Management of lateral end clavicle fractures-using lateral clavicle locking plate: a prospective study


  • Nageswara Rao V. Department of Orthopaedics, G.S.L. Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India
  • Ravichandra V. Department of Orthopaedics, G.I.M.S.A.R. Medical College, Visakhapatnam, Andhra Pradesh, India
  • Lavanya K. M. Department of Community Medicine, G.S.L. Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India
  • C. Ganapathi Swamy Department of Community Medicine, G.S.L. Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India



Lateral end clavicle fractures, Unstable, Functional outcome


Background: Lateral end clavicle fractures are one of the common upper limb fractures. They constitute 21–28% of all clavicle fractures. Of these 10–52% is displaced fractures. The management of fractures of lateral end clavicle remains debated and challenging. The objectivbe of this study is to evaluate the functional outcome following surgical treatment of unstable/displaced (Neer type II lateral clavicle fractures, and acromio-clavicular joint dislocations Rockwood grade III to V) lateral end clavicle fractures using lateral clavicle locking plate.

Methods: It is a prospective study conducted in the orthopaedics department of GSL Medical College and General Hospital for a period of 3 years (April 2016 to March 2019) among a total of 60 patients.

Results: About 23 (38.3%) belonged to 41–50 years age group, followed by 16 (26.7%) to 31–40 years age group and 13 (21.7%) to >51 years age group and 8 (13.3%) to 18–30 years age group. The time from trauma to surgery ranged from 0-15 days with a mean of 5 days and the mean operating time was 41 minutes ranging between 23-70 minutes. Mean duration to union was 13.33±2.126 weeks and the mean Constant Murley score was 88.56. Functional outcome at 6 months follow up was excellent in 8 (13.3%), good in 37 (61.7%), fair in 13 (21.7%) and poor in 2 (3.3%) patients.

Conclusions: Although there is no consensus as to a “gold standard” fixation method for unstable distal clavicle fractures, satisfactory outcomes could be obtained using the lateral clavicle locking plate resulting in sufficient stabilization and good functional outcome.


Van der Meijden OA, Gaskill TR, Millett PJ. Treatment of clavicle fractures: current concepts review. J Shoulder Elbow Surg. 2012;21(3):423-9.

Toogood P, Horst P, Samagh S, Feeley BT. Clavicle fractures: a review of the literature and update on treatment. Phys Sports Med. 2011;39(3):142-50.

Allman FL. Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am.1967;49(4):774-84.

Nordquit A, Peterson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res. 1994;300:127-32.

Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br. 1998;80(3):476-84.

Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elbow Surg. 2002;11(5):452-6.

Khan LAK, Bradnock TJ, Scott C, Robinson CM. Fractures of the clavicle. J Bone Joint Surg Am. 2009;91(2):447-60.

Klein SM, Badman BL, Keating CJ, Devinney DS, Frankle MA, Mighell MA. Results of surgical treatment for unstable distalclavicular fractures. J Shoulder Elbow Surg. 2010;19(7):1049-55.

Flinkkilä T, Ristiniemi J, Hyvönen P, Hämäläinen M. Surgical treatment of unstable fractures of the distal clavicle: a comparative study of Kirschner wire and clavicular hookplate fixation. Acta Orthop Scand. 2002;73(1):50-3.

Nordqvist A, Petersson C, Redlund-Johnell I. The natural course of lateral clavicle fracture. 15 (11–21) year follow-up of 110 cases. Acta Orthop Scand. 1993;64(1):87-91.

Sajid S, Fawdington R, Maneesh Sinha M. Locking plates for displaced fractures of the lateral end of clavicle: Potential pitfalls. Int J Shoulder Surg. 2012;6(4):126-9.

Sambandam B, Gupta R, Kumar S, Maini L. Fracture of distal end clavicle: A review journal of clinical orthopaedics and trauma. 2014;5:65-73.

Paladini P, Pellegrini A, Merolla G, Campi F, Porcellini G. Treatment Of Clavicle Fractures. Translational Medicine @ UniSa. 2012;2(6):47-58.

Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2004;86-A(7):1359-65.

Kona J, Bosse MJ, Staeheli JW, Rosseau RL. Type II distal clavicle fractures: a retrospective review of surgical treatment. J Orthop Trauma. 1990;4(2):115-20.

Neer CS. Fracture of the distal clavicle with detachment of the coracoclavicular ligaments in adults. J Trauma. 1963;3:99-110.

Bosworth BM. Acromioclavicular separation. New method of repair. Surg Gynecol Obstet. 1941:73:866-71.

Faraj AA, Ketzer B. The use of a hook-plate in the management of acromioclavicular injuries. Report of ten cases. Acta Orthop Belg. 2001;67(5):448-51.

Hessmann M, Kirchner R, Baumgaertel F, Gehling H, Gotzen L. Treatment of unstable distal clavicular fractures with and without lesions of the acromioclavicular joint. Injury. 1996;27(1):47-52.

Goldberg JA, Bruce WJ, Sonnabend DH, Walsh WR. Type 2 fractures of the distal clavicle: a new surgical technique. J Shoulder Elbow Surg. 1997;6(4):380-2.

Levy O. Simple, minimally invasive surgical technique for treatment of type 2 fractures of the distal clavicle. J Shoulder Elbow Surg. 2003;12(1):24-8.

Webber MC, Haines JF. The treatment of lateral clavicle fractures. Injury. 2000;31(3):175-9.

Ravish VN, Bharath Raju G, Chopra A. Clinical and radiological outcome of lateral end clavicle fractures treated with locking compression plate: Prospective study of 19 cases. Int J Orthopaed Sci. 2017;3(2):19-22.

Andersen JR, Willis MP, Nelson R, Mighell MA. Precontoured superior locked plating of distal clavicle fractures: A new strategy. Clin Orthop Relat Res. 2011;469:3344-50.

Oh JH, Kim SH, Lee JH, Shin SH, Gong HS. Treatment of distal clavicle fracture: A systematic review of treatment modalities in 425 fractures. Arch Orthop Trauma Surg. 2011;131:525-33.

Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked plates and screws. J Orthop Trauma. 2004;18:488-93.

Neer CS. Fractures of the distal third of the clavicle. Clin Orthop Relat Res. 1968;58:43-50.

Post M. Current concepts in the treatment of fractures of the clavicle. Clin Orthop Relat Res. 1989;245:89-101.

Largo RD, Rudin MA, Hotz TK, Valderrabano V, Käch KK. Anatomic reconstruction of unstable lateral clavicular fractures. J Trauma. 2011;71:1348-51.

Constant CR, Murley AG. A Clinical Method of Functional Assessment of the Shoulder. Clin Orthopaed Rel Res. 1987; 214-6.

Robinson CM, Akhtar MA, Jenkins PJ, Sharpe T, Ray A, Olabi B. Open reduction and endobutton fixation of displaced fractures of the lateral end of the clavicle in younger patients. J Bone Joint Surg Br. 2010;92-B(6):811-6.

Rokito AS, Zuckerman JD, Shaari JM, Eisenberg DP, Cuomo F, Gallagher MA. A comparison of nonoperative and operative treatment of type II distal clavicle fractures. Bull Hosp Jt Dis. 2002;61(1-2):32-9.

Fleming MA, Dachs R, Maqungo S, du Plessis JP, Vrettos BC, Roche SJ. Angular stable fixation of displaced distal-third clavicle fractures with superior precontoured locking plates J Shoulder Elbow Surg. 2015;24(5):700-4.

Faisal Q, Mahesh SG, Gudda NL, Sudhakar BK, Chaitanya W. Treatment of lateral third clavicle fractures by locking compression plate- a prospective study. Intl J Clin Diag Res. 2017;5(4):78-84.

Ieong E, Ferran NA. Lateral Clavicle Fracture Fixation Using a Superiorly Placed Locking Plate. JBJS Essent Surg Tech. 2016;6(4):e40.






Original Research Articles