Dual-construct Fixation for Unstable Lateral-end Clavicle Fractures: Functional and Radiological Outcomes
Year: 2026
Type: article
Abstract: Case seriesvertical shear forces.11,12 CC suspensory fixation addresses vertical instability but has limited rotational control.13,14 This has prompted the development of combined fixations for unstable lateral end fractures.The locking plate provides axial and torsional stability, whereas the CC suspensory device provides vertical stability.Biomechanical studies have shown that this combination increases construct stiffness and load capacity compared to single techniques.[15][16][17] Clinical studies have indicated faster union and better functional outcomes with dual constructs than with locking plates alone.18,19 Given the biomechanical rationale and promising IntroductIonClavicle fractures account for approximately 2.6-4% of all fractures in adults.1,2 Most fractures occur in the midshaft; however, lateral third fractures account for up to 26% of all cases.1,3 These injuries mainly affect young males aged 15-24 years through high-energy trauma, such as road traffic accidents (RTA).1,3 Treatment strategies must ensure predictable healing and a quick return to normal activities.Lateral end clavicle fracture management depends on the fracture pattern and coracoclavicular (CC) ligament relationship, according to the Neer classification.4 Although Neer type I and III fractures are stable, types II and V are unstable because of ligamentous disruption and double disruption of the superior shoulder suspensory complex.4 The sternocleidomastoid muscle pulls the medial fragment posterosuperiorly, whereas the distal fragment is displaced inferiorly owing to the weight of the arm, increasing the risk of nonunion.The nonoperative management of unstable fractures has a high nonunion rate of 20-44%. 5,,6 Although long-term functional outcomes may be similar between the operative and nonoperative groups, the risk of nonunion remains higher in the nonoperative group (20.2%) than in the operative group (2.9%).7 This has led to primary operative fixation for displaced lateral-end clavicular fractures, particularly in young patients.Although clavicular hook plates achieve high union rates, they cause complications such as subacromial impingement and acromial osteolysis, requiring implant removal 8,9 and leading to high reoperation rates.9,10 Anatomically precontoured locking plates provide better fixation but may not adequately resist 1-4,
Institution: Christian Medical College, Vellore
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7130509366