Treatment of Unstable Distal Clavicle Fractures With Multiple Steinmann Pins-A Modification of Neer's Method: A Series of 56 Consecutive Cases.

Abstract

To introduce an alternative fixation technique for Neer type II fractures using Steinmann pins (S-pins). Retrospective case series study. Operating room followed by clinic in tertiary hospital. Between 2001 and 2013, among 66 consecutive patients diagnosed with Neer type II distal clavicle fractures, 11 patients were excluded and 56 clavicles of 55 patients who underwent surgical treatment with multiple transacromial S-pins were selected for analysis. Multiple transacromial S-pin (2.0-mm diameter) fixation was performed. Interfragmentary fixation was performed with 2.7-mm screws in case of oblique fractures. Radiographic results, complications, and clinical outcomes including the Constant-Murley score, the University of California at Los Angeles Shoulder score, and the disabilities of the arm, shoulder, and hand score were evaluated. Radiologic union was achieved in all patients. Coracoclavicular distance was increased by 6.4% compared with that of the uninjured side (P < 0.001). Fourteen patients had lateral migrations of 1 pin (mean migration distance, 11.6 mm). The mean Constant-Murley score was 94.3 (range, 85-100), mean University of California at Los Angeles score was 33.1 (range, 29-35), and mean disabilities of the arm, shoulder, and hand score was 2.7 (range, 0-8.3). The average follow-up period was 30.5 months (range, 24-81 months). Good functional and radiologic results were achieved by the insertion of multiple transacromial S-pins with interfragmentary screw fixation. With its wide indication and relatively simple procedure, this technique may be a possible surgical option for the treatment of Neer type II distal clavicle fractures. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.