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Purpose: This multicenter, retrospective study aimed to compare clinical outcomes and complications between locking plate fixation and new coracoclavicular (CC) fixation for patients with unstable distal clavicle fracture. Methods: We included 142 patients in this TRON study. The mean follow-up was 15.5 (6–31) months. The patients were divided into two groups: the locking plate group (Group L) and CC fixation group (Group C). To adjust for baseline differences between the groups, a propensity score algorithm was used to match two groups in a 1:1 ratio. After matching, we compared operation time and the University of California Los Angeles (UCLA) shoulder score at 3 and 6 months postoperatively and at last follow-up as clinical outcomes and the rate of complications. Results: After matching, 20 cases from each group remained. Operation time was shorter in Group C (75 [22, 111] vs. 100 [38, 120] min; P = 0.023). At 3 months postoperatively, UCLA score in Group C was better, but no significant differences between the groups were found at 6 months and last follow-up after surgery. The rate of complications was not significantly different between the groups. Conclusion: CC fixation might be equivalent to locking plate fixation in clinical outcome, and the operation time is shorter than that required for locking plate fixation. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study was designed to evaluate the frequency of intraoperative complications associated with titanium locking compression plate (LCP) removal. Design: Retrospective study. Methods: Medical records were reviewed for surgical technique, plate types used, position and number of screws, time from internal fixation to plate removal, and intraoperative complications. Radiographs were reviewed to evaluate the position of the plates and screws and the accuracy of the screw direction. Mann–Whitney and Yates Chi-square tests were calculated with the level of significance at P <0.05. Results: All LCPs could be removed. Of the 342 locking head screws (LHSs), a total of 21 (6.1%) screws, 3 (2.0%) 5.0mm screws (3/153) and 18 (10.7%) 3.5mm screws (18/169), were difficult to remove. The frequency of difficulty associated with the 3.5mm LHSs was significantly higher than that of the 5.0mm LHSs (P <0.01). The frequency of difficulty associated with the removal of LHSs at the diaphysis was higher than that of LHSs at the epiphysis (P <0.01), especially with 3.5mm LHSs. The mean age was significantly lower in the patients in whom removal was difficult (P <0.05). Our analysis revealed that the frequency of removal difficulty was high when a 3.5mm LHS was inserted into the diaphysis of young patients. Conclusions: We should recognize that the removal of LCPs can involve numerous problems and great care should be exercised, especially in cases involving 3.5mm LHSs. [Copyright &y& Elsevier]