A comparison of 3 fixation strategies in the treatment of neer type IIB distal clavicle fractures

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Objectives:To compare the stability of NT2B clavicle fractures fixed with either a hook plating (HP), Superior Plating with Suture Augmentation (SPSA), or dual orthogonal plating (DP) with the hypothesis that DP would provide increased multiplanar stability across NT2B fractures.Methods:NT2B distal clavicle fractures were created in cadaveric specimens and fixed using (1) HP, (2) SPSA, or (3) DP. Specimens were cyclically loaded in 3 different planes of motion: (1) anteroposterior (AP), (2) superior-inferior, and (3) axial rotation while displacement was continually recorded. Afterward, a superiorly directed load was applied to the clavicle. Load to failure, stiffness, and mode of failure were recorded.Results:During AP loading, clavicles fixed with a DP had significantly lower mean posterior displacement compared to those fixed with SPSA at every 100-cycle interval of testing, P < 0.01. During inferior-superior loading, specimens fixed with a DP had less superior displacement than specimens fixed with an HP and SPSA, reaching significance at the 500-700 cycles of testing. There was no significant difference in axial rotation stability or load to failure between the 3 fixation techniques.Conclusions:Orthogonally placed minifragment plates provide improved stability against anterior displacement with no significant difference in superior stability, axial rotational stability, stiffness, or load to failure. Further clinical studies are needed to confirm the long-term stability of dual plating and determine the risks and benefits of this novel method of distal clavicle fixation.

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