The effectiveness of double loop Ethibond figure of eight sutures in distal third clavicular fractures in Nakornping Hospital: A pilot study
Keywords:
rate of union, time-to-union, CC-distance, shoulder range of motion, DASH scoreAbstract
Introduction: Treatment of distal third clavicular fractures does not yet have a standard surgical method. The use of metal or suture materials is limited in that it requires repeated surgery to remove the metal or material. There is evidence showing the good efficacy of using new techniques with non-metallic materials (Ethibond).
Objectives: To evaluate the effectiveness of using new techniques with non-metallic materials (Ethibond) in distal third clavicular fractures.
Methods: A pilot study was conducted on patients with distal third clavicular fractures who were admitted to Nakornping Hospital between August 1, 2021, and July 31, 2023. A total of 22 patients underwent clavicle fixation surgery with a new technique of Ethibond to coracoclavicular- stabilization. Primary outcomes included union rate and time-to-union, while secondary outcomes were coracoclavicular (C-C) distance, shoulder range of motion, DASH score, VAS score measured at weeks 2, 6, 12, and 24. Complications, and adverse events were also evaluated. Data were analyzed with descriptive statistics and mixed effect models comparing average scores of outcomes with baseline at week 0.
Results: Of 22 patients, 15 males (68.2%), the mean age was 43.64±13.61 years. Fifteen cases (68.2%) had surgery on their right shoulder, nine patients (40.9%) were loss-of-follow-up. Among 13 patients followed, all (100%) had a clinical union, with a time-to-union of 12 weeks, and a radiographic union with a total of 13 cases from all who showed up for X-ray (100%). VAS score and DASH score were equal to 0 at 12 weeks after surgery. Range of motion, flexion, extension, abduction, adduction, internal rotation and external rotation, CC-distance improved significantly 2 weeks onwards after surgery. No complications or adverse events were observed.
Conclusion: A new technique with non-metallic materials (Ethibond) in distal third clavicular fractures was found to be effective in all outcomes. Patients can return to normal activities within 12 weeks. Therefore, it could be applied as a treatment of choice in the future.
References
Edwards DJ, Kavanagh TG, Flannery MC. Fractures of the distal clavicle: a case for fixation. Injury. 1992;23(1):44-6. doi: 10.1016/0020-1383(92)90125-c.
Neer CS 2nd. Fractures of the distal third of the clavicle. Clin Orthop Relat Res. 1968;58:43-50.
Neer C. Fractures and dislocations of the shoulder. In: Rockwood CA Jr, Green DP, editors. Fractures in Adults. Lippincott: Philadelphia; 1984: p. 711-2.
Badhe SP, Lawrence TM, Clark DI. Tension band suturing for the treatment of displaced type 2 lateral end clavicle fractures. Arch Orthop Trauma Surg. 2007;127(1):25-8. doi: 10.1007/s00402-006-0197-3.
Fazal MA, Saksena J, Haddad FS. Temporary coracoclavicular screw fixation for displaced distal clavicle fractures. J Orthop Surg (Hong Kong). 2007;15(1):9-11. doi: 10.1177/230949900701500103.
Kalamaras M, Cutbush K, Robinson M. A method for internal fixation of unstable distal clavicle fractures: early observations using a new technique. J Shoulder Elbow Surg. 2008;17(1):60-2. doi: 10.1016/j.jse.2007.04.012.
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. 2002-2003;61(1-2):32-9.
Kashii M, Inui H, Yamamoto K. Surgical treatment of distal clavicle fractures using the clavicular hook plate. Clin Orthop Relat Res. 2006;447:158-64. doi: 10.1097/01.blo.0000203469.66055.6a.
Tsuei YC, Au MK, Chu W. Comparison of clinical results of surgical treatment for unstable distal clavicle fractures by transacromial pins with and without tension band wire. J Chin Med Assoc. 2010;73(12):638-43. doi: 10.1016/S1726-4901(10)70139-8.
Strauss EJ, Egol KA, France MA, Koval KJ, Zuckerman JD. Complications of intramedullary Hagie pin fixation for acute midshaft clavicle fractures. J Shoulder Elbow Surg. 2007;16(3):280-4. doi: 10.1016/j.jse.2006.08.012.
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(12):3344-50. doi: 10.1007/s11999-011-2009-5.
Klein SM, Badman BL, Keating CJ, Devinney DS, Frankle MA, Mighell MA. Results of surgical treatment for unstable distal clavicular fractures. J Shoulder Elbow Surg. 2010;19(7):1049-55. doi: 10.1016/j.jse.2009.11.056.
Soliman O, Koptan W, Zarad A. Under-coracoid-around-clavicle (UCAC) loop in type II distal clavicle fractures. Bone Joint J. 2013;95-B(7):983-7. doi: 10.1302/0301-620X.95B7.31316.
Esenyel CZ, Ceylan HH, Ayanoğlu S, Kebudi A, Adanir O, Bülbül M. Treatment of Neer Type 2 fractures of the distal clavicle with coracoclavicular screw. Acta Orthop Traumatol Turc. 2011;45(5):291-6. doi: 10.3944/AOTT.2011.2464.
Martetschläger F, Kraus TM, Schiele CS, Sandmann G, Siebenlist S, Braun KF, et al. Treatment for unstable distal clavicle fractures (Neer 2) with locking T-plate and additional PDS cerclage. Knee Surg Sports Traumatol Arthrosc. 2013;21(5):1189-94. doi: 10.1007/s00167-012-2089-0.
Yang SW, Lin LC, Chang SJ, Kuo SM, Hwang LC. Treatment of acute unstable distal clavicle fractures with single coracoclavicular suture fixation. Orthopedics. 2011;34(6):172. doi: 10.3928/01477447-20110427-10.
Mardani-Kivi M, Mirbolook A, Salariyeh M, Hashemi-Motlagh K, Saheb-Ekhtiari K. The comparison of Ethibond sutures and semitendinosus autograft in the surgical treatment of acromioclavicular dislocation. Acta Orthop Traumatol Turc. 2013;47(5):307-10. doi: 10.3944/aott.2013.3015.
Kanchanatawan W, Wongthongsalee P. Management of acute unstable distal clavicle fracture with a modified coracoclavicular stabilization technique using a bidirectional coracoclavicular loop system. Eur J Orthop Surg Traumatol. 2016;26(2):139-43. doi: 10.1007/s00590-015-1723-1.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Nakornping Hospital
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The articles that had been published in the journal is copyright of Journal of Nakornping hospital, Chiang Mai.
Contents and comments in the articles in Journal of Nakornping hospital are at owner’s responsibilities that editor team may not totally agree with.
