The clavicle fractures are relatively common injuries because of their subcutaneous position and constitute for about 2-4 percent of adult fractures (1). Of these lateral end clavicle fractures account for 12-15%(2). Neer divided fractures into 3 types depending upon relationship of fracture line with coracoclavicular and acromioclavicularligaments(3). Fractures with complete displacement are less common but have a higher risk of subsequent nonunion (1,3,4,5,6). Persistent pain, restriction of movement and loss of strength and endurance of shoulder may develop if the fracture fails to heal (7,8). Coracoclavicular loops and slings of synthetic materials, allograft and autograft are less rigid and have been used in the treatment of acromioclavicularseperations(9). However, the use of these techniques in the treatment of diaplaced lateral clavicular fractures is less well defined (10,11,12,13,14)

Aim:

Achieve goal of modern orthopedics: Complete functional recovery, early mobilization, Minimally invasive surgery and evidence-based decision making for lateral end clavicle (Type 3 ,Neer classification)

Objective:

• Careful selection of patient preoperatively
• To operate all selected patients by standardized technique of CoracoclavicularEndobutton and fiber tap technique
• Post-operative evaluation of patient up to one year, comparison of results with other series and other techniques

MATERIAL AND METHODS:

• Prospective, non-competitive, result oriented, observational studies
• To be carried out at 1000 bed tertiary care hospital: Zydus Medical college and Hospital – Dahod
• Patient inclusion criteria: Patients with lateral end clavicle fracture (Type 2b, Neer classification) treated at hospital between May 2024 to March 2026

Sample size: Minimum 20 patients

Evaluation: Periodic evaluation of results (Radiological and clinical) for 1 year post operatively at minimum 3 months interval. Functional evaluation by UCLA score

Identity of patients will be kept confidential and study would be conducted after permission and under vigilance of Ethics committee

Surgical technique

All patients underwent the same ORIF procedure using the continuous loop double endobutton technique.

Deltoid splitting incision was used

• Deltotrapezial fascia was incised
• Fracture fully exposed and anatomically reduced
• 4 mm drill hole in top of clavicle
• Reamed over with a 4.5 mm cannulated reamer
• 2^nd drill hole 1 cmm lateral to central drill hole
• Loop length determined, which comes in 5 mm increments
• Measured length less than 1 mm of standard loop size – next larger size used
• If within 1 mm of the standard loop size- regular endobutton was used
• Polyethylene suture used, with joint held in reduction, loop is tied securing the button
• Trapezoid stich was taken
• After reconstruction, fracture site reduction and apposition is the main priority

Post operative treatment

• Sling for 4 weeks
• Passive external rotation and shoulder exercises started at 2 weeks
• Discontinue sling after 4 weeks
• Active movement of shoulder encouraged
• Outcome assessment
• The chief criteria were clinical follow up, radiological outcome and fracture related complications
• The patients were evaluated at 0, 6, 12 and 18 months
• The data regarding patient returning back to normal daily work, range of movements of shoulder, tested for weakness of rotator cuff, impingement lesions, signs of dysfunction at the AC joint.
• We considered fractures united if patient had no pain or only mild activity related discomfort and there were no radiological signs of loss of reduction, implant loosening or breakage, or resorption at the fracture site.
• Neer classification

UCLA score

Modified UCLA score

Follow up

A 25-year-old male patient with type 2b neer classification left side closed displaced lateral end clavicular fracture without distal neurovascular deficit, was treated with the surgical technique of endobutton with loop

The patient was followed up post operatively for 6 months, 12 months and 18 months

Pre operative x ray

Immediate post operativexray

6 months follow up

12 month follow up

18 month follow up

Clinical images

RESULTS

• All patients show radiological union with good to excellent outcome
• Post operative follow up at 6, 12, 18 months

DISCUSSION

Operative intervention the majority look at mid shaft clavicle fractures

The endobutton technique was initially developed for reduction of ankle syndesmosis but has been adopted by upper limb surgeons and is now a recognized means of correction.It results in better cosmetic appearance, better patient reported outcomes

CONCLUSION

The study shows encouraging prospect in purely biological osteosynthesis with functional outcome at par with other methods of fixation while avoiding implant related complications Compliance with ethical standards All procedures performed in studies involving human participants were in accordance with the ethical standards. Informed consent was obtained from all individuals participating in the study

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