• Alexander Pieringer, JoEllen Welter, Janic Fischer, and Florian Hess.
• Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland.
• Arch Orthop Trauma Surg. 2023 Aug 1; 143 (8): 492549314925-4931.

PurposeLateral clavicle fractures are unstable and prone to nonunions, which is why they are often treated surgically rather than conservatively. Despite the variety of surgical techniques found in the literature, the best method for treating this rare fracture type has not yet been determined. Our case series aimed to describe a coracoclavicular (CC) reconstruction technique and to assess complications and patient outcomes 1 year postoperatively.MethodsNineteen patients who underwent surgery for an unstable lateral clavicle fracture (IIB, IIC, IID) with a suture button device (Dog Bone, Arthrex, Inc., Naples, FL, USA) were available for clinical and radiological follow-up. The assessments included the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) score, the Constant Score (CS), the Subjective Shoulder Value (SSV), as well as the ipsilateral and contralateral coracoclavicular distance.ResultsThe median age was 50 years (IQR 28-59), 13 (68.4%) were male and the delay to surgery was 5 days (IQR 2-9). The median clinical scores were 100 (ASES), 91 (CS), and 95 (SSV). The CC distance improved postoperatively (p = 0.003). However, nonunion occurred in 3 (15.8%) patients, 5 (26.3%) had other complications, and 5 (26.3%) needed revision surgery (4 plate removals and 1 pseudoarthrosis). The overall complication rate was 36.8%.ConclusionRestoring the CC ligaments alone could not reliably achieve fracture stability, with more than one-third of cases in this series experiencing major complications. Given the high revision and nonunion rates, we do not recommend this type of surgical technique.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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