Treatment of Distal End Clavicle Fractures: Suture Fixation Versus Tension Band Wiring

Background: There are several methods like Kirschner wire, suture fixation, different plaque and etc. for surgical treatment of Neer’s type-II fractures of distal end of clavicle. Objectives: Due to lack of gold standard in treatment of fractures of distal end of clavicle, this study was conducted to compare therapeutic outcomes of tension band wire (TBW) and suture fixation (SF) in treatment of this type of fractures. Methods: This retrospective cross sectional-analytic study was performed on patient with confirmed unilateral unstable Neer’s type-II fracture of distal end of clavicle. Based on surgeon preferred protocol for fixation of fractures, for patients from 21 September 2010 to 20 March 2013 pin and wire were used (TBW group) and patients from 21 March 2013 to 23 September 2015, were enrolled as SF group. Demographic information were recorded separately for both groups. All patients were evaluated and scored based on constant score, VAS, symptomatic hardware, loss of reduction in 3 and 6 months and final visit after surgery. Results: Among 85 patients, 41 and 44 patients were allocated in TBW and SF groups respectively. Mean of follow-up time was 36.7 months. Our findings showed that both groups in three follow-up periods were similar with regard to shoulder function based on constant score, VAS score, loss of reduction, and nonunion. But SF group had lesser symptomatic hardware rather than TBW group (P=0.001). Conclusion: Although the results of pain intensity and function were similar in two groups, existence of symptomatic hardware and need of hardware removal in TBW method are weak points which should be considered.