Novel Lag Screw Application In The Reduction Of Neer Type V Distal Clavicle Fracture - A Case Report And Technical Note

Sep 30, 2026

A case report describes a novel lag screw application to support direct anatomical reduction of an inferior fragment in Neer Type V distal clavicle fractures, an unstable injury requiring restoration of the coracoclavicular ligament. The article outlines the technical rationale for extending lag screw use within a stable plate-screw construct to promote bone-to-bone healing. It also emphasizes reducing reliance on extensive soft-tissue dissection compared with alternative fixation methods while addressing the traditionally difficult inferior fragment reduction.

LanguageEnglish

CategoryHealthcare

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Pages5

Reading Time13 min

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Abstract

Introduction

Case Report

Surgical technique

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Case Report Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 27-31 NovelLag Screw Application In The Reduction Of Neer Type V Distal Clavicle Fracture: A Case Report And Technical Note Shaun Kai Kiat Chua1, Don Thong Siang Koh2, Junkai Liow1, Michael Gui Jie Yam1 Learning Point of the Article: An extended application of a lag screw as a reduction technique in Neer Type V distal clavicle fractures utilizes fundamental trauma principles to offer a simple alternative technique to achieve direct anatomical reduction of the inferior fracture fragment in a stable plate screw construct without the need for extensive soft-tissue dissection. Abstract Introduction: Neer Type V distal clavicle fractures are an unstable fracture configuration that is often treated with surgery. Type V fractures are challenging as the integrity of the coracoclavicular ligament needs to be restored by reducing the inferior fragment – a technically challenging endeavor. Multiple heterogeneous surgical techniques have been proposed in the literature to treat unstable distal clavicle fractures without any consensus onbest practice. To date, there remains a lack of described effective techniquesto aid in reducing the inferior fracture fragment inNeer Type V distal clavicle fractures. Case Report: We employ a novel method of applying a lag screw technique to aid in the reduction of the inferior fragment to solve this notoriously challenging fracture pattern. Conclusion: This novel technique builds on fundamental trauma concepts. The extended use of a lag screw as a reduction technique in distal clavicle fractures has not been described in the literature before. This reduction technique reduces the need for extensive soft-tissue dissection for coracoid exposure, as described in other techniques (e.g., suture anchor or button fixations), while enabling direct incorporation of the inferior fragment, bone-to-bone healing, and benefits fromthe stability ofa plate-screw construct. Keywords: Clavicle fracture, distal, type V, Neer, reduction,lag screw, technique. Introduction Neer Type V distal clavicle fractures are unstable fractures that are notoriously challenging to fix. Type V fractures are described by Neer as an unstable fracture pattern with an inferior clavicle fragment attached to the coracoclavicular ligament [1]. Due to the forces acting on the distal clavicle, high rates ofmalunion and non-union are associated with Type II and Type V fractures [2]. Non-union rates in non-surgical management of distal clavicle fractures havebeen reported to beas high asathird ofcases [3]. Multiple techniques have been proposed in literature without any consensus on best practice to date [3, 4, 5]. Often, indirect techniques are employed to incorporate the reduction of the inferior fragment (clavicle fragment to which the coracoclavicular ligament remains attached) in a Type V fracture [3, 4, 5]. The authors aim tosharea novel use of the lag screwtechnique to aid in thereduction ofaNeer Type V distal clavicle fracture. |
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Website: [www.jocr.co.in](www.jocr.co.in)

DOI:
[https://doi.org/10.13107/jocr.2025.v15.i12.6442](https://doi.org/10.13107/jocr.2025.v15.i12.6442) | Author’s Photo Gallery | | | | | --- | --- | --- | --- | --- | | |
Dr. Shaun Kai Kiat Chua |
Dr. Don Thong Siang Koh | |
Dr. Michael Gui Jie Yam | | |
1Department of Orthopedic Surgery, Tan Tock Seng Hospital, Singapore, 2Department of Orthopedic Surgery, Singapore General Hospital, Singapore.
Address of Correspondence:
Dr. Shaun Kai Kiat Chua,
Department of Orthopedic Surgery, Tan Tock Seng Hospital, Singapore.
E-mail: [shaunkkchua@gmail.com](shaunkkchua@gmail.com) | | | | | Submitted: 16/09/2025; Review: 26/10/2025; Accepted: November 2025; Published: December 2025 | | | | | | DOI: [https://doi.org/10.13107/jocr.2025.v15.i12.6442](https://doi.org/10.13107/jocr.2025.v15.i12.644

FAQs

What problem does the novel lag screw technique address in Neer Type V distal clavicle fractures?

It addresses the technically challenging reduction of the inferior clavicle fragment required to restore the coracoclavicular ligament.

What is the main goal of using a lag screw in this case report?

To aid direct anatomical reduction of the inferior fragment and incorporate it for bone-to-bone healing within a stable plate-screw construct.

How does the technique aim to differ from other commonly described fixation approaches?

It reduces the need for extensive soft-tissue dissection for coracoid exposure compared with approaches such as suture anchor or button fixations.

Sep 30, 2026

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