ARTHROSCOPIC STABILISATION OF ACUTE DISTAL CLAVICLE FRACTURES AND DISLOCATIONS USING THE TIGHTROPE SYNDESMOSIS REPAIR SYSTEM.

Abstract

Purpose of Study Disruption of the coraco-clavicular ligaments may be associated with either dislocation of the Acromioclavicular joint or fracture of the distal clavicle. If sufficient displacement occurs functional disability results. Traditional techniques have required a bra-strap incision and often require late removal of the metalwork. The Tightrope syndesmosis repair system was adapted to be used arthroscopically to reduce and hold the clavicle enabling healing of the ligaments and any associated fracture using a minimally invasive technique but ensuring accurate reduction and secure stabilisation. Between December 2004 and September 2005 20 patients with injuries to the coraco-clavicular ligaments were treated using this system. As the system was in evolution a the majority were treated arthroscopically and a few using an “open” technique. All had either the acromio-clavicular joint reduced or a distal clavicle fracture reduced and stabilised using the Tightrope Syndesmosis Repair system. The system had been modified from that commercially available for use in the ankle with the consent of the manufacturer (Arthrex, Naples, Fla).

Results All patients were evaluated at a minimum of 6 months post operatively using the DASH, ASES and Constant scores The mean ASES score was 94, the mean Constant score was 90, the mean DASH score was 5 One patient had failure of the metalwork due to malposition, this was revised successfully using the Tightrope and one had a transient adhesive capsulitis. There were no other complications and no patient required removal of the metalwork.

Conclusions The authors conclude that this new technique is a safe, simple, cosmetically acceptable and reproducible method of reducing and stabilising the distal clavicle allowing for healing of either the coraco-clavicular ligaments or the distal clavicle.