Locking Plate with Cerclage Wiring Versus Hook Plate Fixation for Unstable Distal Clavicle Fractures: Is There Still a Role for Hook Plates?

<i>Background and Objectives</i>: Hook plate fixation has been widely used for unstable distal clavicle fractures, but concerns remain regarding implant-related complications and the need for secondary removal. Locking plate fixation with supplementary cerclage wiring has been proposed as an alternative that may provide stability while reducing complications. This study compared the clinical and radiologic outcomes of locking plate fixation with cerclage wiring versus hook plate fixation. <i>Materials and Methods</i>: A retrospective review was performed on patients who underwent open reduction and internal fixation for unstable distal clavicle fractures (Cho's classification type II) between 2015 and 2024. Patients with at least 6 months of follow-up were included. Two techniques were evaluated: locking plate with cerclage wiring (Group 1) and hook plate fixation (Group 2). Clinical outcomes, including complications, range of motion, and patient satisfaction, were compared at the final follow-up. <i>Results</i>: A total of 52 patients met the inclusion criteria: 27 in Group 1 and 25 in Group 2. The overall mean follow-up period was 13.17 ± 8.46 months. The distribution of fracture types was not significantly different between groups (<i>p</i> = 0.287). Complications were more frequent in Group 2 (40%), including postoperative stiffness requiring capsular release (70%), nonunion requiring revision (20%), and peri-implant fracture (10%). The overall union rate was 100% in Group 1 and 80% in Group 2. In contrast, Group 1 had only one complication (3.7%), a peri-implant fracture (<i>p</i> = 0.002). Shoulder range of motion at the final follow-up showed no significant difference between groups. <i>Conclusions</i>: Hook plate fixation was associated with a significantly higher complication rate compared with locking plate fixation with cerclage wiring. Locking plate fixation with supplementary cerclage wiring appears to be a better surgical option for unstable distal clavicle fractures.