Tension Band Wiring versus Knowles Pinning for Non-Union of Type-2 Distal Clavicle Fractures

Abstract

Purpose. To compare tension band wiring (TBW) with Knowles pinning for non-union of type-2 distal clavicle fractures. Methods. 22 men and 6 women aged 23 to 62 (mean, 39) years underwent TBW (n=17) or Knowles pinning (n=11) for non-union of type-2 distal clavicle fractures. Both techniques were supplemented with autogenic cancellous bone grafting. Functional outcome of the shoulder was evaluated using the Constant scoring system (maximum score, 100). Excellent (≥90) and good (≥80) scores were defined as satisfactory. Results. Of the 28 patients, 25 were followed up for a mean of 2.6 (range, 1.1–4.2) years, whereas 3 were lost to follow-up. The median times to union were not significantly different between the TBW (n=15) and Knowles pinning (n=10) groups (4.0 vs. 4.3 months, p=0.94). Five non-unions treated with TBW had migration of the Kirschner wires, which was resolved by further restriction of shoulder motion. There were no other complications such as deep infection, non-unions, or malunions. All 25 patients achieved satisfactory full range of shoulder motion with minimal pain. Conclusion. Both techniques achieved high rates of satisfactory outcome. TBW may result in Kirschner wire migration but is preferred for cases with a small distal fragment.