Distal Clavicle Fixation in the Skeletally Immature

Authors:

S. Clifton Willimon, MD, Henry B. Ellis, MD, and Peter J. Millett, MD, MSc

Abstract:

Clavicle fractures are common in skeletally immature patients, but distal clavicle fractures are relatively rare, comprising only 10% to 20% of clavicle fractures in the growing population. Variations exist in this age group as chronological age may not correlate with skeletal age. Some children, specifically those whose age is greater than 15 years, may sustain an adult type of injury pattern. Knowledge of both skeletally mature and immature clavicle fractures is thus useful when caring for the adolescent population.

Displaced distal third clavicle fractures in children, as opposed to adults, retain the integrity of the coracoclavicular (CC) ligaments. The proximal attachment of the CC ligament to the periosteum and the distal attachment to the conoid tubercle of the coracoid are important intact attachments that allow for cortical button fixation in this age group. A displaced clavicle with a CC disruption, as in adults, concerns an orthopedic surgeon with not only a stable fixation of the clavicle but also the biological fixation of the CC ligament. The lack of stable biological fixation of the CC ligament in the skeletally mature patient has thought to be a source of failed repairs in these injuries. This is not the case in the pediatric patient with a similar injury who has intact CC ligaments with a disrupted periosteum and abundant innate biological healing capabilities.

A double-button suture fixation technique has been utilized to improve fixation, avoid the need for hardware removal, and allow earlier mobilization of adolescent patients with distal clavicle fractures. The purpose of this study is to describe a surgical technique for the management of adolescent distal clavicle fractures.

For the complete study: Distal Clavicle Fixation in the Skeletally Immature

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Distal Clavicle Fixation in the Skeletally Immature

Authors:

Abstract:

About the Author: Peter Millett, MD