• Steven M Klein, Brian L Badman, Christopher J Keating, Dennis S Devinney, Mark A Frankle, and Mark A Mighell.
• Gundersen Lutheran Hospital, La Crosse, WI, USA.
• J Shoulder Elbow Surg. 2010 Oct 1; 19 (7): 1049-55.

HypothesisDelayed surgical treatment of unstable distal clavicle fractures is associated with a higher complication rate.Materials And MethodsBetween 1998 and 2008, a retrospective study of 38 patients (average age, 42.9 year) with Neer type II clavicular fractures was performed. Fractures were treated with a hook-plate (22 patients) or with superior locked plate with suture augmentation (16 patients). Patients were divided into acute (27 patients) or delayed (11 patients) treatment groups based on the timing of surgical intervention before or after 4 weeks. All had clinical and radiographic follow-up for 1 year or until fracture union.ResultsUnion was achieved in 36 of 38 patients (94.7%). The acute treatment group had an average American Shoulder and Elbow Surgeons score of 77.9 compared with 65.0 in the delayed group. Six complications occurred (15.8%) including 2 infections (5.3%), 1 hardware failure (2.6%), and 3 peri-implant fractures (7.9%). The complication rate was 36.4% in the delayed group vs 7.4% in the acutely treated group (P = .047).DiscussionA high rate of union was observed in all cases regardless of timing or method of fixation. Despite a high rate of union, the results of treatment in the delayed group were more problematic. Patients treated with a hook-plate in a delayed fashion had more complications than those treated in an acute fashion (P = .039). Peri-implant fractures occurred only in patients treated with hook-plates.ConclusionSurgical timing played a critical role in the outcome and complication rate in treatment of unstable distal third clavicle fractures.Copyright © 2010. Published by Mosby, Inc.

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