Acromioclavicular instability is a frequent injury affecting young and athletic populations. Symptomatic, high-grade dislocations are suggested to be managed by various surgical procedures that utilize different grafts to achieve healing with a pain-free shoulder. Currently, the two modern techniques widely used are hook plate fixation and coracoclavicular ligament fixation using a suspensory loop device.

To investigate the causes and preventive strategies for specific complications after coracoclavicular suture button fixation.

A retrospective study was conducted to analyze the clinical data of 113 patients with acromioclavicular dislocations or distal clavicle fractures admitted to Changshu No.2 People's Hospital from September 2011 to July 2020. Seventy-six patients who suffered acromioclavicular dislocations were categorized as Tossy classification type Ⅲ, while 37 who suffered distal clavicle fractures were classified as Cho classification typeⅡ. There were 42 males and 71 females with an average age of (54.3±9.6) years (23 to 78 years ) . All patients were operated on after an average of 4.2 days from the initial injury. The anteroposterior radiographs of the affected shoulder were performed to evaluate the position of the implants and the reduction. The Karlsson degree system was used to assess the functional recovery of the affected shoulder. Specific complications related to the hardware or the surgical technique were recorded to explore the causes and related preventions.

The mean follow-up period was 39.1 months ( 16 to 120 months) . In the distal clavicle fracture group, one case suffered transient brachial plexus injury when a guide pin was drilled through the base of the coracoid process and recovered immediately with no dysfunction. In the acromioclavicular dislocation group, one case received unanticipated hook plate fixation as a coracoid process fracture was found during the procedure. Another coracoid process fracture and loss of reduction on radiographs were detected one day after the initial operation, and the patient received clavicular bandage immobilization for four weeks. One patient underwent revision surgery with informed consent as the button migrated inferior to the subclavian area, and the complete loss of reduction alignment was found on the immediate radiographs. Seven cases of subluxations on the radiographs were observed one day after the operation, which was attributable to the surgical procedure. The patients received clavicular bandage immobilization for four weeks. One delayed postoperative infection was diagnosed four months after the initial operation and treated with sensitive antibiotics and implant removal. Eleven cases of redislocations were identified during the 1 to 7 months follow-ups. By Karlsson degree system of 12 months after the operations, excellent results were obtained in 55 patients ( 72.4% ) and good in 13 patients ( 17.1%) in the acromioclavicular dislocation group. In contrast, excellent results were obtained in 29 patients (78.4%) and good in 5 patients (13.5% ) in the distal clavicle fracture group.

More attention should be paid to coracoclavicular suture button fixation even though it is maneuverable. It is crucial to create tunnels in the correct position and ideal direction.