ObjectiveTo investigate the effectiveness of anatomical locking plate internal fixation combined with coracoclavicular ligament reconstruction in treatment of the Neer type Ⅱb distal clavicle fractures by comparing with the simple anatomical locking plate internal fixation.MethodsThe clinical data of 40 patients with Neer type Ⅱb distal clavicle fractures who met the criteria between February 2013 and January 2017 were analyzed. Eighteen cases were treated with anatomical locking plate internal fixation and coracoclavicular ligament reconstruction by using a suture anchor (reconstruction group), and 22 cases were treated only with anatomical locking plate internal fixation (non-reconstruction group). There was no significant difference in gender, age, injured side, causes of injury, associated injuries, time from injury to operation between 2 groups (P>0.05). The operation time, medical expense, postoperative coracoclavicular distance, Constant-Murley scores of injured side, and complications were recorded and compared between 2 groups.ResultsAll patients were followed up 12-27 months (mean, 16.3 months). One patient in reconstruction group had superficial wound infection. One patient in non-reconstruction group had pullout of screws from the distal fragment and reduction loss at 1 month postoperatively. The operation time and medical expense in reconstruction group significantly increased when compared with those in non-reconstruction group (P<0.05). All fractures in 2 groups achieved bony union at last follow-up. The rate of coracoclavicular distance increase of injured side in non-reconstruction group was significantly higher than that in reconstruction group (t=2.371, P=0.023). The Constant-Murley scores at 1 month, 3 months after operation, and last follow-up were significantly improved when compared with preoperative values in 2 groups (P<0.05), but no significant difference was observed between 2 groups (P>0.05).ConclusionBoth anatomical locking plate internal fixation with and without coracoclavicular ligament reconstruction can achieve good effectiveness for the Neer type Ⅱb distal clavicle fractures. Therefore, the coracoclavicular ligament reconstruction is not necessary, except for comminuted fractures with the length of lateral fragment less than 1 cm or the patients with poor compliance.
Objective To investigate the necessity of coracoclavicular ligament reconstruction in the treatment of unstable distal clavicular fracture with locking plate. Methods We searched PubMed, the Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang database and VIP database for all the articles about the treatment of unstable distal clavicular fractures using locking plate combined with coracoclavicular ligament reconstruction or locking plate alone from the establishment of databases to November 30th, 2022. According to the inclusion and exclusion criteria, we selected the documents that met the requirements of this paper, and extracted the effective data after evaluating the quality of the documents, including the Constant-Murley score, coracoclavicular distance, fracture healing time, complication rate, operative time, intraoperative blood loss, incision length and the Visual Analogue Scale score of postoperative pain. RevMan 5.4 software was used for meta-analysis. Results A total of 11 retrospective cohort studies were included, and the overall quality of the literature was high. A total of 421 cases were included in this study, including 209 cases in the locking plate combined with coracoclavicular ligament reconstruction group and 212 cases in the locking plate group. The results of meta-analysis showed that locking plate combined with coracoclavicular ligament reconstruction in the treatment of unstable distal clavicular fractures was superior to locking plate alone in the Constant-Murley score [mean difference (MD)=7.35, 95% confidence interval (CI) (2.84, 11.87), P=0.001], coracoclavicular distance [MD=–1.22 mm, 95%CI (–1.92, –0.53) mm, P=0.0006], fracture healing time [MD=–2.76 weeks, 95%CI (–4.74, –0.79) weeks, P=0.006] and complication rate [odds ratio=0.31, 95%CI (0.14, 0.68), P=0.004], but the former had longer operative time [MD=9.27 min, 95%CI (4.53, 14.01) min, P=0.0001]. There was no significant difference in the intraoperative blood loss [MD=3.31 mL, 95%CI (–17.01, 23.63) mL, P=0.75], incision length [MD=0.30 cm, 95%CI (–0.11, 0.71) cm, P=0.15], or Visual Analogue Scale score of postoperative pain [MD=–0.26, 95%CI (–0.79, 0.27), P=0.33]. Conclusions Although the reconstruction of the coracoclavicular ligament increases the time of surgery, locking plate combined with coracoclavicular ligament reconstruction in the treatment of unstable distal clavicular fractures is significantly better than locking plate alone in terms of reduction quality, shoulder function recovery, fracture healing time, and the incidence of complications, without significant intraoperative bleeding, prolonged incision or postoperative pain.