Osteosynthesis using the anatomical plate with grasping arms for unstable distal clavicle fractures: A technical trick and clinical experience

Plate fixation is an established method of treating distal clavicle fractures. However, it is often difficult to maintain the reduction of distal fragments with conventional plates, especially in cases where the distal fragments are small or comminuted. This study aimed to introduce a technical trick and clinical experience of osteosynthesis using an anatomical nonlocking plate with grasping arms (SCORPION NEO plate) for unstable distal clavicle fractures. During fixation, distal fragments are grasped by the plate arms and fixed with 2 screws. We retrospectively reviewed 41 patients who underwent osteosynthesis for unstable distal clavicle fractures (Neer type 2 and 5) using a SCORPION NEO plate. Patients were divided into 2 groups: Type unstable 1, where the trapezoid ligament adhered to a distal fragment, and type unstable II (UII), where the trapezoid ligament adhered to a third fragment detached from a distal fragment. Although delayed union, plate loosening, plate-related pain, infection, and stiffness were observed in 2 (4.9%), 2 (4.9%), 3 (7.3%), 1 (2.4%), and 1 patient (2.4%), respectively; all fractures united at the time of final follow-up. Operating time for the UII group was significantly longer than that for the UI group. There were no significant differences between the 2 groups in postoperative complications and coracoclavicular distance ratios at the time of bone union. Our results demonstrated that osteosynthesis with the anatomical plate with grasping arms could be a viable option in the treatment of unstable distal clavicle fractures, especially in cases where distal fragments are not contiguous with the trapezoid ligament.