To identify the prevalence of concomitant glenohumeral injuries in surgically treated Neer type II distal clavicle fractures and relate its clinical importance.
Between 11/2011 and 11/2015 41 patients, suffering from a displaced and unstable distal clavicle fracture were included. 20 patients (group 1) received surgical treatment by means of plate osteosynthesis in combination with an arthroscopically assisted coraco-clavicular ligament augmentation. In group 2 (n = 21 patients) the fracture was treated by hooked plating solely, and diagnostic arthroscopy was conducted during hardware retrieval after the fracture had healed. All arthroscopies were performed in a standardized fashion, images were blinded retrospectively, and evaluated by two independent investigators.
In total, concomitant glenohumeral pathologies were found in 26.8% of cases (41 patients, mean age 43.6 ± 16.6 years). In Group 1 (n = 20, arthroscopically assisted fracture treatment) the prevalence was 25%, in Group 2 (n = 21, diagnostic arthroscopy during implant removal) 28.5% (p = 0.75). Concomitant glenohumeral injuries included Labrum- and SLAP-tears, partial and full thickness rotator cuff tears as well as lesions to the biceps pulley system. Concomitant injuries were addressed in 2 patients of group 1 (10%, 2× labrum repair) and in 3 patients of group 2 (14.3%, of Group 2 (2× arthroscopic cuff repair of full thickness tear, 1× subpectoral biceps tenodesis in an type IV SLAP lesion, p = 0.68).
The present study could clarify the acute and for the first time mid-term implication and clinical relevance of concomitant glenohumeral injuries. They have been observed in averaged 27% of Neer type II distal clavicle fractures at these two times. However, the findings of this study show that not all concomitant lesions remain symptomatic. While lesions are still present after fracture healing, it’s treatment may be depicted upon symptoms at the time of implant removal. In turn, early diagnosis and treatment of concomitant injuries seems reasonable, as untreated injuries can remain symptomatic for more than 6 months after the fracture and recovery may be delayed.
Neer CS 2nd. Fractures of the distal third of the clavicle. Clin Orthop Relat Res. 1968;58:43–50. PubMed
Beirer M, Zyskowski M, Cronlein M, Pforringer D, Schmitt-Sody M, Sandmann G, Huber-Wagner S, Biberthaler P, Kirchhoff C. Concomitant intra-articular glenohumeral injuries in displaced fractures of the lateral clavicle. Knee Surg Sports Traumatol Arthrosc. 2015;5(10):3237–41.
Biz C, Berizzi A, Cappellari A, Crimì A, Tamburin S, Iacobellis C. The treatment of acute Rockwood type III acromio-clavicular joint dislocations by two different surgical techniques. Acta Biomed. 2015;86(3):251–9. PubMed
Bayne O. BJL-trosrof-trctIBJ. In: Welsh R, editor. Surgery of the shoulder. Philadelphia: CV Mosby. 1994; p. 167–71.
Ellman H. Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res. 1990;254:64–74.
Fox JANMA, Romeo AA. Arthroscopic subscapularis repair. Tech Should Elbow Surg. 2003;4:154–68. CrossRef
O'Donnell TM, McKenna JV, Kenny P, Keogh P, O'Flanagan SJ. Concomitant injuries to the ipsilateral shoulder in patients with a fracture of the diaphysis of the humerus. J Bone Joint Surg B. 2008;90(1):61–5. CrossRef
- Concomitant glenohumeral injuries in Neer type II distal clavicle fractures
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
Mail Icon II