الفهرس 
ContentsOnly 14 pages are availabe for public view
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Abstract
Lateral-third clavicle fractures represent approximately 25% of all clavicle fractures. According to Neer, Lateral-third clavicle fractures are classified as : Type I lateral clavicle fracture occurs distal to the coracoclavicular ligaments. Type II injuries are characterized by a medial fragment that is separated from the coracoclavicular ligaments. Type III injuries are characterized by an intra-articular fracture of the acromioclavicular joint with intact coracoclavicular ligaments. The ideal management of the fracture of the distal third of the clavicle remains a topic of debate. Non operative treatment result in a high percentage of nonunion and delayed union rate. Several techniques have been described to treat these difficult fractures, including Kirschner wires, tension band fixation, coracoclavicular fixation with sutures or screws and plate fixation. Tension band fixation has led to many problems including k-wire migration, non union, loss of reduction and diminished shoulder function. Specially designed hook plates showed increased incidence of complications such as subacromial impingement, rotator cuff ruptures, bone resorption, acromion fractures and pain. Fracture of lateral third clavicle can be treated with open reduction and internal fixation by the distal radius volar locking compression plate and the early clinical outcomes were satisfactory. In this study, the aim of the work was to evaluate the early clinical outcome of the internal fixation of distal clavicle fracture (Neer type II) with distal radius volar locking compression plate as regard fracture union, shoulder function and complications. The inclusion criteria were patients with distal clavicle fractures, identified as type II according to Neer classification system aged 18-53 years, recent fracture within 3 weeks and no previous surgery on the shoulder. The exclusion criteria were open fracture of distal end clavicle, pre-operative shoulder lesion which interfere with shoulder function and old fracture more than 3 weeks. In this study, twenty patients (17 males and 3 females) with mean age of 35.45 years suffering from lateral third clavicle fracture Neer type II were operated using distal radius volar locking compression plate. The patients showed 100% bone union rate within average time of 1.55 month (range from one month to two months). All patients showed satisfactory shoulder function with mean oxford shoulder function score of 45.35 (range from 43 to 47 In this study, No implant failure, loss of reduction of the fracture, or skin breakdown was observed in this series. Superficial infection occurred in two cases (10% of cases) and acromioclavicular disruption in two cases (10% of cases) in which the distal fragment was small 2 cm. Surgical management of Neer type II lateral clavicle fractures using 3.5-mm distal radius volar locking compression plate results in a predictable outcome, with excellent shoulder function and a very low complication rate. This technique appears to offer significant advantages compared to other methods. However this technique requires at least 2cm distal end to be applied safely without complications. We recommend addition of k-wire through acromioclavicular joint for 3 weeks when the distal end is very small 2 cm to permit healing of acromioclavicular capsule.