• Jaron R Andersen, Matt P Willis, Ryan Nelson, and Mark A Mighell.
• Florida Orthopaedic Institute, 13020 Telecom Parkway N, Temple Terrace, FL 33637, USA.
• Clin. Orthop. Relat. Res. 2011 Dec 1;469(12):3344-50.

BackgroundThe ideal management of fractures of the distal third of the clavicle remains a topic of debate. Locked plating is a new treatment method but is not yet widely studied.Questions/PurposesWe therefore determined union rates, function, and complications treated with locked plating.Patients And MethodsWe retrospectively reviewed 20 patients with Neer Type II distal clavicle fractures. All patients were treated with superior locked plating augmented with suture cerclage or screw fixation into the coracoid when there were concerns with screw purchase in the lateral fragment. Union was assessed radiographically and function was reported in terms of American Shoulder and Elbow Surgeons (ASES) scores and motion. Sixteen of 20 patients were followed for a minimum of 1 year; four of the patients with less than 1 year followup were included only for reporting of complications. The 16 patients were followed a minimum of 12 months (average, 30.7 months; range, 13-87 months).ResultsUnion occurred in 15 of 16 (94%) patients. Average forward elevation and external rotation were 165.6° (range, 115°-180°) and 58.8° (range, 20°-90°), respectively. The average ASES score at the most recent followup was 79.0 (range, 33.3-100). Complications occurred in two patients. One patient developed an infected nonunion and a second patient sustained a peri-implant fracture.ConclusionsAcute unstable distal clavicle fractures can be treated with superior locking plates with union rates, ASES scores, and ROM that are comparable to similar studies in the literature. The treatment method described allows supplemental fixation such as suture augmentation or a coracoclavicular screw.Level Of EvidenceLevel IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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