Distal Clavicle Refracture after All-Suture Double Coracoclavicular and Acromioclavicular Stabilization: A Case Report.

INTRODUCTION: Distal clavicle fractures account for 10-30% of all clavicle fractures, with a considerable proportion being displaced. Although both conservative and various surgical approaches can lead to favorable outcomes and functional results, the optimal treatment strategy remains a subject of debate. All-suture techniques are becoming increasingly popular due to advantages such as enhanced torsional and axial stability and reduced implant-associated morbidity. Nonetheless, potential consequences, such as the effects of bone remodeling issues and refracture predisposition, remain inadequately investigated.

CASE REPORT: We report the case of a 25-year-old athletic male who sustained a displaced, very distal clavicle fracture with poor bone stock. This case highlights a previously unreported complication of all-suture osteosynthesis: the development of a bone groove, likely caused by the recurrent "sawing" motion of the sutures. Although the initial fracture healed appropriately, a subsequent injury - a fall while skiing - resulted in a new fracture at the site of the bone groove. Nonetheless, as the initial fracture had consolidated well and bone stock in the lateral fragment was adequate, plate osteosynthesis was successfully performed for the second fracture, with no complications observed.

CONCLUSION: All-suture stabilization is a viable option for dislocated distal clavicle fractures with poor bone stock, offering good stability and fewer implant-related issues. However, this case highlights a potential complication, bone groove formation at the augmentation site, possibly predisposing to refracture. Suture material choice may influence this risk, warranting further investigation.