🔩 Common Fixation Devices Used for AC Joint / Distal Clavicle Surgery

🔩 Common Fixation Devices Used for AC Joint / Distal Clavicle Surgery:

1. Hook Plate – a contoured plate that hooks under the acromion to stabilize the distal clavicle.

Radiographically: long plate along the clavicle with a hook projecting beneath the acromion.

2. Clavicular Locking Plate – low-profile plate with multiple screws along the distal clavicle.

Radiographically: several screws seen linearly along the clavicle.

3. EndoButton / TightRope (Suture-Button Device) – two small metallic buttons connected by a high-strength suture for coracoclavicular ligament reconstruction.

It is a suture-button device used to stabilize the coracoclavicular (CC) joint, typically for severe acromioclavicular (AC) joint separations or distal clavicle fractures. The surgical procedure involves drilling tunnels through the clavicle and coracoid process and then passing a strong suture with two buttons through these tunnels.The buttons are then secured on either side of the bone, effectively mimicking and reinforcing the natural CC ligaments, which holds the clavicle and coracoid together. 

Radiographically: On standard AP or scapular Y views:

Superior button (clavicular side): appears as small, round or rectangular metallic opacity over the superior surface of the distal clavicle. Usually the most visible part (seen end-on).

Inferior button (coracoid side): Often faint or obscured by overlying bone of the coracoid or glenoid. May appear as a second small metallic density inferior to the clavicle, but not always distinct on AP view.

Connecting suture is radiolucent (not seen). Only the buttons are radiopaque.