Absorbable Suture Fixation for Severely Displaced Type 4 Clavicle Fractures.

Type 4 clavicle fractures in skeletally immature patients are relatively uncommon and often undergo surgical intervention due to severe pain and uncertain remodeling of the displaced distal clavicle into the trapezius muscle. There remains no consensus on the optimal surgical technique for pediatric patients. Many commonly described methods for distal clavicle fractures in adults rely on rigid fixation or coracoid fixation. These techniques may increase the risk of implant complications or iatrogenic fractures in skeletally immature patients. The purpose of this paper is to demonstrate our method of suture fixation across the acromioclavicular joint and coracoclavicular ligament footprints for severely displaced type 4 clavicle fractures in children. We describe the surgical technique and postoperative management ​and compare this technique with alternative operative strategies reported in the literature. Key Concepts: (1)Pediatric type 4 acromioclavicular (AC) fractures are rare and involve displacement of the distal clavicle through the trapezius musculature.(2)Commonly described operative techniques rely on rigid fixation or coracoid fixation, which may increase the risk of complications.(3)The thick periosteal sleeve surrounding the distal clavicle in pediatric patients can be used for restoration.(4)Suture-based fixation across the AC joint and from the coracoclavicular ligament footprints allows stable fixation while preserving native anatomy.