Unstable distal clavicle fractures: Outcomes of internal fixation of clavicle and coracoclavicular stabilization

Background This study evaluates outcomes following internal fixation of unstable distal clavicle fractures (DCFs) with or without coracoclavicular (CC) stabilization. Methods A retrospective review was conducted for patients who underwent open repair of unstable DCFs at a single institution from 2017 to 2024. Fixation techniques included locking plate alone (P) or plate with CC stabilization [transcoracoid suture button (P + B), coracoid anchor (P + A)]. Collected variables included demographics, clinical details, patient-reported outcome measurement information system (PROMIS) scores, American Shoulder and Elbow Surgeons (ASES) scores, and Visual Analog Scale (VAS) Pain. Results Seventeen patients with DCFs (17 shoulders;11 males, 6 females; mean age 45 [23–78] years) were followed for an average of 32.0 (3.4–69.3) months. Fixation groups included P (6), P + B (8), and P + A (3). Neer types included IIA (4), IIB (6), and V (7). Mean outcome scores were PROMIS upper extremity 49.2 ± 10.5, pain interference 47.0 ± 7.2, pain intensity 39.3 ± 7.0, ASES 89.3 ± 14.3, and VAS 1.5 ± 2.2. Three patients (18%) experienced postoperative issues: plate prominence (2) and shoulder stiffness (1); none required reoperation. Discussion The addition of CC stabilization to locking plate fixation in high-risk unstable DCFs results in favorable outcomes and predictable healing rates. Level of evidence IV, case series.