Operative management of an extra-lateral distal clavicle fracture pattern: a study of 48 patients and a proposed update to the modified Neer classification

Background The purpose of this study was to determine the efficacy of operative management for the treatment of patients with an extra-lateral distal clavicle fracture pattern. This fracture pattern is not currently included in the modified Neer classification. Methods We retrospectively reviewed 48 patients who underwent open reduction and internal fixation of an acute extra-lateral distal clavicle fracture pattern between August 2005 and March 2019. The postoperative clinical outcomes were time to union; active shoulder range of motion; scar size; patient sensation of a “normal” shoulder; and Disabilities of the Arm, Shoulder and Hand score. Results Postoperatively, all patients achieved union at an average of 7.9 weeks (range, 4-20 weeks). All patients regained full active shoulder range of motion at an average of 10.1 weeks (range, 5-44 weeks) and had a scar size of 3-4 cm; 93.8% of patients reported that their shoulder felt normal again after union. The mean Disabilities of the Arm, Shoulder and Hand score was 1.7 (range, 0-28) at 12 months postoperatively. Conclusion The patients had very good clinical outcomes following operative management of an extra-lateral distal clavicle fracture pattern. We recommend that this fracture pattern be added to the current modified Neer classification as a type IIC fracture. The purpose of this study was to determine the efficacy of operative management for the treatment of patients with an extra-lateral distal clavicle fracture pattern. This fracture pattern is not currently included in the modified Neer classification. We retrospectively reviewed 48 patients who underwent open reduction and internal fixation of an acute extra-lateral distal clavicle fracture pattern between August 2005 and March 2019. The postoperative clinical outcomes were time to union; active shoulder range of motion; scar size; patient sensation of a “normal” shoulder; and Disabilities of the Arm, Shoulder and Hand score. Postoperatively, all patients achieved union at an average of 7.9 weeks (range, 4-20 weeks). All patients regained full active shoulder range of motion at an average of 10.1 weeks (range, 5-44 weeks) and had a scar size of 3-4 cm; 93.8% of patients reported that their shoulder felt normal again after union. The mean Disabilities of the Arm, Shoulder and Hand score was 1.7 (range, 0-28) at 12 months postoperatively. The patients had very good clinical outcomes following operative management of an extra-lateral distal clavicle fracture pattern. We recommend that this fracture pattern be added to the current modified Neer classification as a type IIC fracture.