Close treatment of acute unstable distal clavicle fractures with coracoclavicular fixation by the TightRope® system via two minimal incisions

Distal clavicular unstable fractures (Neer type IIb) with disruption of the coracoclavicular ligament can result in delayed union or non-union such that surgical intervention is required. Various surgical methods have been introduced, but no gold standard has been established. This paper introduces a mini-open technique for the treatment of distal clavicle fractures (Neer type IIb) associated with ruptured coracoclavicular ligament using the TightRope® System. With two minimal incisions, the AC TightRope Constant Guide (ACTRCG) was positioned between the top of the clavicle and the base of the coracoid process. With the help of ACTRCG, the TightRope® System was fixed between the clavicle and the coracoids, achieving coracoclavicular (CC) stabilization. CC stabilization restored the coracoclavicular space to reduce the fracture, which changed the pattern of the fracture from Neer type II to type I. Neer type I only requires conservative treatment. Therefore, repair of the torn coracoclavicular ligament or fixation of the fracture with a plate was unnecessary because the bony union was expected. From April 2014 to January 2016, 12 consecutive patients with acute, closed Neer type IIb distal clavicular fractures were treated operatively at our institution using this mini-open technique. One patient was lost to follow-up and excluded from the study. The mean follow-up time was 14.9 months (range, 8-20 months). All fractures healed without secondary procedures. The mean union time was 14.18 weeks. The mean operation time was 31.5 minutes, and mean blood loss was 5.5 ml. The mean UCLA shoulder rating score was 34.3. Ten patients had excellent results, and 1 had good results. All patients were able to resume their previous levels of activity. This technique provides a simplified way to achieve coracoclavicular stabilization to fix distal clavicle fractures. All patients were satisfied with their functional results and cosmetic appearance. The mini-open treatment is a minimally invasive surgical technique that has been proven effective for the treatment of these lesions. It can be performed quickly, is less invasive and relatively simple, and is characterized by less morbidity, less hospitalization, excellent cosmetic results, and early rehabilitation.