{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:08:16Z","timestamp":1790996896606,"version":"4.1.0"},"reference-count":21,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Unstable distal clavicle fractures (Neer type II) have a relatively high risk of nonunion and often require operative fixation. Hook plates are widely used, particularly when the distal fragment is small or comminuted, because they provide strong vertical stability. However, hook plates are associated with subacromial irritation, acromial wear, and the need for routine implant removal. Distal locking plates with supplementary cerclage augmentation can achieve fixation without subacromial impingement and may reduce implant-related complications. This study aimed to compare clinical and radiologic outcomes of hook plates versus locking plates with or without cerclage augmentation for Neer type II distal clavicle fractures. Materials and Methods: In this single-center retrospective cohort, adult patients with Neer type II distal clavicle fractures who underwent open reduction and internal fixation between March 2021 and August 2022, with \u22656 months of follow-up, were reviewed. Patients were allocated into two groups according to implant: hook plate (Group 1, n = 16) and distal locking plate with or without cerclage augmentation (Group 2, n = 26). Primary outcomes were complication rate, radiographic union, and shoulder range of motion (ROM). Secondary outcomes included pain (PVAS) and functional scores (SANE, ASES, Constant, UCLA). Results: Forty-two patients were analyzed (locking n = 26, hook n = 16). Groups were comparable in age (51.3 \u00b1 16.0 vs. 54.4 \u00b1 17.1 years), follow-up (7.0 \u00b1 4.0 vs. 8.4 \u00b1 4.3 months), sex distribution, smoking status, and mechanism of injury. Radiographic union was achieved in 24\/26 (92.3%) patients in the locking group and 14\/16 (87.5%) in the hook group; two cases of nonunion or reduction failure occurred in each group (p = 0.612). Final patient-reported outcomes and ROM were similar between groups (e.g., ASES 68.2 \u00b1 15.5 vs. 64.4 \u00b1 18.3, Constant 57.3 \u00b1 9.5 vs. 44.9 \u00b1 20.5; all p &gt; 0.05). Forward flexion tended to be higher in the locking group (138.9 \u00b1 28.0\u00b0 vs. 113.3 \u00b1 36.7\u00b0, p = 0.182), although without statistical significance. No deep infection, peri-implant fracture, or hardware failure requiring unplanned revision was observed. Subacromial wear was identified in four patients (25%) in the hook plate group, whereas no such change was observed in the locking group. Conclusions: Both hook plates and distal locking plates (\u00b1cerclage) provided high union rates and satisfactory functional outcomes for Neer type II distal clavicle fractures. However, hook plates were associated with subacromial wear, whereas locking plate constructs avoided subacromial complications. When distal fragment purchase is feasible\u2014or can be supplemented with cerclage augmentation\u2014locking plate fixation represents a reliable first-line option, with hook plates reserved for cases with minimal distal bone stock or complex comminution.<\/jats:p>","DOI":"10.3390\/medicina62010002","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T12:05:35Z","timestamp":1766145935000},"page":"2","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Locking Plate With or Without Cerclage Augmentation Versus Hook Plate for Neer Type II Distal Clavicle Fractures: A Single-Center Retrospective Cohort"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7665-536X","authenticated-orcid":false,"given":"Hyojune","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital of Chung-Ang University of Medicine, Dongjak-gu, Seoul 06973, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8004-3016","authenticated-orcid":false,"given":"Jaeyoung","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Eulji University Hospital, Eulji University School of Medicine, Daejeon 35233, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1186\/s13018-019-1518-x","article-title":"Clavicle hook plate versus distal clavicle locking plate for Neer type II distal clavicle fractures","volume":"14","author":"Li","year":"2019","journal-title":"J. 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