Hook plates for sternoclavicular joint dislocations can be associated with hardware-related issues

Hook plates for sternoclavicular joint dislocations can be associated with hardware-related issues | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Hook plates for sternoclavicular joint dislocations can be associated with hardware-related issues Sheng Xiaoyong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6250193/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: This study evaluates the efficacy and complications associated with sternoclavicular（SC）hook plates in treating traumatic sternoclavicular joint (SCJ) dislocations. Methods: A retrospectively analyzed on patients who underwent SC hook plates forfixation SCJ dislocations, focusing on hardware-related complications such as plate breakages and fixation failures. Clinical outcomes, functional recovery, and complications were assessed. Postoperative imaging, including X-raysand CT scans, was used to evaluate joint reduction and hardware integrity, Functional out comes were measured using the Constant Shoulder Score (CSS) and Visual Analog Scale (VAS) for pain. Results: SC hook plates effectively stabilized the joint and significantly improved function, as demonstrated by an increase in the mean CSS scores from 36.4 preoperatively to 86.6 postoperatively, and a decrease in VAS scores from 7.2 to 1.6. However, 4 patients (8.7%) experienced plate breakages without redislocation, and 1 patient (2%) experienced fixation failure, requiring revision surgeries. No major neurovascular complications were observed. Conclusions: While SC hook plates provide effective stabilization for SCJ dislocations, they are associated with hardware-related complications, including plate breakages and fixation failures. Improvements in implant design, patient selection are necessary to address these issues and improve long-term outcomes. Future research should focus on the developing of more ergonomic implants and exploration of alternative treatment options. Orthopedics Sternoclavicular Hook Sternoclavicular joint Dislocation Hardware Failure Joint Stabilization Postoperative Outcomes Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Sternoclavicular joint (SCJ) dislocations, although uncommon, present significant challenges in trauma surgery due to the joint's crucial role in shoulder stability and its proximity to vital structures [ 1 ] . These dislocations are classified as anterior, which are more but less severe, and posterior, which are rarer yet potentially life-threatening due to the risk of compressing on the trachea, blood vessels, or esophagus [ 2 ] . Treatment options for SCJ dislocations range from conservative methods, such as closed reduction and immobilization for stable anterior dislocations to surgical interventions such as open reduction and internal fixation (ORIF) or ligament reconstruction for posterior dislocations or cases of persistent instability [ 3 – 5 ] . The introduction of SC hook plates has advanced the surgical treatment by providing enhanced mechanical stability, particularly in traumatic cases, and allowing for early mobilization [ 6 – 8 ] . Despite these benefits, the technique may be associated with complications, including hardware failure, plate loosening, and functional impairments, highlighting the need for further refinement the procedure and long-term outcome evaluation. Therefore, there is a pressing need for a comprehensive assessment of the risks and benefits of using of hook plates in treating SCJ dislocations. This study aims to fill this gap by thoroughly examining the challenges and complications associated with SC hook plate use. The primary objective is to systematically evaluate the frequency, types, and consequences of hardware and functional complications, while also offering recommendations for optimizing surgical techniques and implant design to improve patient outcomes. 1. Methodology 1.1 Study Design This retrospective cohort analysis involved 46 patients who underwent treatment with SC hook plates for traumatic SCJ dislocations between 2015 and 2022 at our hospital. Inclusion criteria were patients with acute traumatic SCJ dislocations who had failed manual reduction, experienced redislocation after repositioning or could not tolerate prolonged joint immobilization, thus requiring surgical intervention. The exclusion criteria were patients with chronic SCJ injuries, those managed conservatively, and individuals with underlying conditions that could affect bone healing. 1.2 Surgical Technique The procedure began with the administration of general anesthesia and patient positioning in the supine orientation. An inverted "7"-shaped incision was made along the upper midline of the sternum (Fig. 1B). The periosteum on the affected side of the sternum, along with attachment of the sternocleidomastoid muscle, were carefully detached using a periosteal dissector. A drill guide mold was positioned at the sternum's midline (Fig. 2A), and a 4.2mm hole was drilled perpendicular to the posterior wall (Figure 1C, Fig. 2B). Sternum pulling guide is placed behind the sternum (Fig. 2C) and the introducer Cable head is connected to the guide (Fig. 2D). The SCJ was reduced by pulling the proximal clavicle and applying downward pressure. The appropriate sternum locking hook plate from Zhejiang CANWELL Medical Equipment Co. was selected based on the trial mold and measured thickness. The cable was tightened to insert the hook into the drilled sternal tunnels (Fig. 1D, Fig. 2E), and the plate was placed over the clavicle. After drilling and tapping the clavicle, three screws were inserted, and joint stability was assessed (Fig. 1E, Fig. 2F). If instability persisted, a shim-like nut and lock nut were installed to secure the joint; otherwise, otherwise the cable nut was removed. Finally, the sternocleidomastoid muscle and SCJ capsule were sutured with intermittent sutures to close the incision. 1.3 Postoperative Management: Two weeks after surgery, patients were fitted with a triangular shoulder sling, and gradual functional exercises were initiated. Shoulder abduction and flexion were restricted to 90 degrees for the first months, and strenuous activities avoided for an additional three months. Removal of the SC hook plate was generally recommended between 6 to 12 months post-surgery. 1.4 Data Collection Shoulder function and pain were measured preoperatively and postoperatively using the Constant Shoulder Score (CSS) and Visual Analog Scale (VAS), respectively. Radiographic imaging, including X-rays and CT scans, was used to monitor joint repositioning, evaluate hook plate placement accuracy, and assess hardware integrity throughout recovery. Intraoperative parameters, such as operative time, blood loss, and complications, were recorded. Patients were closely monitored for an average of 26.7 months during postoperative follow-up through clinic visits or phone calls conducted at specific intervals. 1.5 Statistical Analysis A comparative analysis between preoperative and postoperative outcomes was conducted using statistical tests, such as paired t-tests, to assess changes in joint function and pain levels, contributing to a comprehensive evaluation of the effectiveness of hook plates in improving patient recovery. 2. Results 2.1 Patient Demographics and Clinical Data The study cohort consisted of 46 individuals who underwent treatment with SC hook plates for SCJ dislocations between 2015 and 2022. The demographic analysis revealed a mean age of 49.3 years (range: 28 to 73 years), with a predominant representation of male patients (44 males, 2 females). High-energy trauma, primarily resulting from traffic accidents (44 cases) and sports injuries (2 cases), was the most common mechanism of injury. 42 cases were classified as anterior dislocations, and 4 cases as posterior dislocations. This classification is important due to the increased risks associated with posterior dislocations, highlighting the significance of using hook plates in these cases (Table 1). 2.2 Surgical Outcomes The average operative duration for the 46 patients undergoing SC hook plate fixation varied between 55 and 95 minutes, with a mean of 65.2 ± 8.4 minutes. Notably, there were no instances of nerve or vascular injuries reported as intraoperative complications, and the average blood loss during surgery was minimal at 46.2 ± 14.6 mL. Preoperatively, the mean CSS was 36.4 ± 4.8 points (range: 28–46 points). At the final follow-up, the postoperative mean CSS score significantly improved to 86.6 ± 6.2 points (range: 80–92), with a p-value of < 0.05, indicating a statistically significant difference. Additionally, the mean VAS score improvement from 7.2 ± 1.4 (range: 5–8) preoperatively to 1.6 ± 0.4 (range: 0–3) at the final follow-up, a p-value of < 0.05, denoting a statistically significant difference. Postoperative radiographic assessments, including X-rays and CT scans, consistently demonstrated successful joint repositioning in all cases, with the hook plates effectively maintaining proper SCJ alignment. Throughout the follow-up period, hardware integrity remained intact, with no instances of significant hardware loosening or displacement immediately post-surgery, However, a few cases of hardware-related complications emerged during recovery. 2.3 Complications and Hardware Issues Following the use of SC hook plates, the study identified several hardware-related complications. Notably, a 66-year-old male patient (2%) experienced fixation failure and redislocation within 10 days post-surgery, necessitating revision surgery (Fig. 3). Additionally, during follow-ups, plate breakages were observed in 4 patients (8.7%) (Fig. 4), although these occurrences did not result in redislocation or require immediate revision surgeries. 3. Discussion This study demonstrated successful joint repositioning in the majority of cases, as confirmed by postoperative radiographic evaluations. Most patients showed significant functional recovery, evidenced by improvements in the CSS and VAS for pain, indicating effective restoration of shoulder function. However, the study also identified complications, including hardware failure in the form of plate breakages (8.7%) and one case (2%) of fixation failure resulting in redislocation. These hardware-related issues highlight a substantial risk associated with hook plate usage, particularly in older patients with osteoporosis or those who are more physically active. Despite these challenges, most patients maintained joint stability and achieved positive functional outcomes postoperatively, However, those experiencing hardware complications required further interventions and had extended recovery periods. This emphasizes the need of close monitoring hardware integrity and importance of considering patient-specific factors to mitigate risks and improve long-term outcomes. Although no instances of neurovascular injury were reported, hardware breakages did not necessitate revision surgeries, prolong recovery, or significantly impact overall outcomes. These findings underscore the balance between the mechanical stability provided by hook plates and the potential risks of hardware-related complications, particularly in complex dislocations or high-demand patient populations. Conservative management (e.g., closed reduction and immobilization) are often preferred for stable anterior dislocations; however, it may fail to provide long-term stability in some cases. This failure can result in chronic instability, a higher risk of redislocation (up to 21–100%) [ 9 ] , and poor functional outcomes [ 10 ] , including persistent pain, decreased functionality, post-traumatic arthritis, and cosmetic deformities. Moreover, in cases of severe dislocation, conservative treatment often falls short in restoring full joint stability, increasing the likelihood of requiring surgical intervention for better long-term recovery. In contrast, surgical intervention with hook plates provides immediate stability, early mobilization, and significantly lower redislocation rates (2% in our cohort), although it is associated with hardware-related risks. This highlights the importance of individualized treatment plans based on dislocation severity and patient-specific factors. Comparison between SC hook plates and other techniques, such as acromioclavicular (AC) hook plates and ligament repair (using artificial or autologous ligaments), reveals distinct differences. AC hook plates are commonly used for AC joint dislocations due to their robust fixation properties and ability to maintain reduction. Qu et al. [ 7 ] reported successful treatment of 10 patients with anterior SCJ dislocation using AC hook plates without complications, with a follow-up of 16.9 months, providing sufficient short-to-medium-term outcomes but lacking the long-term complications observed in this study. Ligament repair, whether using artificial or autologous grafts, takes a more biological approach by relying on the body's natural healing mechanisms. This method typically involves longer recovery periods due to the dependence on ligament healing and carries a heighter risk of redislocation in severe trauma cases compared to the immediate stabilization provided by hook plates. Nevertheless, ligament repair has the advantage of avoiding hardware complications and may be preferable in less severe dislocations, where the risk of hardware failure is minimal [ 11 – 14 ] . Several less invasive techniques, such as Button devices connected to suture and minimally invasive suture fixation, offers a more anatomical approach, particularly for chronic instability or low-demand injuries, However, these techniques requires prolonged rehabilitation and may lack sufficient stability in high-energy trauma [ 11 ] . Minimally invasive techniques, such as FiberWire® fixation, avoid hardware-related complications but may be less effective in cases of severe ligamentous disruption or osteoporotic bone [ 12 , 15 ] . While these methods have the advantage of avoiding hardware issues, they may not be suitable for acute, unstable posterior dislocations or high-demand patients requiring rapid stabilization. The choice of technique should be tailored to injury severity, patient characteristics, and functional demands, underscoring the need for further comparative studies to optimize treatment selection. This study makes a significantly contribution by addressing complications, challenges, and long-term outcomes associated with SC hook plates in treatment of SCJ dislocation, complementing the generally favorable outcomes reported in earlier studies [ 6 – 8 , 16 , 17 ] , While past research indicated no complications, wound infections, or plate/screw breakages, this study highlights potential risks, offering a more comprehensive understanding of long-term performance and hardware-related complications in specific patient subsets. By identifying this novel complication, absent in prior studies, this research underscores potential gaps in earlier evaluations, emphasizing the importance of thorough long-term monitoring and hardware performance analysis. This discovery suggests that previous studies may have underestimated certain risks over extended periods or in specific patient groups, contributing to the refinement of clinical practice through rigorous postoperative follow-up and surgical technique adaptation to proactively address future treatment challenges. Furthermore, this finding underscores the ongoing need for plate design innovation and continued research to capture the full spectrum of associated linked with SC hook plates. The SC hook plate has significantly advanced shoulder trauma surgery by providing immediate mechanical stability for acute traumatic dislocations. Its ability to effectively realign the joint, particularly in complex posterior dislocations, leading to enhanced functional recovery. This advancement is particularly crucial in managing dislocations near critical structures such as the trachea and blood vessels, where conventional methods may fall short. While the hook plate substantially improves patient outcomes, hardware-related complications, such as plate breakage and fixation failure, highlight the need for ongoing plate design innovation and surgical technique. Overall, the SC hook plate represents a significant advancement in shoulder trauma surgery, with continuous potential for refinement to mitigate complications and improve long-term success. The retrospective study design, small sample size, and limited follow-up duration are notable limitations, reduce the generalizability of findings and prevent a comprehensive assessment of long-term complications. To address these limitations, future research should include larger sample sizes, prospective studies, and extended follow-up periods to further explore the enduring efficacy of the plates. Additionally, recommending enhancements in implant design and surgical techniques is crucial for minimizing risks and ensuring superior outcomes for patients with SCJ dislocation. 4. Conclusion This study affirms the effectiveness of SC hook plates in stabilizing traumatic SCJ dislocations, particularly in cases requiring immediate mechanical stability. However, the observed hardware-related complications, such as fixation failure and plate breakages, highlight the need for ongoing innovation in implant design and surgical techniques. Future research should prioritize the development of more durable implants, comprehensive long-term outcome assessments, and individualized treatment strategies to optimize patient outcomes. Declarations Ethics Approval and Consent to Participate: The study was approved by the Ethics Committee of Taizhou Hospital of Zhejiang Province of Ethics Committee (Approval Number: kL20240919). Informed consent was obtained from all participants prior to inclusion in the study. Consent for Publication: Written informed consent for publication of their clinical details and images was obtained from the parents or legal guardians of the patients. A copy of the consent form is available for review by the Editor of this journal. Availability of Data and Materials: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing Interests: The authors declare that they have no competing interests. Funding: This work was funded by the Enze Medical Center (Group) Scientific Research Fund (19EZC28, 21EZD21). Authors' Contributions: [Li Sheng] designed the study. [Jie Feng] collected and analyzed the data. [Xiaoyong Sheng] contributed to the writing and editing of the manuscript. All authors read and approved the final manuscript. Acknowledgments: We would like to thank Taizhou Hospital of Zhejiang Province for their assistance and support in this study. References Miniato M. A.,Anand P., Varacallo M.,Anatomy, Shoulder and Upper Limb, Shoulder[J]2021, Kiel J.,Ponnarasu S., Kaiser K.,Sternoclavicular Joint Injury[J]2021, Wang S.,Chen Z.,Lin L., et al. ,Long-term results for traumatic sternoclavicular joint dislocation treated with a sternoclavicular joint-specific plate[J].ANZ J Surg,2021,91(4):653-657 Tasnim S.,Shirafkan A., Okereke I.,Diagnosis and management of sternoclavicular joint infections: a literature review[J].J Thorac Dis,2020,12(8):4418-4426 Lacheta L.,Dekker T. J.,Goldenberg B. T., et al. ,Minimum 5-Year Clinical Outcomes, Survivorship, and Return to Sports After Hamstring Tendon Autograft Reconstruction for Sternoclavicular Joint Instability[J].Am J Sports Med,2020,48(4):939-946 Xin H.,Wang X.,Zhang S., et al. ,Novel sternoclavicular hook plate for the treatment of posterior sternoclavicular dislocation: a retrospective study[J].J Orthop Surg Res,2023,18(1):945 Qu Y. Z.,Xia T.,Liu G. H., et al. ,Treatment of Anterior Sternoclavicular Joint Dislocation with Acromioclavicular Joint Hook Plate[J].Orthop Surg,2019,11(1):91-96 Zhang C.,Lin L.,Liang J., et al. ,Efficacy analysis of a novel sternoclavicular hook plate for treatment of unstable sternoclavicular joint dislocation or fracture[J].J Orthop Surg (Hong Kong),2017,25(1):2309499016684488 Morell D. J., Thyagarajan D. S.,Sternoclavicular joint dislocation and its management: A review of the literature[J].World J Orthop,2016,7(4):244-250 Bae D. S.,Kocher M. S.,Waters P. M., et al. ,Chronic recurrent anterior sternoclavicular joint instability: results of surgical management[J].J Pediatr Orthop,2006,26(1):71-74 Gaines R. J.,Liporace F. A.,Yoon R. S., et al. ,A novel technique for ligamentous reconstruction of the sternoclavicular joint[J].J Orthop Trauma,2014,28(3):e65-69 Quayle J. M.,Arnander M. W.,Pennington R. G., et al. ,Artificial ligament reconstruction of sternoclavicular joint instability: report of a novel surgical technique with early results[J].Tech Hand Up Extrem Surg,2014,18(1):31-35 Keohane D., Morrissey D.,Repair of sternoclavicular joint ligament: a novel approach[J].Ir J Med Sci,2022,191(5):2141-2145 Adamcik S.,Ahler M.,Gioutsos K., et al. ,Repair of sternoclavicular joint dislocations with FiberWire((R))[J].Arch Orthop Trauma Surg,2017,137(3):341-345 Adamcik S.,Ahler M.,Gioutsos K., et al. ,Repair of sternoclavicular joint dislocations with FiberWire(®)[J].Arch Orthop Trauma Surg,2017,137(3):341-345 Zhang C. Y.,Lin L.,Liang J. B., et al. ,[A new type sternoclavicular hook plate for unstable sternoclavicular joint dislocation and fracture][J].Zhongguo Gu Shang,2016,29(11):1040-1044 Zhang Y.,Xing B.,Hou X., et al. ,A novel sternoclavicular hook plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular join[J].BMC Surg,2022,22(1):250 Table 1 Table 1 is not available with this version. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6250193","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":430311001,"identity":"d457fe82-2b5b-44c1-80a4-d67cadc5f35b","order_by":0,"name":"Sheng Xiaoyong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYDACCQglB+UyE6/FmHQtiQ1Ea5Gf3Xzs4de2w+n90u0PH92osGbgb+9OwKvF4M6xdGOZM4dzZ845kGyccyadQeLM2Q34tUjkmElLVBzO3XAj4Zh0btthoEgufi3yM/K/SUsYHE63v5HY/jv3HxFaGG7ksEl+qDicYCCRzMac20CEFoMbaWbSDGfSDWfcSGOWzjmWzkPQL/Izkp9J/myzluefkf7wc06NtRx/ey8BhwEBMw9DM5zDQ1A5CDD+YKgjSuEoGAWjYBSMUAAAYqZHzJdCAPcAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-4699-471X","institution":"Taizhou Hospital of Zhejiang Province","correspondingAuthor":true,"prefix":"","firstName":"Sheng","middleName":"","lastName":"Xiaoyong","suffix":""}],"badges":[],"createdAt":"2025-03-18 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styloid\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6250193/v1/a2c59f2dfc7ba7213c89f0db.jpg"},{"id":79551942,"identity":"21942c2b-d765-4277-b80e-07b1a779aac4","added_by":"auto","created_at":"2025-03-31 06:43:17","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":38310,"visible":true,"origin":"","legend":"\u003cp\u003eSternum styloid drilling is performed with a 4.2 mm diameter drill.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6250193/v1/35b9660c84d6c19b1f7081de.jpg"},{"id":79551951,"identity":"89ed72dc-23b7-49f1-9161-7d6dcb923795","added_by":"auto","created_at":"2025-03-31 06:43:18","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":33755,"visible":true,"origin":"","legend":"\u003cp\u003eSternum pulling guide is placed behind the sternum.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6250193/v1/e9fd255cf57b8f5e1817105c.jpg"},{"id":79551950,"identity":"4e7371f1-f08b-4bbe-8bd3-a17ecec04bbc","added_by":"auto","created_at":"2025-03-31 06:43:18","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":41108,"visible":true,"origin":"","legend":"\u003cp\u003eCable head is connected to the guide.\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6250193/v1/f096c23e2959d7e1d5f5b52d.jpg"},{"id":79551946,"identity":"0b964eaf-f881-4d1a-8883-7a910624cb0e","added_by":"auto","created_at":"2025-03-31 06:43:17","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":28187,"visible":true,"origin":"","legend":"\u003cp\u003eCable is connected to the hook end of the plate and is led out through the sternal foramen.\u003c/p\u003e","description":"","filename":"5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6250193/v1/d0edeb74a7755c37c06cd148.jpg"},{"id":79552528,"identity":"55698556-7fac-425d-bb98-eb879cca4616","added_by":"auto","created_at":"2025-03-31 06:51:18","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":38344,"visible":true,"origin":"","legend":"\u003cp\u003eSternoclavicular joint immobilization is completed.\u003c/p\u003e","description":"","filename":"6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6250193/v1/cea29d19809dcbedc78ae020.jpg"},{"id":79553119,"identity":"ff154b45-ddc7-4306-aefc-3d7c95b7c373","added_by":"auto","created_at":"2025-03-31 06:59:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":684256,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6250193/v1/2626e641-925d-4d09-8394-2ead23e25502.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eHook plates for sternoclavicular joint dislocations can be associated with hardware-related issues\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSternoclavicular joint (SCJ) dislocations, although uncommon, present significant challenges in trauma surgery due to the joint's crucial role in shoulder stability and its proximity to vital structures\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. These dislocations are classified as anterior, which are more but less severe, and posterior, which are rarer yet potentially life-threatening due to the risk of compressing on the trachea, blood vessels, or esophagus\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Treatment options for SCJ dislocations range from conservative methods, such as closed reduction and immobilization for stable anterior dislocations to surgical interventions such as open reduction and internal fixation (ORIF) or ligament reconstruction for posterior dislocations or cases of persistent instability\u003csup\u003e[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe introduction of SC hook plates has advanced the surgical treatment by providing enhanced mechanical stability, particularly in traumatic cases, and allowing for early mobilization\u003csup\u003e[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Despite these benefits, the technique may be associated with complications, including hardware failure, plate loosening, and functional impairments, highlighting the need for further refinement the procedure and long-term outcome evaluation. Therefore, there is a pressing need for a comprehensive assessment of the risks and benefits of using of hook plates in treating SCJ dislocations.\u003c/p\u003e \u003cp\u003eThis study aims to fill this gap by thoroughly examining the challenges and complications associated with SC hook plate use. The primary objective is to systematically evaluate the frequency, types, and consequences of hardware and functional complications, while also offering recommendations for optimizing surgical techniques and implant design to improve patient outcomes.\u003c/p\u003e"},{"header":"1. Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Study Design\u003c/h2\u003e \u003cp\u003eThis retrospective cohort analysis involved 46 patients who underwent treatment with SC hook plates for traumatic SCJ dislocations between 2015 and 2022 at our hospital. Inclusion criteria were patients with acute traumatic SCJ dislocations who had failed manual reduction, experienced redislocation after repositioning or could not tolerate prolonged joint immobilization, thus requiring surgical intervention. The exclusion criteria were patients with chronic SCJ injuries, those managed conservatively, and individuals with underlying conditions that could affect bone healing.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e1.2 Surgical Technique\u003c/h3\u003e\n\u003cp\u003eThe procedure began with the administration of general anesthesia and patient positioning in the supine orientation. An inverted \"7\"-shaped incision was made along the upper midline of the sternum (Fig.\u0026nbsp;1B). The periosteum on the affected side of the sternum, along with attachment of the sternocleidomastoid muscle, were carefully detached using a periosteal dissector. A drill guide mold was positioned at the sternum's midline (Fig.\u0026nbsp;2A), and a 4.2mm hole was drilled perpendicular to the posterior wall (Figure 1C, Fig.\u0026nbsp;2B). Sternum pulling guide is placed behind the sternum (Fig.\u0026nbsp;2C) and the introducer Cable head is connected to the guide (Fig.\u0026nbsp;2D).\u003c/p\u003e \u003cp\u003eThe SCJ was reduced by pulling the proximal clavicle and applying downward pressure. The appropriate sternum locking hook plate from Zhejiang CANWELL Medical Equipment Co. was selected based on the trial mold and measured thickness. The cable was tightened to insert the hook into the drilled sternal tunnels (Fig.\u0026nbsp;1D, Fig.\u0026nbsp;2E), and the plate was placed over the clavicle. After drilling and tapping the clavicle, three screws were inserted, and joint stability was assessed (Fig.\u0026nbsp;1E, Fig.\u0026nbsp;2F). If instability persisted, a shim-like nut and lock nut were installed to secure the joint; otherwise, otherwise the cable nut was removed. Finally, the sternocleidomastoid muscle and SCJ capsule were sutured with intermittent sutures to close the incision.\u003c/p\u003e\n\u003ch3\u003e1.3 Postoperative Management:\u003c/h3\u003e\n\u003cp\u003eTwo weeks after surgery, patients were fitted with a triangular shoulder sling, and gradual functional exercises were initiated. Shoulder abduction and flexion were restricted to 90 degrees for the first months, and strenuous activities avoided for an additional three months. Removal of the SC hook plate was generally recommended between 6 to 12 months post-surgery.\u003c/p\u003e\n\u003ch3\u003e1.4 Data Collection\u003c/h3\u003e\n\u003cp\u003eShoulder function and pain were measured preoperatively and postoperatively using the Constant Shoulder Score (CSS) and Visual Analog Scale (VAS), respectively. Radiographic imaging, including X-rays and CT scans, was used to monitor joint repositioning, evaluate hook plate placement accuracy, and assess hardware integrity throughout recovery. Intraoperative parameters, such as operative time, blood loss, and complications, were recorded. Patients were closely monitored for an average of 26.7 months during postoperative follow-up through clinic visits or phone calls conducted at specific intervals.\u003c/p\u003e\n\u003ch3\u003e1.5 Statistical Analysis\u003c/h3\u003e\n\u003cp\u003eA comparative analysis between preoperative and postoperative outcomes was conducted using statistical tests, such as paired t-tests, to assess changes in joint function and pain levels, contributing to a comprehensive evaluation of the effectiveness of hook plates in improving patient recovery.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e "},{"header":"2. Results","content":"\u003ch2\u003e2.1 Patient Demographics and Clinical Data\u003c/h2\u003e\u003cp\u003eThe study cohort consisted of 46 individuals who underwent treatment with SC hook plates for SCJ dislocations between 2015 and 2022. The demographic analysis revealed a mean age of 49.3 years (range: 28 to 73 years), with a predominant representation of male patients (44 males, 2 females). High-energy trauma, primarily resulting from traffic accidents (44 cases) and sports injuries (2 cases), was the most common mechanism of injury. 42 cases were classified as anterior dislocations, and 4 cases as posterior dislocations. This classification is important due to the increased risks associated with posterior dislocations, highlighting the significance of using hook plates in these cases (Table\u0026nbsp;1).\u003c/p\u003e\u003ch3\u003e2.2 Surgical Outcomes\u003c/h3\u003e\u003cp\u003eThe average operative duration for the 46 patients undergoing SC hook plate fixation varied between 55 and 95 minutes, with a mean of 65.2 ± 8.4 minutes. Notably, there were no instances of nerve or vascular injuries reported as intraoperative complications, and the average blood loss during surgery was minimal at 46.2 ± 14.6 mL. Preoperatively, the mean CSS was 36.4 ± 4.8 points (range: 28–46 points). At the final follow-up, the postoperative mean CSS score significantly improved to 86.6 ± 6.2 points (range: 80–92), with a p-value of \u0026lt; 0.05, indicating a statistically significant difference. Additionally, the mean VAS score improvement from 7.2 ± 1.4 (range: 5–8) preoperatively to 1.6 ± 0.4 (range: 0–3) at the final follow-up, a p-value of \u0026lt; 0.05, denoting a statistically significant difference. Postoperative radiographic assessments, including X-rays and CT scans, consistently demonstrated successful joint repositioning in all cases, with the hook plates effectively maintaining proper SCJ alignment. Throughout the follow-up period, hardware integrity remained intact, with no instances of significant hardware loosening or displacement immediately post-surgery, However, a few cases of hardware-related complications emerged during recovery.\u003c/p\u003e\u003ch2\u003e2.3 Complications and Hardware Issues\u003c/h2\u003e\u003cp\u003eFollowing the use of SC hook plates, the study identified several hardware-related complications. Notably, a 66-year-old male patient (2%) experienced fixation failure and redislocation within 10 days post-surgery, necessitating revision surgery (Fig.\u0026nbsp;3). Additionally, during follow-ups, plate breakages were observed in 4 patients (8.7%) (Fig.\u0026nbsp;4), although these occurrences did not result in redislocation or require immediate revision surgeries.\u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eThis study demonstrated successful joint repositioning in the majority of cases, as confirmed by postoperative radiographic evaluations. Most patients showed significant functional recovery, evidenced by improvements in the CSS and VAS for pain, indicating effective restoration of shoulder function. However, the study also identified complications, including hardware failure in the form of plate breakages (8.7%) and one case (2%) of fixation failure resulting in redislocation. These hardware-related issues highlight a substantial risk associated with hook plate usage, particularly in older patients with osteoporosis or those who are more physically active. Despite these challenges, most patients maintained joint stability and achieved positive functional outcomes postoperatively, However, those experiencing hardware complications required further interventions and had extended recovery periods. This emphasizes the need of close monitoring hardware integrity and importance of considering patient-specific factors to mitigate risks and improve long-term outcomes. Although no instances of neurovascular injury were reported, hardware breakages did not necessitate revision surgeries, prolong recovery, or significantly impact overall outcomes. These findings underscore the balance between the mechanical stability provided by hook plates and the potential risks of hardware-related complications, particularly in complex dislocations or high-demand patient populations.\u003c/p\u003e\u003cp\u003eConservative management (e.g., closed reduction and immobilization) are often preferred for stable anterior dislocations; however, it may fail to provide long-term stability in some cases. This failure can result in chronic instability, a higher risk of redislocation (up to 21–100%)\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e, and poor functional outcomes\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, including persistent pain, decreased functionality, post-traumatic arthritis, and cosmetic deformities. Moreover, in cases of severe dislocation, conservative treatment often falls short in restoring full joint stability, increasing the likelihood of requiring surgical intervention for better long-term recovery. In contrast, surgical intervention with hook plates provides immediate stability, early mobilization, and significantly lower redislocation rates (2% in our cohort), although it is associated with hardware-related risks. This highlights the importance of individualized treatment plans based on dislocation severity and patient-specific factors.\u003c/p\u003e\u003cp\u003eComparison between SC hook plates and other techniques, such as acromioclavicular (AC) hook plates and ligament repair (using artificial or autologous ligaments), reveals distinct differences. AC hook plates are commonly used for AC joint dislocations due to their robust fixation properties and ability to maintain reduction. Qu et al. \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e reported successful treatment of 10 patients with anterior SCJ dislocation using AC hook plates without complications, with a follow-up of 16.9 months, providing sufficient short-to-medium-term outcomes but lacking the long-term complications observed in this study. Ligament repair, whether using artificial or autologous grafts, takes a more biological approach by relying on the body's natural healing mechanisms. This method typically involves longer recovery periods due to the dependence on ligament healing and carries a heighter risk of redislocation in severe trauma cases compared to the immediate stabilization provided by hook plates. Nevertheless, ligament repair has the advantage of avoiding hardware complications and may be preferable in less severe dislocations, where the risk of hardware failure is minimal\u003csup\u003e[\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e–\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eSeveral less invasive techniques, such as Button devices connected to suture and minimally invasive suture fixation, offers a more anatomical approach, particularly for chronic instability or low-demand injuries, However, these techniques requires prolonged rehabilitation and may lack sufficient stability in high-energy trauma\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Minimally invasive techniques, such as FiberWire® fixation, avoid hardware-related complications but may be less effective in cases of severe ligamentous disruption or osteoporotic bone\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. While these methods have the advantage of avoiding hardware issues, they may not be suitable for acute, unstable posterior dislocations or high-demand patients requiring rapid stabilization. The choice of technique should be tailored to injury severity, patient characteristics, and functional demands, underscoring the need for further comparative studies to optimize treatment selection.\u003c/p\u003e\u003cp\u003eThis study makes a significantly contribution by addressing complications, challenges, and long-term outcomes associated with SC hook plates in treatment of SCJ dislocation, complementing the generally favorable outcomes reported in earlier studies\u003csup\u003e[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e–\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, While past research indicated no complications, wound infections, or plate/screw breakages, this study highlights potential risks, offering a more comprehensive understanding of long-term performance and hardware-related complications in specific patient subsets. By identifying this novel complication, absent in prior studies, this research underscores potential gaps in earlier evaluations, emphasizing the importance of thorough long-term monitoring and hardware performance analysis. This discovery suggests that previous studies may have underestimated certain risks over extended periods or in specific patient groups, contributing to the refinement of clinical practice through rigorous postoperative follow-up and surgical technique adaptation to proactively address future treatment challenges. Furthermore, this finding underscores the ongoing need for plate design innovation and continued research to capture the full spectrum of associated linked with SC hook plates.\u003c/p\u003e\u003cp\u003eThe SC hook plate has significantly advanced shoulder trauma surgery by providing immediate mechanical stability for acute traumatic dislocations. Its ability to effectively realign the joint, particularly in complex posterior dislocations, leading to enhanced functional recovery. This advancement is particularly crucial in managing dislocations near critical structures such as the trachea and blood vessels, where conventional methods may fall short. While the hook plate substantially improves patient outcomes, hardware-related complications, such as plate breakage and fixation failure, highlight the need for ongoing plate design innovation and surgical technique. Overall, the SC hook plate represents a significant advancement in shoulder trauma surgery, with continuous potential for refinement to mitigate complications and improve long-term success.\u003c/p\u003e\u003cp\u003eThe retrospective study design, small sample size, and limited follow-up duration are notable limitations, reduce the generalizability of findings and prevent a comprehensive assessment of long-term complications. To address these limitations, future research should include larger sample sizes, prospective studies, and extended follow-up periods to further explore the enduring efficacy of the plates. Additionally, recommending enhancements in implant design and surgical techniques is crucial for minimizing risks and ensuring superior outcomes for patients with SCJ dislocation.\u003c/p\u003e"},{"header":"4. Conclusion","content":"\u003cp\u003eThis study affirms the effectiveness of SC hook plates in stabilizing traumatic SCJ dislocations, particularly in cases requiring immediate mechanical stability. However, the observed hardware-related complications, such as fixation failure and plate breakages, highlight the need for ongoing innovation in implant design and surgical techniques. Future research should prioritize the development of more durable implants, comprehensive long-term outcome assessments, and individualized treatment strategies to optimize patient outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003eEthics Approval and Consent to Participate:\u003c/h3\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of\u0026nbsp;Taizhou Hospital of Zhejiang Province of Ethics Committee (Approval Number: kL20240919). Informed consent was obtained from all participants prior to inclusion in the study.\u003c/p\u003e\n\u003ch3\u003eConsent for Publication:\u003c/h3\u003e\n\u003cp\u003eWritten informed consent for publication of their clinical details and images was obtained from the parents or legal guardians of the patients. A copy of the consent form is available for review by the Editor of this journal.\u003c/p\u003e\n\u003ch3\u003eAvailability of Data and Materials:\u003c/h3\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003ch3\u003eCompeting Interests:\u003c/h3\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch3\u003eFunding:\u003c/h3\u003e\n\u003cp\u003eThis work was funded by the\u0026nbsp;Enze Medical Center (Group) Scientific Research Fund (19EZC28, 21EZD21).\u003c/p\u003e\n\u003ch3\u003eAuthors' Contributions:\u003c/h3\u003e\n\u003cp\u003e[Li Sheng] designed the study. [Jie Feng] collected and analyzed the data. [Xiaoyong Sheng] contributed to the writing and editing of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch3\u003eAcknowledgments:\u003c/h3\u003e\n\u003cp\u003eWe would like to thank Taizhou Hospital of Zhejiang Province for their assistance and support in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMiniato M. A.,Anand P., Varacallo M.,Anatomy, Shoulder and Upper Limb, Shoulder[J]2021,\u003c/li\u003e\n\u003cli\u003eKiel J.,Ponnarasu S., Kaiser K.,Sternoclavicular Joint Injury[J]2021,\u003c/li\u003e\n\u003cli\u003eWang S.,Chen Z.,Lin L., et al. ,Long-term results for traumatic sternoclavicular joint dislocation treated with a sternoclavicular joint-specific plate[J].ANZ J Surg,2021,91(4):653-657\u003c/li\u003e\n\u003cli\u003eTasnim S.,Shirafkan A., Okereke I.,Diagnosis and management of sternoclavicular joint infections: a literature review[J].J Thorac Dis,2020,12(8):4418-4426\u003c/li\u003e\n\u003cli\u003eLacheta L.,Dekker T. J.,Goldenberg B. T., et al. ,Minimum 5-Year Clinical Outcomes, Survivorship, and Return to Sports After Hamstring Tendon Autograft Reconstruction for Sternoclavicular Joint Instability[J].Am J Sports Med,2020,48(4):939-946\u003c/li\u003e\n\u003cli\u003eXin H.,Wang X.,Zhang S., et al. ,Novel sternoclavicular hook plate for the treatment of posterior sternoclavicular dislocation: a retrospective study[J].J Orthop Surg Res,2023,18(1):945\u003c/li\u003e\n\u003cli\u003eQu Y. Z.,Xia T.,Liu G. H., et al. ,Treatment of Anterior Sternoclavicular Joint Dislocation with Acromioclavicular Joint Hook Plate[J].Orthop Surg,2019,11(1):91-96\u003c/li\u003e\n\u003cli\u003eZhang C.,Lin L.,Liang J., et al. ,Efficacy analysis of a novel sternoclavicular hook plate for treatment of unstable sternoclavicular joint dislocation or fracture[J].J Orthop Surg (Hong Kong),2017,25(1):2309499016684488\u003c/li\u003e\n\u003cli\u003eMorell D. J., Thyagarajan D. S.,Sternoclavicular joint dislocation and its management: A review of the literature[J].World J Orthop,2016,7(4):244-250\u003c/li\u003e\n\u003cli\u003eBae D. S.,Kocher M. S.,Waters P. M., et al. ,Chronic recurrent anterior sternoclavicular joint instability: results of surgical management[J].J Pediatr Orthop,2006,26(1):71-74\u003c/li\u003e\n\u003cli\u003eGaines R. J.,Liporace F. A.,Yoon R. S., et al. ,A novel technique for ligamentous reconstruction of the sternoclavicular joint[J].J Orthop Trauma,2014,28(3):e65-69\u003c/li\u003e\n\u003cli\u003eQuayle J. M.,Arnander M. W.,Pennington R. G., et al. ,Artificial ligament reconstruction of sternoclavicular joint instability: report of a novel surgical technique with early results[J].Tech Hand Up Extrem Surg,2014,18(1):31-35\u003c/li\u003e\n\u003cli\u003eKeohane D., Morrissey D.,Repair of sternoclavicular joint ligament: a novel approach[J].Ir J Med Sci,2022,191(5):2141-2145\u003c/li\u003e\n\u003cli\u003eAdamcik S.,Ahler M.,Gioutsos K., et al. ,Repair of sternoclavicular joint dislocations with FiberWire((R))[J].Arch Orthop Trauma Surg,2017,137(3):341-345\u003c/li\u003e\n\u003cli\u003eAdamcik S.,Ahler M.,Gioutsos K., et al. ,Repair of sternoclavicular joint dislocations with FiberWire(\u0026reg;)[J].Arch Orthop Trauma Surg,2017,137(3):341-345\u003c/li\u003e\n\u003cli\u003eZhang C. Y.,Lin L.,Liang J. B., et al. ,[A new type sternoclavicular hook plate for unstable sternoclavicular joint dislocation and fracture][J].Zhongguo Gu Shang,2016,29(11):1040-1044\u003c/li\u003e\n\u003cli\u003eZhang Y.,Xing B.,Hou X., et al. ,A novel sternoclavicular hook plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular join[J].BMC Surg,2022,22(1):250\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is not available with this version.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Sternoclavicular Hook, Sternoclavicular joint Dislocation, Hardware Failure, Joint Stabilization, Postoperative Outcomes","lastPublishedDoi":"10.21203/rs.3.rs-6250193/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6250193/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThis study evaluates the efficacy and complications associated with sternoclavicular（SC）hook plates in treating traumatic sternoclavicular joint (SCJ) dislocations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA retrospectively analyzed on patients who underwent SC hook plates forfixation SCJ dislocations, focusing on hardware-related complications such as plate breakages and fixation failures. Clinical outcomes, functional recovery, and complications were assessed. Postoperative imaging, including X-raysand CT scans, was used to evaluate joint reduction and hardware integrity, Functional out comes were measured using the Constant Shoulder Score (CSS) and Visual Analog Scale (VAS) for pain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eSC\u003cstrong\u003e \u003c/strong\u003ehook plates effectively stabilized the joint and significantly improved function, as demonstrated by an increase in the mean CSS scores from 36.4 preoperatively to 86.6 postoperatively, and a decrease in VAS scores from 7.2 to 1.6. However, 4 patients (8.7%) experienced plate breakages without redislocation, and 1 patient (2%) experienced fixation failure, requiring revision surgeries. No major neurovascular complications were observed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eWhile SC hook plates provide effective stabilization for SCJ dislocations, they are associated with hardware-related complications, including plate breakages and fixation failures. Improvements in implant design, patient selection are necessary to address these issues and improve long-term outcomes. Future research should focus on the developing of more ergonomic implants and exploration of alternative treatment options.\u003c/p\u003e","manuscriptTitle":"Hook plates for sternoclavicular joint dislocations can be associated with hardware-related issues","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-31 06:43:13","doi":"10.21203/rs.3.rs-6250193/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"25c7a3ef-09cb-4cb7-a0fd-bd86f498f87e","owner":[],"postedDate":"March 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":45830381,"name":"Orthopedics"}],"tags":[],"updatedAt":"2025-03-31T06:43:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-31 06:43:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6250193","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6250193","identity":"rs-6250193","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}