Work

A biomechanical comparison of hook plate vs. superolateral locking plate with coracoclavicular suture fixation for distal third clavicle fractures with coracoclavicular ligament disruption

Year: 2025

Type: article

Abstract: Background Unstable distal third clavicle fractures involving coracoclavicular ligament disruption are prone to nonunion and often require surgical fixation. While hook plates and superior lateral locking plates with coracoclavicular suture augmentation are both commonly used, biomechanical comparisons are limited. Methods Eighteen fresh-frozen adult cadaveric shoulders (nine contralateral matched pairs) were randomized to receive either hook plates or superior locked plates with coracoclavicular suture fixation constructs after simulated Neer type IIb distal clavicle fractures. Constructs were cyclically loaded at 70 N for 500 cycles, followed by load-to-failure testing. Displacement and failure modes were recorded and statistically analyzed using paired t-tests (p < 0.05). Results At 50 N and 70 N, superior locked plates with coracoclavicular suture fixation demonstrated significantly less displacement than hook plates (p < 0.05) across all measured cycles. Comparisons were made using a paired t-test. Mean displacement at 70 N, cycle 500 was 5.5 mm (hook plates) versus 3.0 mm (superior locked plates with coracoclavicular suture fixation). Superior locked plates with coracoclavicular suture fixation constructs also had significantly higher load to failure (364.8 N versus 281.9 N, p < 0.05). Failure modes differed. Hook plates typically failed by hook bending and screw pullout, while superior locked plates with coracoclavicular suture fixation failed primarily via suture rupture or anchor pullout. Conclusions Superior locked plates with coracoclavicular suture fixation constructs provide superior biomechanical stability compared to hook plates in Neer type IIb fractures, with less displacement and greater failure strength under load. These results support the clinical use of superior locked plates with coracoclavicular suture fixation as a robust alternative to traditional hook plating.

Source: JSES Reviews Reports and Techniques

DOI: 10.1016/j.xrrt.2025.100645