Dual-construct Fixation for Unstable Lateral-end Clavicle Fractures: Functional and Radiological Outcomes

Background: Unstable lateral end clavicle fractures tend to have high nonunion rates when treated nonoperatively.Surgery is often recommended; however, the optimal fixation method is controversial.Dual-construct fixation, which combines a locking plate with coracoclavicular (CC) suspensory fixation, provides both axial and vertical stability.This study reports the outcomes of this technique.Methods: We retrospectively reviewed four consecutive male patients (mean age: 32.5 years) with unstable lateral end clavicular fractures caused by high-energy trauma who underwent surgical fixation.All patients were treated with open reduction and internal fixation using an anatomic distal clavicle locking plate augmented with CC suspensory fixation.Patients were evaluated at a mean follow-up period of 17 months postoperatively.The outcomes included radiographic union, range of motion (ROM), and patient-reported outcome measures (PROMs), such as the disabilities of the arm, shoulder, and hand (DASH) score, American shoulder and elbow surgeons (ASES) score, Oxford shoulder score (OSS), and Constant-Murley score (CMS).Results: Radiographic union was achieved in all four patients (100%) at a mean follow-up of 12 weeks.At the final follow-up, all patients demonstrated excellent functional outcomes, with a mean DASH score of 3.4, ASES score of 95, OSS of 45.4, and CMS of 94.The ROM was restored to the preinjury level.No significant complications, such as infections, hardware failure, or nonunion, were observed. Conclusion:In this case series, dual-construct fixation for unstable lateral end clavicle fractures was safe and effective, achieving high union rates and functional recovery without any short-term complications.This technique provides a stable biomechanical environment for fracture union.