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New system offers a minimally invasive method to repair distal clavicle fractures
Surgeons have success using a system which is intended for for stabilization of ankle fractures.
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SAN DIEGO — Researchers have determined a fixation system designed for ankle fractures to be a safe and reproducible method of reducing and stabilizing the distal clavicle after a fracture or dislocation.
The findings were presented by Duncan Tennent, FRCS, at the 28th Annual Meeting of the Arthroscopy Association of North America, here. Tennent’s study aimed to determine the efficacy of the Tightrope Syndesmosis Repair System (Arthrex), which had been adapted to be used arthroscopically. The result, the study claims, is minimally invasive but still provides stabilization and accurate reduction.
“It is a simple technique, if you are comfortable with arthroscopy,” Tennent said. “It is safe. It is cosmetically attractive for patients. It can be done open or arthroscopically. We have demonstrated that the results are stable at the time.”
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Parameters and findings
The study was a prospective cohort series of 19 consecutive patients with an acute grade 4 or 5 acromioclavicular joint (ACJ) dislocation or distal clavicle fracture that was stabilized arthroscopically using the Tightrope system. Review was conducted at a mean of 2 years by an independent observer. Outcome measures in the study included DASH, ASES, Constant and Walch ACJ scores, as well as radiographic review with AP and axial X-rays.
According to the study, the mean ASES score was 95.6, Constant mean scores were 94, DASH mean scores were 2.5 and Walch mean scores were 17.5.
Two female patients requested the clavicle button be removed, as it was palpable and causing them discomfort. Two patients demonstrated a slight loss of ACJ position on an AP X-ray — equivalent to a grade 2 subluxation — but the study reported that this was not clinically noticeable.
Invasiveness is important
Tennent said the results were satisfactory even though the patients had only undergone a minimally invasive procedure. The study labels this as clinically relevant, citing that traditional techniques typically required a bra-strap incision and also often required late removal of the instrumentation.
Moderator Alan S. Curtis, MD, praised the study and had questions.
“You mentioned the chronic patient,” Curtis asked. “What modifications have you made when using this type of fixation for that individual?”
Tennent said one of the most important aspects to ensure the success of the technique is to use it relatively soon after surgery. “You have to do it less than 4 weeks after injury,” he said. “After that, it will start to get some form of healing and [the technique] will fail. We have gone ahead and started to stretch the indications. I have gotten some failures when I went in too late.”
For more information:
- Alan S. Curtis, MD, is Chairman of the annual Boston Shoulder and Sports course with Boston Sports & Shoulder Center. He can be reached at 830 Boylston St., Ste. 107, Chestnut Hill, MA 02467; 617-264-1100; e-mail: bsscurtis@aol.com.
- Duncan Tennent, FRCS, is a physician at St. George’s Shoulder Unit at St. George’s Hospital in London. He can be reached at St. George’s Shoulder Unit, St. George’s Hospital, Blackshaw Road, Tooting, London SW17 0QT; 020 8725 2032; e-mail: duncan@tennent.net. He receives royalties from Arthrex.
Reference:
- Tennent D. Arthroscopy stabilization of acute distal clavicle fractures and dislocations using Tightrope. Paper # SS-16. Presented at the 28th Annual Meeting of the Arthroscopy Association of North America. April 30-May 3. San Diego.