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  • For Patients, GPs & Physiotherapies - 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]
  • Excellent clinical results over more than 13 years with the Verso rTSA.
    Very high patient satisfaction and return to full activities including sports. [Read more]
  • The least complications with the Verso shoulder compared with other reverse shoulder systems
    From the Royal National Orthopaedic Hospital, Birmingham, UK
    S. Robati, M.K. Shahid, J. Allport, A. Ray and G. Sforza
    Bone & Joint Journal 2013, Vol. 95-B Supp. 25-27

    Complication Rates From Three Commonly Used Reverse Polarity Total Shoulder Replacements: A Minimum Two Year Follow-Up Of 64 Cases
  • Excellent results with the Verso TSA were published in Italy! 
    A group of oorthopaedic surgeons from northern Italy from Piacenza and Verona published their first few years experience with the stemless reverse TSA - The VERSO. 
    They present Excellent clinical and radiologic results that mirror the results of the designing centre!
    (Read more) [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]
  • 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]
  • 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.
    and it was launched and in increase use in Australia. 

  • Due to the current state of lockdown due the Coronavirus outbreak, We offer Virtual Video consultations for post-operative patients and follow-up and offer Virtual Video consultations for advice for new patients.

    If interested please call:
    Prof. Ofer Levy - Secretary - Cherie 07800875033
    Mr. Giuseppe Sforza - Secretary - Tania 07488384479
    NHS - Secretary - Gail 0118 902 8109
      [Read more]
  • Further scientific support from Robert Hudek et al. paper to Prof. Levy’s theory on the role of C Acnes in the aetiology of Osteoarthritis (Read More)
  • The RSU Academy Course for GPs and Physiotherapists will take place virtually, via Zoom,

    weekly every Wednesday between 19:00 - 20:00 UK time.

    This week on the 18/11/2020:

    Shoulder Instability - Diagnosis and treatment options – Update

    [Read more]
  • תן כתף לשלום

    מומחה ישראלי ומומחה פלסטיני משתלמים ביחד אצל פרופ׳ עפר לוי המנהל את המרכז הבינלאומי לכירורגיה של הכתף ברידינג. האם כאן יתחיל השלום במזרח התיכון? שיחה

    [Read more]
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.