Relationship between the lateral acromion angle and postoperative persistent pain of distal clavicle fracture treated with clavicle hook plate

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Abstract

Background

The clavicular hook plate is an accepted surgical procedure for distal clavicle fractures. The relationship of the characteristics of the hook plate, acromioclavicular joint and acromion morphology, and clinical outcome has remained poorly understood. We reviewed the clinical records of patients who had distal clavicle fractures with different lateral acromion angles treated using a clavicle hook plate and evaluated their clinical outcomes with respect to shoulder pain and acromial morphology.

Methods

We retrospectively reviewed 102 patients with distal clavicle fractures treated with hook plates at our institution from 2010 to 2017. They were divided into four groups according to lateral acromion angle on shoulder AP view X-rays. The angle was defined as the incline angle between the superior surface of distal clavicle and the inferior facet of acromion on coronal plane. We reviewed their clinical features, including Neer’s impingement sign, MRI findings, and outcomes using Japanese Orthopaedic Association Scores. The mean follow-up was 25.5 months (range, 24 to 28 months).

Results

All patients in group D (large lateral acromion angle (α) > 40°, acromion coronal angle (β) < 60°) complained of postoperative symptoms. Compared to those with common lateral acromion angle, the incidence of postoperative impingement in group D was undoubtedly much higher (100%). Japanese Orthopaedic Association (JOA) scores in group D were worse at 3 months post-surgery, 3 months post plate removal, and at the last follow-up despite a slightly earlier removal in this group.

Conclusion

Lateral acromion angle appears to be an important factor in the development of postoperative pain and worse outcomes (JOA scores) in patients treated with the hook plate. The incidence of subacromial impingement and rotator cuff lesion (RCL) increased with the α angle. Early limited mobility and removal of the implant may improve the prognosis and resolve the postoperative shoulder pain.

Study design

Retrospective review, level of evidence IV.

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Most cited references 28

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The incidence of fractures of the clavicle.

A Nordqvist, C J Petersson (1994)

The age- and gender-specific incidences were calculated in 2035 cases of fracture of the clavicle. The fractures were classified in three groups according to the Allman system. Each group was further divided into undisplaced and displaced fracture subgroups, with an extra subgroup of comminuted midclavicular fractures in Group I. Seventy-six percent of the fractures were classified as Allman Group I. The median age in this group was 13 years. There were significant differences in age- and gender-specific incidence between the undisplaced, displaced, and comminuted fracture subgroups. Twenty-one percent were classified as Allman Group II. The median age of the patients was 47 years, and there was no difference in age between the undisplaced and displaced fracture subgroups. Three percent were classified as Allman Group III, and the median age of the patients in this group was 59 years. All three groups were characterized by a significant preponderance of men, and there was a significant increase in the incidence of clavicular fracture, both overall and sports-related, between 1952 and 1987.

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Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion - dynamic sonographic evaluation

Hsin-Yu Lin, Poo-Kuang Wong, Wei-Pin Ho … (2014)

Background Clavicular hook plates are effective fixation devices for distal clavicle fractures and severe acromioclavicular joint dislocations. However, increasing number of studies has revealed that subacromial portion of the hook may induce acromial bony erosion, shoulder impingement, or even rotator cuff damage. By sonographic evaluation, we thus intended to determine whether the presence of hook plate may induce subacromial shoulder impingement and its relationship relative to surrounding subacromial structures. Methods We prospectively followed 40 patients with either distal clavicle fracture or acromioclavicular joint dislocation that had surgery using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate. All patients were evaluated by monthly clinical and radiographic examinations. Static and dynamic musculoskeletal sonography examinations were performed at final follow-up before implant removal. Clinical results for pain, shoulder function, and range of motion were evaluated using Constant-Murley and Disability of Arm, Shoulder, and Hand (DASH) scores. Results Clinically, 15 out of 40 patients (37.5%) presented with subacromial impingement syndrome and their functional scores were poorer than the non-impinged patients. Among them, six patients were noted to have rotator cuff lesion. Acromial erosion caused by hook pressure developed in 20 patients (50%). Conclusions We demonstrated by musculoskeletal sonography that clavicular hook plate caused subacromial shoulder impingement and rotator cuff lesion. The data also suggest an association between hardware-induced impingement and poorer functional scores. To our knowledge, the only solution is removal of the implant after bony consolidation/ligamentous healing has taken place. Thus, we advocate the removal of the implant as soon as bony union and/or ligamentous healing is achieved.

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Surgical treatment of distal clavicle fractures using the clavicular hook plate.

Kouji Yamamoto, Hiroaki Inui, Masafumi Kashii (2006)

From 1999 to 2003, 34 patients with unstable distal clavicular fractures (Neer Type 2) had surgery using the acromioclavicular titanium hook plate. To investigate the reliability of clavicular hook plate fixation and the effects of hook plates in the subacromial space, we retrospectively reviewed clinical results for pain, shoulder function, range of motion, and radiographic results. The Japanese Orthopaedic Association scores for shoulder disorders indicated good clinical results (mean, 98.3 points). All patients had radiographic bony union. Complications included plate displacement in one patient, acromion fracture caused by widening of the hook hole in one patient, and a rotator cuff tear caused by hook subacromial impingement in one patient. This plate fixation method is useful for treating unstable distal clavicular fracture. However, careful operative planning and familiarity with the technique are necessary to prevent complications including subacromial impingement, rotator cuff damage, acromion fracture, and hook cut-out. Care must be used when establishing the position of the hook hole, and it is best to remove the plate after bony union.

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Author and article information

Contributors

Jiong Jiong Guo: guojiongjiong@suda.edu.cn , drjjguo@163.com

Journal

Journal ID (nlm-ta): J Orthop Surg Res

Journal ID (iso-abbrev): J Orthop Surg Res

Title: Journal of Orthopaedic Surgery and Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1749-799X

Publication date (Electronic): 11 June 2020

Publication date PMC-release: 11 June 2020

Publication date Collection: 2020

Volume: 15

Electronic Location Identifier: 217

Affiliations

[1 ]GRID grid.429222.d, ISNI 0000 0004 1798 0228, Department of Orthopedics, , The First Affiliated Hospital of Soochow University, ; 188 Shizi St, Suzhou, 215006 China

[2 ]Department of Orthopedics, Suzhou Dushuhu Public Hospital, The First Affiliated Hospital of Soochow University Dushuhu Branch, Suzhou, China

[3 ]GRID grid.7836.a, ISNI 0000 0004 1937 1151, Orthopaedic Research Unit, Department of Orthopaedic Surgery, , Groote Schuur Hospital and Red Cross Children’s Hospital, University of Cape Town, ; Cape Town, South Africa

Article

Publisher ID: 1737

DOI: 10.1186/s13018-020-01737-z

PMC ID: 7291562

PubMed ID: 32527319

SO-VID: b0e44c1e-e3d5-446a-be1a-d598e58132d5

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 4 April 2020

Date accepted : 28 May 2020

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: distal clavicle fractures,clavicle hook plate,lateral acromion angle,distal clavicle–acromion coronal angle,subacromial impingement,rotator cuff lesion

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ScienceOpen disciplines: Surgery

Keywords: distal clavicle fractures, clavicle hook plate, lateral acromion angle, distal clavicle–acromion coronal angle, subacromial impingement, rotator cuff lesion

Relationship between the lateral acromion angle and postoperative persistent pain of distal clavicle fracture treated with clavicle hook plate

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Most cited references 28

The incidence of fractures of the clavicle.

Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion - dynamic sonographic evaluation

Surgical treatment of distal clavicle fractures using the clavicular hook plate.

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