Evaluation of Modified CC Stabilization Using LARS Artificial Ligament in Unstable Distal Clavicle Fracture

Background: Unstable distal clavicle fracture is common, and there is no consensus regarding the gold standard treatment. The purpose of this study was to report a new surgical technique for the treatment of unstable distal clavicle fracture with modified coracoclavicular (CC) stabilization using a ligament augmentation and reconstruction system (LARS) artificial ligament, and to evaluate the clinical and radiographic outcomes.Patients and methods: We retrospectively reviewed 18 patients with acute unstable distal clavicle fractures (type Ⅱb) treated between January 2009 and June 2018 with modified CC stabilization using LARS artificial ligament. Indexes for evaluation included fracture healing, quality of reduction, and presence of complications (e.g., infections, nerve injuries, iatrogenic clavicle or coracoid fracture, the fixation loop failure, or loss of reduction). Shoulder function was evaluated using the Constant-Murley score.Results: Patients were assessed at a mean time of 31.8 months follow-up. All 18 patients experienced radiographic union. Follow-up radiographs showed anatomical reduction in 15 patients and slight loss of reduction in 3 patients. There were 2 cases of calcification of the CC ligament, 1 case of degenerative change around the acromioclavicular (AC) joint, and 1 case of clavicular osteolysis around screws noted during the follow-up. At the final follow-up, Constant scores were 91.2 ± 6.9.Conclusions: Treating unstable distal clavicle fractures (type Ⅱb) with modified CC stabilization using LARS artificial ligament resulted in a high union rate, satisfactory fracture reduction, a low complication rate, and excellent shoulder function. We consider this simple surgical technique that naturally restores stability to the distal clavicle fracture is an efficient method for treating the fracture.