Clavicle hook plate fixation for displaced lateral-third clavicle fractures (Neer type II): a functional outcome study Daniel W. Good, BA, MRCSI*, Darren F. Lui, MCh, MRCS, Michael Leonard, MCh, MRCS, Seamus Morris, MCh, FRCS (Trauma Orth), John P. McElwain, FRCS (Trauma Orth) Department of Trauma Orthopaedics, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children’s Hospital, Dublin, Ireland Background: Controversy exists with the use of the acromioclavicular hook plate for the treatment of lateral-third clavicle fractures (Neer type II). This is thought to stem from problems associated with the hook plate causing impingement symptoms, which can cause long-term limitation of movement and pain. Our aim was to evaluate the functional outcomes of patients with lateral-third clavicle fractures treated with the hook plate. Methods: We prospectively reviewed all patients who underwent surgery from July 2005 to August 2009 using our prospectively recorded electronic patient information database. All patients were assessed in the clinic to determine both Oxford and Constant shoulder scores. Results: We identified 36 patients who underwent surgery with the hook plate, 26 men and 10 women. The mean age was 36.2 years (range, 22-60 years). Of the patients, 46% were smokers. The median length of hospital stay was 2 days (interquartile range [IQR], 1-3). The median follow-up was 28 months (IQR, 23-37). The median time from date of injury to surgery was 7 days (IQR, 4-76). The mean time to union was 3 months (IQR, 2-4), and the union rate was 95%. In total, 92% of plates were removed. The median time to removal was 4.5 months (IQR, 3-8.75). There were no complications. Two patients pre- sented months later after falls with fractures around the medial end of the hook plate. Conclusion: Hook plates are an effective form of treatment for lateral third clavicle fractures. The best outcomes occur with plate removal before 6 months postoperatively, provided that the fracture has healed. Level of evidence: Level IV, Case Series, Treatment Study. Ó 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Keywords: Hook plate; functional outcomes; lateral-third clavicle fractures; constant score There is equipoise for many surgeons with regard to the management of displaced lateral-third fractures of the clavicle (Neer type II) (Fig. 1). This stems from the fact that both conservative treatment and surgical treatment are associated with complications. Conservative management This study received institutional ethical board approval. *Reprint requests: Daniel W. Good, MB, BCh, BAO, BA, MRCSI, Department of Trauma Orthopaedics, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children’s Hospital, Tallaght, Dublin 24, Ireland. E-mail address: goodd@tcd.ie (D.W. Good). J Shoulder Elbow Surg (2012) 21, 1045-1048 www.elsevier.com/locate/ymse 1058-2746/$ - see front matter Ó 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. doi:10.1016/j.jse.2011.07.020