Abstract
Lateral-end clavicle fractures, especially unstable Neer IIb patterns, are prone to nonunion due to disruption of the acromioclavicular (AC) ligaments. Conventional plate or hook plate fixation may provide inadequate stability. Locking plate fixation augmented with AC TightRope (Arthrex, Naples, FL, USA) or suture button construct aims to improve stability, accelerate healing, and enhance functional recovery. The objective of this study is to evaluate the efficacy of augmented fixation compared with conventional fixation in terms of union, functional outcomes, pain, and complications. A systematic review and meta-analysis of studies published up to October 2025 was conducted, including clinical and biomechanical studies comparing locking plate with or without AC augmentation. Outcomes included Constant-Murley Score (CMS), Visual Analog Scale (VAS), union rate, union time, and complications. Quality was assessed using the Newcastle-Ottawa Scale and a biomechanical checklist. Five studies met the inclusion criteria. Augmented fixation showed higher CMS (MD = 4.4; 95% CI [2.1, 6.7]), faster union (-2.2 weeks; 95% CI [-3.5, -0.9]), lower VAS (-1.54; 95% CI [-2.3, -0.8]), and fewer complications (OR = 0.38; 95% CI [0.15, 0.95]) compared with conventional fixation. Union rates were consistently high (97-100%) in clinical studies, and biomechanical data demonstrated superior construct stability. Locking plate fixation with AC TightRope or suture-button augmentation provides improved function, faster healing, reduced pain, and lower complication rates in unstable lateral-end clavicle fractures.