Distal clavicle fracture occurs lateral to the attachments of the coracoclavicular (CC) ligaments. Its expanded definition is described as a one-third lateral fracture of the clavicle. The Neer classification or modified Neer classification proposed by Rockwood for distal clavicle fractures has been widely used to determine fracture stability. In 1990, Craig introduced a more detailed classification system by expanding the original Neer classification system. There was no controversy over the surgical indication of distal clavicle fractures combined with concomitant CC ligament rupture. Current reports described many surgical procedures to treat these unstable fractures. However, few studies introduced a treatment alternative, to facilitate the choice of optimal fixation methods according to the classification of distal clavicle fractures. Objective To explore the role of Cho classification as an alternative method of unstable distal clavicle fracture in adults.

A retrospective study was conducted to analyze the clinical data of 62 patients with unstable distal clavicle fractures admitted to the No 2 People's Hospital of Changshu from June 2018 to July 2020. There were 39 males and 23 females with an average age of (54.3±14.8) years ( range from 23 to 86 years ) . Seventeen patients were treated with clavicular hook plate fixation (groups A ) , twenty-four patients experienced distal clavicle microporous locking plate fixation ( groups B ) , and twenty-one patients received mini titanium plate fixation ( groups C ) . The three groups were compared and analyzed with operation time, intraoperative blood loss, intraoperative C-arm fluoroscopy, postoperative hospitalization time, visual analogue scale (VAS) of discharge, and UCLA score for functional recovery of the affected shoulder.

The mean follow-up time was 23.9 months (9-34 months) . There were no significant differences among the three groups in the frequency of operation time, intraoperative blood loss, intraoperative C-arm fluoroscopy, and postoperative hospitalization time ( P>0.05 ) . Average VAS in groups A was improved to (5.3±1.4) points when discharged, with a significant difference from (3.3±1.3) points for groups B and a considerable difference from (3.5±1.5) points for groups C (P<0.05) . According to UCLA degree system of six months after the operation, excellent results were obtained in 20 patients (83.3%) and good in 3 patients (12.5%) in group B, and excellent results were obtained in 18 patients (85.7%) and good in 1 patient (4.8%) in groups C. In contrast, excellent results were obtained in 8 patients (47.1% ) and four patients (23.5%) in group A. There were statistical differences between groups A and groups B (P<0.05) , as well as group A and group C (P<0.05) .

The Cho classification system of distal clavicle fracture in adults is reliable and helpful for choosing the optimal fixation methods and achieving superior clinical outcomes.