الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
 |  | from | 132 |  |  |
| | | from | 132 | | |
Abstract
Study limitations: various limitations still existed, including the following:
This study was a small series because unstable distal clavicle fractures were relatively rare. The operations were not performed by a single surgeon, and the level of experience could influence the outcome as tightrope procedure need more experience. Distal clavicle fractures account for roughly 10%–30% of all clavicle fractures and some may be treated by conservative management. It is widely accepted, however, that unstable distal clavicle fractures require surgical treatment to obtain superior clinical outcomes (i.e., lower nonunion rates) compared to those of conservative treatment. There are many fixation options for the treatment of distal clavicle fractures, such as precontoured locking plate, hook plate, CC fixation with a screw or flexible material, arthroscopic technique, tension band wiring, and trans acromial fixation. Both fixation techniques used in our study have their advantages and disadvantages. We can use tightrope in old patients by experienced surgeon to save time and to avoid second surgery as most of old patients have comorbidities and not fit for more surgeries. We can also use hook plate in young muscular patients to achieve a safe and good anatomic reduction and early rehabilitation and return to work after metal removal from 3 to 6 months. However, to date, consensus has not been reached on which fixation method is the gold standard. Furthermore, there are no prospective randomized studies enabling a comparison of these different approaches. Therefore, surgeons should be skilled with various fixation methods and decide with their patient which approach is most appropriate for them. Further studies with high levels of evidence are needed to determine the best treatment approach for distal clavicle fractures.