table 5

Last Follow-Up Radiologic Outcome of Distal Clavicle Fracture IIa and IIb

Values are presented as mean±standard deviation. ACD: Acromioclavicular distance, CCD: Coracoclavicular distance, ACI: Acromioclavicular interval. ^*Statistically significant (p<0.05).

Figure & Data

REFERENCES

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Clinical and Radiologic Outcomes of Acute Acromioclavicular Joint Dislocation: Comparison of Kirschner's Wire Transfixation and Locking Hook Plate Fixation
Yong Girl Rhee, Jung Gwan Park, Nam Su Cho, Wook Jae Song
Clinics in Shoulder and Elbow.2014; 17(4): 159. CrossRef

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Tension Band Wiring for Distal Clavicle Fracture: Radiologic Analysis and Clinical Outcome

J Korean Fract Soc. 2014;27(2):127-135. Published online April 30, 2014

DOI: https://doi.org/10.12671/jkfs.2014.27.2.127

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Tension Band Wiring for Distal Clavicle Fracture: Radiologic Analysis and Clinical Outcome

Fig. 1 (A) Neer and Rockwood classification of distal clavicle fracture IIa: both the conoid and the trapezoid ligaments remain attached to the distal fragment. (B) Neer and Rockwood classification of distal clavicle fracture IIb: medial fragment instability is a result of disruption of the conoid ligament.

Fig. 2 (A) Preoperative radiologic analysis. a: acromioclavicular distance (ACD), b: coracoclavicular distance (CCD), c: acromioclavicular interval (ACI). (B) Postoperative radiologic analysis. a: ACD, b: CCD, c: ACI after K-wire insertion. ACI is increased. But, CCD is decreased.

Fig. 3 A 47-year-old women injured by traffic accident. Type IIa. (A) The radiograph shows a type IIa distal clavicle fracture of the left shoulder. Coracoclavicular (CC) distance b increased. (B) Postoperative radiograph shows a distal clavicle fracture fixed with tension band wiring. CC distance b was decreased, acromioclavicular (AC) interval c was increased. (C) After removal of wires at postoperative one year, AC interval c was reduced as compared with immediate postoperative radiograph.

Fig. 4 A 24-year-old man injured by falling down. Type IIb. (A) The radiograph shows a type IIb distal clavicle fracture of the left shoulder. Coracoclavicular (CC) distance b increased. (B) Postoperative radiograph shows a distal clavicle fracture fixed with tension band wiring. CC distance b was decreased, acromioclavicular (AC) interval c was increased. (C) After removal of wires at postoperative one year, AC interval c was reduced as compared with immediate postoperative radiograph.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Tension Band Wiring for Distal Clavicle Fracture: Radiologic Analysis and Clinical Outcome

Table 1

Summary of Cases

TBW: Tension band wiring, Circum: Circumferential additional wiring.

Table 2

Radiologic Outcome of Distal Clavicle Fracture Treatment: At Base Line and at the Last Follow-Up

Values are presented as mean±standard deviation. AC: Acromioclavicular, CC: Coracoclavicular. ^*Statistically significant (p<0.05). ^†Difference between affected side and normal side.

Table 3

Preoperative Radiologic Outcome of Distal Clavicle Fracture IIa and IIb

Values are presented as mean±standard deviation. ACD: Acromioclavicular distance, CCD: Coracoclavicular distance, ACI: Acromioclavicular interval. ^*Statistically significant (p<0.05).

Table 4

Immediate Postoperative Radiologic Outcome of Distal Clavicle Fracture IIa and IIb

Values are presented as mean±standard deviation. ACD: Acromioclavicular distance, CCD: Coracoclavicular distance, ACI: Acromioclavicular interval. ^*Statistically significant (p<0.05).

Table 5

Last Follow-Up Radiologic Outcome of Distal Clavicle Fracture IIa and IIb

Values are presented as mean±standard deviation. ACD: Acromioclavicular distance, CCD: Coracoclavicular distance, ACI: Acromioclavicular interval. ^*Statistically significant (p<0.05).

Table 1 Summary of Cases

TBW: Tension band wiring, Circum: Circumferential additional wiring.

Table 2 Radiologic Outcome of Distal Clavicle Fracture Treatment: At Base Line and at the Last Follow-Up

Values are presented as mean±standard deviation. AC: Acromioclavicular, CC: Coracoclavicular. ^*Statistically significant (p<0.05). ^†Difference between affected side and normal side.

Table 3 Preoperative Radiologic Outcome of Distal Clavicle Fracture IIa and IIb

Values are presented as mean±standard deviation. ACD: Acromioclavicular distance, CCD: Coracoclavicular distance, ACI: Acromioclavicular interval. ^*Statistically significant (p<0.05).

Table 4 Immediate Postoperative Radiologic Outcome of Distal Clavicle Fracture IIa and IIb

Values are presented as mean±standard deviation. ACD: Acromioclavicular distance, CCD: Coracoclavicular distance, ACI: Acromioclavicular interval. ^*Statistically significant (p<0.05).

Table 5 Last Follow-Up Radiologic Outcome of Distal Clavicle Fracture IIa and IIb

Values are presented as mean±standard deviation. ACD: Acromioclavicular distance, CCD: Coracoclavicular distance, ACI: Acromioclavicular interval. ^*Statistically significant (p<0.05).