Analysis of the efficacy of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicle fractures with coracoclavicular ligament injuries
Authors: Liu Bin , Shi Lei , Ma Huifang , Jiang Jishi , Yu Haiyang 
Published: October 2024

Objective To investigate the efficacy of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicular fractures with coracoclavicular ligament injuries.Methods A retrospective analysis was performed on 43 patients with distal clavicular fractures accompanied by coracoclavicular ligament injuries, who were treated with an Endobutton plate between January 2017 and December 2023. The fracture sites were categorized based on the fixation method employed: high-strength suture Nice knot fixation (experimental group, n = 23) and acromioclavicular Kirschner wire fixation (control group, n = 20). No significant differences were observed in general demographic data, including age, gender, injury etiology, Craig classification, hospitalization duration, visual analog scale (VAS) scores, American Shoulder and Elbow Surgeons (ASES) Scores, and Constant-Murley scores between the two groups (P > 0.05). In addition to tracking postoperative fracture problems and healing, the injured side's increased coracoclavicular space rate was computed. Utilizing the VAS, determine the affected shoulder's pain threshold. to compare the ASES and Constant-Murley ratings for the shoulder joint before and after surgery.Results Both patient groups successfully underwent surgery without any significant complications, such as vessel or nerve injury or coracoid fracture. Postoperatively, the control group experienced one case of mild screw tract infection and one case of Kirschner wire displacement. Conversely, the experimental group did not report any significant complications. Both groups were followed up for a period ranging from 12 to 33 months, with an average follow-up duration of (20.53 ± 5.16) months. The fractures in both groups healed, with healing times of (12.82 ± 1.12) weeks and (17.25 ± 1.71) weeks, respectively. This difference was statistically significant (P < 0.05). At the final follow-up, the coracoclavicular space expansion rate was (9.25 ± 2.53) % in the experimental group and (8.10 ± 2.53) % in the control group, with no significant difference observed (P > 0.05). Both groups demonstrated significant improvements in VAS scores, Constant-Murley scores, and ASES scores post-operatively compared to pre-operative values (P < 0.05). The Constant-Murley score and ASES score at one-month post-operation were significantly superior in the experimental group than in the control group, indicating a statistically significant difference (P < 0.05). However, no statistical difference was observed at three months post-operation or during the final follow-up (P > 0.05).Conclusion In the management of distal clavicle fractures accompanied by coracoclavicular ligament injuries, particularly oblique fractures or those with butterfly-shaped fragments, the application of a high-strength Nice knot suture in conjunction with Endobutton plate fixation can effectively stabilize the fracture site. This approach not only mitigates complications associated with Kirschner wire fixation but also enhances fracture healing, leading to favorable postoperative outcomes.