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  • Applications for the shoulder fellowship starting in 2017 is now open.
    Please apply by visiting the Unit and sending your CV to Jan Barker
    Visits to the Reading shoulder unit are welcome - Please liaise with Jan Barker [Read more]
  • RSU is advertising for shoulder fellowship to start in July 2017
    a post-CCT shoulder fellowship for One year. please send CV to Mrs Jan Barker and arrange a visit to meet Prof Levy and Mr Sforza. [Read more]
  • Coming up courses:
    we invite you to join us:
    • Cadaveric Shoulder Arthroplasty Instructional course,  22-23 February 2018. Poznan, Poland.
    With UK and International faculty

    Limited places - Register early
    • GP Teaching event 21 March 2018 - Royal Berkshire Hospital
    The next GP teaching event will take place on 21 March 2018 at the Royal Berkshire Hospital, Trust Education Centre at 18:30 (Food will be provided)
    18:30 - 19:00 - arrival and registration 
    19:00 - 20:30 Teaching:
    • Algorithm for assesment and treatment of the painful shoulder
    • Examination of the shoulder
    • Advances in shoulder surgery

    I will encourage you to register early as places are limited. 

    For registration please e-mail or call on 01189028116.


  • New, New, New: Innovative Design Orthopaedics -
    IDO Isometer Shoulder Muscle Strength Gauge. [Read more]
  • Verso Stemless TSA with a new company Innovative Design Orthopaedics (IDO)
  • Shoulder study day for Physiotherapists
    Will be available soon.
    Please register your interest by e-mail to: [Read more]
  • For GPs - New!!! NHS Choose & Book
    The Unit at Berkshire Independent Hospital is open for NHS patients through Choose & Book (Extended Choice Network).
    Book online
    or contact the secretaries. [Read more]
  • Groundbreaking research from the Reading Shoulder Unit by Prof. Ofer Levy and his team regarding Propionibacterium Acnes and shoulder arthritis. 
    Propionibacterium acnes: an underestimated etiology in the pathogenesis of osteoarthritis?

    This is a very important article in that it suggests the presence of propionibacterium in previously unoperated shoulders with arthritis and furthermore that 'aseptic' failures of shoulder arthroplasty may, in fact, be related to indolent infections with this slow growing organism.
    Read comments by Dr Frederick A. Matsen III, M.D.
    [Read more]
  • New Survey on usage of shoulder replacement prostheses.
    Take the survey [Read more]
  • Listen to the BBC Radio4 programme - a day in the operating theatre at the Reading Shoulder Unit at the Royal Berkshire Hospital - Case Notes with Dr Mark Porter on Regional anaesthesia for shoulder surgery [Read more]
  • The least complications with the Verso shoulder compared with other reverse shoulder systems
    From the Royal National Orthopaedic Hospital, Birmingham, UK

    Bone Joint J 2013 vol. 95-B no. SUPP 27 25

    S. Robati, M.K. Shahid, J. Allport, A. Ray and G. Sforza 
  • Art at the Reading Shoulder and Elbow Centre
    Original fine art prints all dealing with human body in different situations by four artists are exhibited in the Reading Shoulder and Elbow centre 

    The prints on display are available to buy, with the artist contributing a donation to research. For more information please contact the secretaries in the unit.

    [Read more]
  • The Verso stemless rTSA is approved in Australia & New Zealand by the TGA.
    Its use is launched soon in Australia & New Zealand. 

  • Excellent clinical results over more than 11 years with the Verso rTSA.
    Very high patient satisfaction and return to full activities including sports. [Read more]
  • Cadaveric Shoulder Arthroplasty Instructional Course 22-23 February 2018 - Poznan, Poland

    Enquiries: Sean Bate +44 7469 191672
Fractures and Dislocations

Suture Fixation for Distal Clavicle Fractures



Suture Fixation for Distal Clavicle Fractures

Distal clavicle fractures comprise 15% of all clavicle fracture. Neer classified these fractures into 3 groups, based on the coraco-clavicular ligaments and the acromio-clavicular joint. The type 2 Neer fractures exhibit significant displacement. Conservative management has a high rate of delayed and non-union.

Operative management is therefore recommended. Various surgical procedures are available which include trans acromial wires, coraco-clavicular screws, (hook)plates and more recently the tight rope.


Technique of  Suture Fixation:

The patient is placed in the beach chair position. An image intensifier is positioned to allow adequate imaging of the fracture. A small longitudinal skin incision (usually about 3 cm) is made over the fracture site. The delto-trapezial fascia is incised horizontally to expose the fracture. The fracture ends are refreshed. A 2 mm drill hole is made in the distal fragment. A PDS loop is passed through the drill hole from anterior to posterior and used to shuttle a PDS cord through. A second  drill hole is made in the proximal fragment. The posterior limb of the PDS cord is passed over the fracture site and brought anteriorly. This is then passed through the proximal drill hole from anterior to posterior using the PDS loop. The fracture is then reduced by elevating the arm and the PDS cord is tied over the top in a figure of eight.

The patients are then placed in a polysling with a body belt for 6 weeks before mobilising the shoulder.

Fig 1 : Diagramatic representation of Technique

Fig 2: Introperative image showing Fig of 8 loop in situ

This technique is simple with good clinical outcome. It avoids the need for extensive exposure, especially around the coracoid, and provides good cosmesis.

Fig 3a: Pre op Radiograph

Fig 3a: Post op Radiograph



Simple, minimally invasive surgical technique for treatment of type 2 fractures of the distal clavicle. Ofer Levy, MD, MCh(Orth), Reading Shoulder Unit, Berkshire, United Kingdom.
J Shoulder Elbow Surg, January/February 2003; 12 (1); 24-28.