Background: Nonunion frequently follows distal clavicle fracture. Tradition
al pinning methods using the through acromioclavicular articulation may res
ult in osteoarthritic changes or ankylosis. This study introduces a direct
pinning technique in which the acromioclavicular joint is spared.
Methods: Twelve patients with displaced distal clavicle fractures received
open reduction and fixation with Kirschner wires (K-wires) and tension-band
wires, from May 1996 to March 1997. The indication for surgery was type Il
a fracture or fracture with displacement. Unrestricted passive and active r
ange of motion was performed as soon as possible after the operation. Stret
ching and exertional exercises were permitted after radiographs showed an o
sseous union and after the implants were removed.
Results: Eleven patients achieved osseous union with painless full motion.
Union time ranged from 3 to 6 months. One patient suffered from more commin
uted fracture because of a fall 2 months after operation. This patient rece
ived a revision surgery with distal clavicle resection and coracoclavicle r
econstruction. Symptomless ossification around the coracoclavicle ligament
was noted on radiographs in one patient. The ossification did not progress
after the 9-month follow-up.
Conclusion. Edwards reported a rate of 45% delayed union and 30% nonunion i
n type II fractures. Several techniques had been described in the relevant
literature. In our practice, fixation with Kirschner wires and tension-band
wires has been successful in the treatment for displaced distal clavicle f