Clavicular fractures involving the distal end represent approximately 21% to 28% of all clavicular fractures. Conservative treatment for such fractures has shown non-union rates ranging from 22% to 50%. Hence, surgical intervention is currently recommended. Acromioclavicular joint dislocations account for approximately 12% of shoulder joint injuries. Conservative management of severe dislocations results in residual pain and restricted shoulder joint mobility, while superior displacement deformities of the distal clavicle significantly affect aesthetics. The treatment approach for distal clavicular fractures and acromioclavicular joint dislocations is similar. However, previously utilized methods such as hook plates, clavicular hooks, and Kirschner wire fixation have shown higher complication rates and suboptimal clinical outcomes. With the advancement in sports medicine, using a strut plate suspension fixation to reconstruct the coracoclavicular ligaments has become a crucial method for treating distal clavicular fractures and acromioclavicular joint dislocations. Traditionally performed arthroscopically, this method presents a steep learning curve and is unavailable in hospitals without shoulder arthroscopy, limiting its widespread adoption. Additionally, due to locator design issues, off-center clavicular and coracoid bone tunnels may lead to tunnel cutting, causing iatrogenic fractures of the clavicle and coracoid process, resulting in reconstruction failure.

To investigate the therapeutic effect of non-arthroscopic Specific positioning/reduction device-assisted double Endobutton in the treatment of distal clavicular fractures and acromioclavicular dislocations.

A retrospective study and analysis of 38 patients with distal clavicular fractures and acromioclavicular joint dislocations were treated using minimally invasive small incision non-arthroscopic specific positioning/reduction devices from January 2020 to July 2023. Among them were 26 males and 12 females, with an average age of (45.34±14.67) years. The average postoperative follow-up duration was (22.18±17.91) months. Acromioclavicular joint dislocations were observed in 33 cases (4 of Rockwood type III and 29 of Rockwood type V). In comparison, distal clavicular fractures were found in 5 cases, all of which were Neer type V. A comparative analysis was conducted between the affected and unaffected shoulder joints regarding Constant score, UCLA score, VAS pain score at pre-treatment, and one week, one month, three months, six months, and one-year post-treatment. Additionally, the occurrence of complications in the affected shoulder was also evaluated.

The patient experienced a significant reduction in symptoms within one month after surgery. Statistical significance (P<0.05) was observed in the differences in VAS pain scores between the affected side at one-week post-surgery compared to pre-surgery and at one-month post-surgery compared to one-week post-surgery. Postoperative functional scores showed a notable improvement, leading to immediate good stability. Statistical significance (P<0.05) was found in the differences of Constant scores for the affected side at one-week post-surgery compared to pre-surgery, at one-month post-surgery compared to one-week post-surgery, at three months post-surgery compared to one-month post-surgery- and at six months post-surgery compared to 3 months post-surgery. Similarly, the differences in UCLA scores for the affected side at one-week post-surgery compared to pre-surgery, at one-month post-surgery compared to one-week post-surgery, and at three months post-surgery compared to one-month post-surgery were statistically significant (P<0.05). Constant and UCLA scores for the affected side compared to the unaffected side showed statistically significant differences before and during post-treatment follow-ups (P<0.05) .

Using a non-arthroscopic coracoclavicular ligament reconstruction-specific positioning/reduction device in conjunction with strut plate suspension fixation offers a method for treating distal clavicular fractures and acromioclavicular joint dislocations. This approach enables rapid and accurate fixation and swift recovery, minimizes complications, has a short learning curve, and facilitates widespread adoption.