All methods were performed in accordance with the relevant guidelines and regulations, and the ethics committee at our hospital approved the study protocol. Individual informed consent was waived by the Ethics Committee of the Shanghai Tenth People's Hospital due to the retrospective nature of this study. This study retrospectively compared the outcomes of the locking plate combined with a suture button to the hook plate and locking plate methods in the treatment of distal clavicle Neer type IIb fractures, in order to provide a better understanding and surgical options for Neer type IIb fractures. However, to our knowledge, there is limited information on the clinical outcomes of the locking plates combined with a suture button in the treatment of Neer type IIb distal clavicle fractures. It was recently reported that a locking plate combined with a suture button was used for distal clavicle Neer type IIb fractures ( 14). Both surgical methods have certain complication rates and even require revision. Previous studies have compared the outcomes after locking plate and hook fixation for the treatment of Neer type II distal clavicle fractures, which show similar union rates ( 12, 13). Among them, locking plates and hook plates have been widely applied in the treatment of Neer type IIb fractures. Moreover, many of these strategies can contribute to postoperative complications, including screw loosening or breakage, loss of reduction, and rotator cuff and acromion bone damage. Each surgical approach has its own strengths and weaknesses. A range of surgical techniques have been proposed to treat distal clavicle fractures including the locking plate (LP) ( 7), hook plate (HP) ( 8), coracoclavicular (CC) fixation ( 9), k-wire fixation ( 10), and screw fixation alone ( 11). To date, there is no consensus regarding the best surgical approach. Surgical techniques for the treatment of distal clavicle fractures can be challenging due to comminution and large deforming forces at the fracture site ( 6). Thus, surgical fixation is considered for the treatment of Neer type IIb distal clavicle fractures. It is reported that unstable distal clavicle fractures have high nonunion rates when treated nonoperatively ( 4, 5). According to the Neer classification system, type IIb is an unstable fracture characterized by the obvious displacement of the fracture and additional rupture of the conoid ligament, leaving the trapezoid intact ( 1, 3). The Neer classification system offers a useful framework for clinicians to assess the type of fractures. The management of distal clavicle fractures still represents a great clinical challenge ( 1, 2). Distal clavicle fractures refer to fractures that occur in the lateral third of the clavicle, which make up approximately 10%–30% of all clavicle fractures.
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