Evaluation of Combined Use of Pre-contoured Locking Distal Clavicle Plate and Tunneled Suspensory Device Fixation for Unstable Lateral End Clavicle Fracture.

Introduction: Unstable lateral end clavicle fractures (Neer type 2) are prone to non-union due to various deforming forces and present a challenge in management. While multiple fixation techniques exist, each has its own complications. Combining a pre-contoured locking distal clavicle plate with a tunneled suspensory device gives best clinical and biomechanical results. Materials and Methods: This prospective interventional study included 50 patients with unilateral Neer type 2 fractures of clavicle, treated with combined fixation using a pre-contoured locking distal clavicle plate and tunneled EndoButton. Patients were followed up for 6 months postoperatively. Functional outcomes were assessed using Constant-Murley and modified University of Calofornia Los Angeles (UCLA) scores, and radiological outcomes included coracoclavicular distance measurements and fracture union rates. Results: The mean Constant-Murley score improved from 79.2 at 6 weeks to 94.1 at 6 months, comparable to uninjured shoulder (P = 0.894). Similarly, the modified UCLA score improved from 28.9 to 33.8 over the same period (P = 0.256). All patients achieved radiological union. Coracoclavicular distance significantly reduced postoperatively and remained comparable to contralateral side at final follow-up (P = 0.107). Complications were minimal, with no cases of nonunion, hardware failure or EndoButton migration. Conclusion: Combined fixation using a pre-contoured locking distal clavicle plate and tunneled suspensory EndoButton device offers excellent radiological union and functional outcomes with minimal complications making it a reliable option for treating unstable lateral end clavicle fractures.