Clinical efficacy of Endobutton combined with mini-plate in the treatment of Neer IIB (IIC) type distal clavicle fracture.

Abstract

Objective: This study aimed to investigate the clinical outcomes of employing Endobutton with a mini-plate for managing Neer IIB (IIC) type distal clavicle fractures.

Methods: A retrospective case-control approach was utilized, examining clinical data from 62 patients with Neer IIB (IIC) type distal clavicle fractures treated at our institution from January 2018 to December 2022. Patients were divided into 2 groups: 32 treated with an Endobutton and a mini-plate (study group) and 30 with a clavicular hook steel plate (control group). Surgical metrics such as duration, incision length, and hospital stay were documented. Follow-up assessments included fracture healing, postoperative complications, and the necessity for secondary internal fixation removal. Preoperative and postoperative coracoclavicular distances (CCD) were recorded at various intervals. Pain and shoulder joint functionality were evaluated using the Visual Analog Scale (VAS) and Constant-Murley score.

Results: All patients successfully underwent surgery and were followed up. The follow-up period for the study group was 12-23 months (18.7 ± 2.7), and for the control group, it was 12-22 months (15.8 ± 1.6). The surgery duration was significantly shorter in the control group [(65.12 ± 9.88) minutes] compared to the study group [(82.58 ± 7.36) minutes, P < 0.05]. In comparison, the incision length in the control group was longer than that in the study group [(69.58 ± 6.43) mm vs. 58.24 ± 4.83 mm, P < .05]. There were no significant di!erences in hospital stay and fracture healing time between the 2 groups (P > .05). In the control group, all patients required secondary removal of internal fixation, while in the study group, only 1 patient needed it. Complications such as subacromial bone erosion, distal clavicle osteolysis, subacromial impingement with shoulder pain, and skin irritation were observed in the control group, while only skin irritation due to thinness was noted in the study group, with statistically significant di!erences between the groups (P < .05). Postoperative CCD improved significantly in both groups. At the final follow-up, the increase in CCD was greater in the control group (1.819 ± 0.97 mm) compared to the study group (0.274 ± 0.18 mm, P < .05). The study group showed better VAS scores at 6months (1.22 ± 0.96) and the last follow-up [(1.22 ± 0.96), (0.68 ± 0.57) points] compared to the control group [(2.97 ± 0.86), (1.98 ± 0.84) points, P < .05]. The Constant-Murley functional scores were also better in the study group [(81.67 ± 5.54), (90.45 ± 3.42) points] than in the control group [(91.45 ± 3.44), (94.21 ± 1.43) points, P < .05].

Conclusion: The use of an Endobutton combined with a mini-plate for Neer IIB (IIC) type distal clavicle fractures offers significant advantages, including improved recovery of shoulder joint function, fewer postoperative complications, and reduced need for secondary internal fixation removal. This approach is a viable treatment option for Neer IIB (IIC) type distal clavicle fractures.

Level of evidence: Level III, Therapeutic study.