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      Cerclaje coracoclavicular y banda de tensión con sutura en el tratamiento de fracturas del tercio externo de la clavícula tipos II y V Translated title: Coraco-clavicular loop and tension band suture in type II and type V distal-third clavicle fractures

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          Abstract

          Resumen: Se han descrito diferentes técnicas quirúrgicas para el tratamiento de las fracturas inestables del tercio distal de la clavícula. Las complicaciones asociadas y la necesidad de retirar los implantes siguen siendo motivo de preocupación. Proponemos una técnica quirúrgica que utiliza suturas de alta resistencia para restaurar la estabilidad vertical y horizontal en las fracturas del tercio distal de la clavícula de tipo II y V de la clasificación de Neer. Esta técnica se ha utilizado en tres casos; dos de tipo V y uno de tipo II. En todos se obtuvo la consolidación ósea y todos reanudaron sus actividades previas a la lesión, incluyendo actividad deportiva, a los seis meses de la cirugía. La técnica de cerclaje coracoclavicular y banda de tensión con sutura es un procedimiento sencillo que permite la estabilización vertical y horizontal de la fractura. Permite obtener buenos resultados clínicos y puede ser una alternativa coste-efectiva eficaz en el tratamiento de estas lesiones aunque se requiere una serie más larga y un seguimiento a largo plazo para evaluar adecuadamente los resultados.

          Translated abstract

          Abstract: Many surgical techniques have been used to address unstable distal third clavicle fractures. Complications and the need for hardware removal are still a concern. We propose a surgical technical using high-strength sutures to restore vertical and horizontal stability in Neer type II and Neer type V distal-third clavicle fractures. It has been used in three cases; two type V and one type II. In all cases, bone healing was achieved uneventfully and all patients resumed their pre-injury activities including sports at six-months postoperatively. The coraco-clavicular loop and tension band suture technique is a simple procedure that allows vertical and horizontal stabilization of the fracture. It achieves good clinical results and it may be a cost-effective alternative to other techniques although a longer series and long-term follow-up is required to adequately assess the results.

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          Treatment of distal clavicle fracture: a systematic review of treatment modalities in 425 fractures.

          The Neer type II distal clavicle fracture is notorious for its high nonunion rate, and surgical treatment is usually recommended. We reviewed articles from January 1990 to September 2009, and among them, 425 cases from 21 studies were included. According to the 425 cases in the literature, sixty patients were treated nonsurgically and 365 surgically. From 365 patients who were treated surgically, 105 were identified as receiving the coracoclavicular stabilization, 162 hook plate, 42 intramedullary fixation, 16 interfragmentary fixation, and 40 K-wire plus tension band wiring. The nonsurgical treatment resulted in 20 (33.3%) nonunions and 4 (6.7%) other complications. The surgical treatment resulted in 6 (1.6%) nonunions, 81 (22.2%) complications other than nonunion. The nonunion rate was significantly high with nonsurgical treatment (p < 0.001), and the complication rate was statistically high with surgery (p = 0.002). With surgical treatment, the nonunion rate was not significantly different among the modalities (p = 0.391). The complication rate was significantly higher in cases of the hook plate (40.7%) and the K-wire plus tension band wiring (20.0%) than those of the coracoclavicular stabilization (4.8%), the intramedullary (2.4%) and the interfragmentary fixation (6.3%). For the nonsurgical treatment, the functional outcomes were generally acceptable despite the high nonunion rate. The nonsurgical treatment could be considered as the first line treatment after sufficient counsel with the patient. The nonunion rate is high, however, the functional outcome is acceptable in most of the cases with nonunion. If the surgical treatment is considered, the intramedullary screw fixation, CC stabilization and interfragmentary fixation would be preferred because of their low complication rate.
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            Fixation method for treatment of unstable distal clavicle fracture: systematic review and network meta-analysis

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              A biomechanical comparison of new techniques for distal clavicular fracture repair versus locked plating

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                Author and article information

                Journal
                aom
                Acta ortopédica mexicana
                Acta ortop. mex
                Colegio Mexicano de Ortopedia y Traumatología A.C. (Ciudad de México, Ciudad de México, Mexico )
                2306-4102
                April 2021
                : 35
                : 2
                : 236-239
                Affiliations
                [1] Las Palmas de Gran Canaria orgnameHospital Universitario Insular de Gran Canaria orgdiv1Departamento de Cirugía Ortopédica y Traumatología España
                Article
                S2306-41022021000200236 S2306-4102(21)03500200236
                10.35366/101873
                31f699f8-1285-4803-b9c3-42ca307a57e2

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 21 January 2021
                : 17 May 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 7, Pages: 4
                Product

                SciELO Mexico

                Categories
                Técnica quirúrgica

                Clavícula distal,coracoclavicular,fijación sutura,tercio externo,tratamiento,Distal clavicle fracture,coracoclavicular fixation,lateral clavicle,suture technique

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