A Prospective Comparative Study of Hook Plate and Tension Band Wiring in Lateral End Clavicle Fractures

Abstract

Background and Objectives: Clavicle fractures are common injuries due to its subcutaneous position, accounting for approximately 2.6-4% of all adult fractures and 35% of all the injuries in shoulder girdle. Distal clavicle injuries account for 15-20% of all clavicle fractures. Fractures of the distal clavicle are a challenging and controversial issue for orthopaedic surgeons. With a wide range of treatment options and numerous recommendations in the literature, this type of fracture remains one of the most debated in clinical practice. To date, there is no universally accepted "gold standard" treatment for these injuries. This study is undertaken with the primary objective to study the functional outcome of lateral end fractures of clavicle treated with hook plate and with tension band wiring.

Materials and Methods: It is a prospective study conducted from February 2023 to February 2025 in Adichunchanagiri Institute of Medical Sciences, B.G. Nagara, Mandya. 30 cases of lateral end fractures of clavicle treated with hook plate and tension band wiring. Outcomes were assessed based on operative parameters, functional score (Constant and Murley score), time to union and complications.

Results: In this study, around 73% cases were male, with most cases falling in the 30-39 age group, with the mean age of 37.73±9.78 years in HP group and of TBW group was 41.87±11.51 years. Right clavicle was affected more (63%) than left side, with majority injuries (67%) occurring as a result of Road Traffic Accident (RTA).

In the present study, complete union of the fracture was seen in all 15 patients of the HP group (100%) and 14 patients of the TBW group (95%). There were 6 complications in the hook plate group and 13 in the TBW group (P=0.021). In the HP group, the mean Constant and Murley score was 88.13±6.53 points (70–95) and TBW group, the mean score was 84.60±9.41 points (66–94) (p-value: 0.245).

Conclusion: Both hook plating and TBW for treatment of displaced fractures of lateral end of clavicle could achieve good results and have proven to provide good fracture reduction and stability, and achieve a bony union with a very close period between them, so the choice of the surgical technique must consider the patient’s lifestyle and occupational requirements, as hook plating leads to earlier mobilization and an earlier return to work and daily life routine with fewer complications than the tension band wiring.