Comparative study on effectiveness of clavicular hook plate fixation in treatment of acromioclavicular joint dislocation and distal clavicle fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Shengkai ¹ , LIU Jiehan ¹ , WEI Hongxiang ¹ , FANG Kaibin ² , XIE Yun ^3,4,5 , ZHENG Lifeng ^3,4,5 , LIN Jianhua ^3,4,5 ,  LIN Jinluan ^3,4,5

1. School of Basic Medicine Sciences, Fujian Medical University, Fuzhou Fujian, 350000, P. R. China;
2. Department of Orthopaedics, the Second Affiliated Hospital, Fujian Medical University, Quanzhou Fujian, 362000, P. R. China;
3. Department of Orthopaedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou Fujian, 350005, P. R. China;
4. Department of Orthopaedics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou Fujian, 350212, P. R. China;
5. Fujian Institute of Orthopaedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou Fujian, 35000, P. R. China;

Corresponding author：

LIN Jinluan, Email: jinluanlin@163.com

Keywords：

Distal clavicle fracture; acromioclavicular joint dislocation; clavicle hook plate; subacromial osteolysis

DOI：

10.7507/1002-1892.202504077

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To compare the effectiveness of clavicular hook plates in the treatment of acromioclavicular joint dislocation and distal clavicle fractures. Methods A clinical data of 90 patients, who underwent clavicle hook plate fixation between January 2014 and June 2023, was retrospectively analyzed. There were 40 patients with distal clavicle fractures (fracture group) and 50 with acromioclavicular joint dislocations (dislocation group). There was no significant difference in the baseline data of gender, age, cause of injury, side of injury, time from injury to operation, and bone density between the two groups (P>0.05). The time to remove the internal fixators and the occurrence of complications were recorded. Before removing the internal fixator and at 3 months after removing, the visual analogue scale (VAS) score was used to evaluate the degree of pain, and the mobility of the shoulder joint in forward flexion, elevation, and abduction was measured. Before removing the internal fixators, the Constant-Murley score and the University of California, Los Angeles (UCLA) score were used to evaluate the function of the shoulder joint. X-ray films of the shoulder joint were taken during follow-up to observe the occurrence of subacromial osteolysis, osteoarthritis of the acromioclavicular joint, and osteoarthritis of the acromion end of the clavicle. Subgroup comparison was conducted between patients with and without subacromial osteolysis in the two groups. Results All incisions healed by first intention in both groups. All patients were followed up 1-9 years, with a median of 5 years; the difference in follow-up time between the two groups was not significant (P>0.05). During follow-up, subacromial osteolysis occurred in 74 cases, including 41 cases of typeⅠand 33 cases of type Ⅱ, distal clavicle bone atrophy in 15 cases, and acromioclavicular joint osteoarthritis in 8 cases. There was no significant difference in the removal time of internal fixators, the incidence of bone atrophy, and the incidence of osteoarthritis between the two groups (P<0.05). There was no significant difference in the incidence of subacromial steolysis (P>0.05). Before removing the internal fixators, there was no significant difference in UCLA scores and Constant-Murley scores between the two groups (P>0.05), while there was a significant difference in shoulder joint range of motion in all directions (P<0.05). After removing the internal fixators, only the difference in elevation was significant (P<0.05). There was no significant difference in the VAS score between groups before and after removing the internal fixators (P>0.05). In the fracture and dislocation groups, there was only a significant difference in plate length between the subgroup with and without subacromial osteolysis (P<0.05), while there was no significant difference in the above related indicators (P>0.05). Conclusion Clavicular hook plate is a good choice for treating acromioclavicular dislocation or distal clavicle fractures, but the incidence of subacromial osteolysis is higher, and the degree of bone resorption is more severe in fracture patients. After the removal of the internal fixator, the shoulder function significantly improved. It is recommended to remove the internal fixator as soon as possible within the allowable range of the condition.

1.	Saccomanno MF, Sircana G, Cardona V, et al. Biologic and synthetic ligament reconstructions achieve better functional scores compared to osteosynthesis in the treatment of acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc, 2021, 29(7): 2175-2193.
2.	Combalia A, Combalia M, Muñoz-Mahamud E. Acromioclavicular dislocation associated with fracture of the coracoid process: a series of cases and review of the literature. Int Orthop, 2025, 49(5): 1223-1234.
3.	Liu J, Mi J, Jin Y, et al. Three-dimensional mapping of distal clavicle fractures: Displacement patterns and clinical implications for surgical management. Orthop Surg, 2025, 17(6): 1656-1668.
4.	Li D, Qiao R, Yang N, et al. Clinical analysis of the acromial height-measuring device combined with new-type clavicular hook plate and standard clavicular hook plate in the treatment of Neer type II distal clavicle fractures. J Orthop Surg Res, 2022, 17(1): 448. doi: 10.1186/s13018-022-03338-4.
5.	Kim YS, Yoo YS, Jang SW, et al. In vivo analysis of acromioclavicular joint motion after hook plate fixation using three-dimensional computed tomography. J Shoulder Elbow Surg, 2015, 24(7): 1106-1111.
6.	Shimpuku E, Uchiyama Y, Imai T, et al. Relationship between subacromial bone erosion and hook position of clavicular plate in distal clavicle fractures. J Orthop Trauma, 2022, 36(6): e243-e249.
7.	Di Francesco A, Zoccali C, Colafarina O, et al. The use of hook plate in type Ⅲ and V acromio-clavicular Rockwood dislocations: clinical and radiological midterm results and MRI evaluation in 42 patients. Injury, 2012, 43(2): 147-152.
8.	Tiren D, van Bemmel AJ, Swank DJ, et al. Hook plate fixation of acute displaced lateral clavicle fractures: mid-term results and a brief literature overview. J Orthop Surg Res, 2012, 7: 2. doi: 10.1186/1749-799X-7-2.
9.	郭飞达, 陈晓俊, 邢文钊, 等. 非镜下专用定位/复位器辅助袢钢板治疗锁骨远端骨折和肩锁关节脱位的疗效分析. 中华肩肘外科电子杂志, 2024, 12(1): 40-48.
10.	Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res, 1987(214): 160-164.
11.	Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg (Am), 1986, 68(8): 1136-1144.
12.	Oh HS, Kim S, Hyun JH, et al. Effect of subacromial erosion shape on rotator cuff and clinical outcomes after hook plate fixation in type 5 acromioclavicular joint dislocations: a retrospective cohort study. BMC Musculoskelet Disord, 2022, 23(1): 42. doi: 10.1186/s12891-021-04987-y.
13.	Li D, Qiao R, Yang N, et al. Clinical analysis of the acromial height-measuring device combined with new-type clavicular hook plate and standard clavicular hook plate in the treatment of Neer type II distal clavicle fractures. J Orthop Surg Res, 2022, 17(1): 448. doi: 10.1186/s13018-022-03338-4.
14.	崔煦, 王秀会, 王明辉, 等. 锁骨钩钢板内固定治疗锁骨外侧端损伤术后发生肩峰下骨溶解的临床病例分析. 中华手外科杂志, 2020, 36(6): 476-478.
15.	Chiang CL, Yang SW, Tsai MY, et al. Acromion osteolysis and fracture after hook plate fixation for acromioclavicular joint dislocation: a case report. J Shoulder Elbow Surg, 2010, 19(4): e13-e15.
16.	Eschler A, Gradl G, Gierer P, et al. Hook plate fixation for acromioclavicular joint separations restores coracoclavicular distance more accurately than PDS augmentation, however presents with a high rate of acromial osteolysis. Arch Orthop Trauma Surg, 2012, 132(1): 33-39.
17.	Hoffler CE, Karas SG. Transacromial erosion of a locked subacromial hook plate: case report and review of literature. J Shoulder Elbow Surg, 2010, 19(3): e12-e15.
18.	Shimpuku E, Uchiyama Y, Imai T, et al. Relationship between subacromial bone erosion and hook position of clavicular plate in distal clavicle fractures. J Orthop Trauma, 2022, 36(6): e243-e249.
19.	Shih CM, Huang KC, Pan CC, et al. Biomechanical analysis of acromioclavicular joint dislocation treated with clavicle hook plates in different lengths. Int Orthop, 2015, 39(11): 2239-2244.
20.	Shen PC, Zhu Y, Zhang H, et al. Three-dimensional morphological analysis of acromioclavicular joint in patients with and without subacromial erosion after hook plate fixation. J Int Med Res, 2018, 46(1): 511-521.
21.	Pan X, Lv RY, Lv MG, et al. TightRope vs clavicular hook plate for Rockwood Ⅲ-Ⅴ acromioclavicular dislocations: A meta-analysis. Orthop Surg, 2020, 12(4): 1045-1052.
22.	Tuxun A, Keremu A, Aila P, et al. Combination of clavicular hook plate with coracoacromial ligament transposition in treatment of acromioclavicular joint dislocation. Orthop Surg, 2022, 14(3): 613-620.
23.	Liu G, Hu Y, Ye F, et al. Clavicular hook plate for acute high-grade acromioclavicular dislocation involving Rockwood type Ⅴ: clinical and radiological outcomes and complications evaluation. Int Orthop, 2022, 46(10): 2405-2411.

1. Saccomanno MF, Sircana G, Cardona V, et al. Biologic and synthetic ligament reconstructions achieve better functional scores compared to osteosynthesis in the treatment of acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc, 2021, 29(7): 2175-2193.
2. Combalia A, Combalia M, Muñoz-Mahamud E. Acromioclavicular dislocation associated with fracture of the coracoid process: a series of cases and review of the literature. Int Orthop, 2025, 49(5): 1223-1234.
3. Liu J, Mi J, Jin Y, et al. Three-dimensional mapping of distal clavicle fractures: Displacement patterns and clinical implications for surgical management. Orthop Surg, 2025, 17(6): 1656-1668.
4. Li D, Qiao R, Yang N, et al. Clinical analysis of the acromial height-measuring device combined with new-type clavicular hook plate and standard clavicular hook plate in the treatment of Neer type II distal clavicle fractures. J Orthop Surg Res, 2022, 17(1): 448. doi: 10.1186/s13018-022-03338-4.
5. Kim YS, Yoo YS, Jang SW, et al. In vivo analysis of acromioclavicular joint motion after hook plate fixation using three-dimensional computed tomography. J Shoulder Elbow Surg, 2015, 24(7): 1106-1111.
6. Shimpuku E, Uchiyama Y, Imai T, et al. Relationship between subacromial bone erosion and hook position of clavicular plate in distal clavicle fractures. J Orthop Trauma, 2022, 36(6): e243-e249.
7. Di Francesco A, Zoccali C, Colafarina O, et al. The use of hook plate in type Ⅲ and V acromio-clavicular Rockwood dislocations: clinical and radiological midterm results and MRI evaluation in 42 patients. Injury, 2012, 43(2): 147-152.
8. Tiren D, van Bemmel AJ, Swank DJ, et al. Hook plate fixation of acute displaced lateral clavicle fractures: mid-term results and a brief literature overview. J Orthop Surg Res, 2012, 7: 2. doi: 10.1186/1749-799X-7-2.
9. 郭飞达, 陈晓俊, 邢文钊, 等. 非镜下专用定位/复位器辅助袢钢板治疗锁骨远端骨折和肩锁关节脱位的疗效分析. 中华肩肘外科电子杂志, 2024, 12(1): 40-48.
10. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res, 1987(214): 160-164.
11. Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg (Am), 1986, 68(8): 1136-1144.
12. Oh HS, Kim S, Hyun JH, et al. Effect of subacromial erosion shape on rotator cuff and clinical outcomes after hook plate fixation in type 5 acromioclavicular joint dislocations: a retrospective cohort study. BMC Musculoskelet Disord, 2022, 23(1): 42. doi: 10.1186/s12891-021-04987-y.
13. Li D, Qiao R, Yang N, et al. Clinical analysis of the acromial height-measuring device combined with new-type clavicular hook plate and standard clavicular hook plate in the treatment of Neer type II distal clavicle fractures. J Orthop Surg Res, 2022, 17(1): 448. doi: 10.1186/s13018-022-03338-4.
14. 崔煦, 王秀会, 王明辉, 等. 锁骨钩钢板内固定治疗锁骨外侧端损伤术后发生肩峰下骨溶解的临床病例分析. 中华手外科杂志, 2020, 36(6): 476-478.
15. Chiang CL, Yang SW, Tsai MY, et al. Acromion osteolysis and fracture after hook plate fixation for acromioclavicular joint dislocation: a case report. J Shoulder Elbow Surg, 2010, 19(4): e13-e15.
16. Eschler A, Gradl G, Gierer P, et al. Hook plate fixation for acromioclavicular joint separations restores coracoclavicular distance more accurately than PDS augmentation, however presents with a high rate of acromial osteolysis. Arch Orthop Trauma Surg, 2012, 132(1): 33-39.
17. Hoffler CE, Karas SG. Transacromial erosion of a locked subacromial hook plate: case report and review of literature. J Shoulder Elbow Surg, 2010, 19(3): e12-e15.
18. Shimpuku E, Uchiyama Y, Imai T, et al. Relationship between subacromial bone erosion and hook position of clavicular plate in distal clavicle fractures. J Orthop Trauma, 2022, 36(6): e243-e249.
19. Shih CM, Huang KC, Pan CC, et al. Biomechanical analysis of acromioclavicular joint dislocation treated with clavicle hook plates in different lengths. Int Orthop, 2015, 39(11): 2239-2244.
20. Shen PC, Zhu Y, Zhang H, et al. Three-dimensional morphological analysis of acromioclavicular joint in patients with and without subacromial erosion after hook plate fixation. J Int Med Res, 2018, 46(1): 511-521.
21. Pan X, Lv RY, Lv MG, et al. TightRope vs clavicular hook plate for Rockwood Ⅲ-Ⅴ acromioclavicular dislocations: A meta-analysis. Orthop Surg, 2020, 12(4): 1045-1052.
22. Tuxun A, Keremu A, Aila P, et al. Combination of clavicular hook plate with coracoacromial ligament transposition in treatment of acromioclavicular joint dislocation. Orthop Surg, 2022, 14(3): 613-620.
23. Liu G, Hu Y, Ye F, et al. Clavicular hook plate for acute high-grade acromioclavicular dislocation involving Rockwood type Ⅴ: clinical and radiological outcomes and complications evaluation. Int Orthop, 2022, 46(10): 2405-2411.

Chinese Journal of Reparative and Reconstructive Surgery

Latest ArticlesComparative study on effectiveness of clavicular hook plate fixation in treatment of acromioclavicular joint dislocation and distal clavicle fractures

Abstract Full text Figures/Tables Video References Cited by

Format

Content