Reconstruction of the disrupted acromioclavicular (AC) joint has historically resulted in high complication rates. As a result, there has been a move toward anatomic coracoclavicular (CC) ligament fixation and reconstruction, owing to its numerous biomechanical advantages and perceived clinical advantages. To report and analyze the unique complications associated with these anatomic CC ligament procedures using either cortical fixation buttons (CFBs) or tendon grafts (TGs) and to evaluate the effect that these complications have on patient outcomes. Case series; Level of evidence, 4. From January 2006 until May 2011, a total of 59 primary anatomic CC ligament procedures were performed using either CFBs or TGs. Demographic, surgical, subjective (including the American Shoulder and Elbow Surgeons [ASES], quick Disabilities of the Arm, Shoulder and Hand [QuickDASH], Short Form–12 [SF-12], and Single Assessment Numeric Evaluation [SANE] scores), and radiographic data along with surgical complications were prospectively collected and retrospectively analyzed. Construct survivorship, defined as the maintenance of reduction of the AC joint, was calculated using the Kaplan-Meier method at 12- and 24-month intervals. Surgical treatment for AC joint dislocations was performed in 3 women (4 shoulders) and 52 men (55 shoulders) with a mean age of 43.6 years (range, 18-71 years); 13 shoulders (22.0%) underwent fixation using the CFB technique, and 46 shoulders (78.0%) underwent reconstruction using the TG technique. The overall complication rate was 27.1% (16/59) in this study. There were 3 complications (23.1%) in the CFB group, including 1 coracoid fracture and 2 cases of hardware failure resulting in a loss of reduction. There were 13 complications (28.2%) in the TG group, including 4 graft ruptures, 2 clavicle fractures, 1 case of hardware failure, 1 hypertrophic distal clavicle, 2 cases of hardware pain, 1 suture granuloma, 1 case of adhesive capsulitis, and 1 case of axillary neuropathy. Twelve- and 24-month construct survivorship was calculated to be 86.2% and 83.2%, respectively. Of the 43 shoulders that did not have a complication, mean ASES scores significantly improved from 57.5 (range, 0-97) to 91 (range, 63-100) (P < .001), and mean SF-12 physical component summary scores significantly improved from 45 (range, 25-58) to 56 (range, 43-65.8) (P < .001) after a mean 2.4-year follow-up (range, 1.0-5.7 years). There were no significant differences in outcomes between those that did and did not experience a complication, with the exception that those with complications had significantly decreased median patient satisfaction compared with those without complications (3.5 vs 9, respectively; P = .049). Anatomic procedures to treat disrupted CC ligaments using either CFBs or TGs resulted in an overall complication rate of 27.1% (16/59). Construct survivorship was calculated to be 86.2% at 12 months and 83.2% at 24 months. Good to excellent outcomes could only be reported in those patients who did not have a complication.

Background The number of displaced midshaft clavicle fractures treated surgically is increasing and plate fixation is often the treatment modality of choice. The study quality and scientific levels of evidence at which possible complications of this treatment are presented vary greatly in literature. Purposes The purpose of this systematic review is to assess the prevalence of complications concerning plate fixation of dislocated midshaft clavicle fractures. Methods A computer-based search was carried out using EMBASE and PUBMED/MEDLINE. Studies included for review reported complications after plate fixation alone or in comparison to either treatment with intramedullary pin fixation and/or nonoperative treatment. Two quality assessment tools were used to assess the methodological quality of the studies. Included studies were ranked according to their levels of evidence. Results After study selection and reading of the full texts, 11 studies were eligible for final quality assessment. Nonunion and malunion rates were less than 10% in all analysed studies but one. The vast majority of complications seem to be implant related, with irritation or failure of the plate being consistently reported on in almost every study, on average ranging from 9 to 64%. Conclusion The quantity of relevant high evidence studies is low. With low nonunion and malunion rates, plate fixation can be a safe treatment option for acute dislocated midshaft clavicle fractures, but complications related to the implant material requiring a second operation are frequent. Future prospective trials are needed to analyse the influence of various plate types and plate position on implant-related complications.