Comparative analysis of vertical double plate versus clavicle hook plate for unstable distal clavicle fractures

Abstract

Abstract To compare the clinical efficacy of vertical double-plate fixation (combining a distal clavicle locking plate and a radial lateral plate) versus clavicular hook plate fixation for unstable distal clavicle fractures. A retrospective analysis was conducted on 37 patients with unstable distal clavicle fractures (Neer II/V) treated at our institution from May 2015 to May 2023. Twenty-one patients underwent open reduction and internal fixation with clavicular hook plates (16 Neer II, 5 Neer V), while 16 patients received vertical double-plate fixation (12 Neer II, 4 Neer V). Postoperative evaluations included: 1) radiographic assessment of fracture healing at 1, 2, 3, and 6 months; 2) Visual Analogue Scale (VAS) pain scores during passive shoulder mobilization at 1, 2, and 4 weeks; and 3) Constant-Murley shoulder function scores and complication rates (incision infection, nonunion, acromial osteolysis, impingement syndrome) at 3, 6 and 12 months. The clavicular hook plate group (mean age 47.96±17.01 years) and vertical double-plate group (mean age 49.47±15.33 years) showed comparable demographics. All patients achieved fracture union within 3–6 months, with no implant displacement. The vertical double-plate group demonstrated significantly lower VAS scores during early rehabilitation (4.6±1.09, 4.05±0.88, 2.8±1.0 vs. 7.25±1.16, 5.9±1.12, 4.75±0.71; P<0.05). At 3, 6 and 12 months, Constant-Murley scores were markedly higher in the vertical double-plate group (84.41±4.48, 92.25±2.47, 94.55 vs. 75.35±5.92, 83.4±3.87, 88.10±2.10; P<0.05). The clavicular hook plate group exhibited higher complication rates: 4 cases of impingement syndrome, 3 of acromial osteolysis, and 5 with limited shoulder mobility—all improving after implant removal. Both techniques effectively achieve fracture union for unstable distal clavicle fractures. However, vertical double-plate fixation offers superior pain control, facilitates earlier functional rehabilitation, improves shoulder functional recovery, and reduces postoperative complications, demonstrating enhanced clinical efficacy compared to hook plate fixation.