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Non-operative treatment of a fracture to the coracoid process with acromioclavicular dislocation in an adolescent.

Pedersen V, Prall WC, Ockert B, Haasters F - Orthop Rev (Pavia) (2014)

Bottom Line: Since magnetic resonance tomography revealed intact AC and coracoclavicular ligaments, we initiated non-operative treatment with immobilization and unloading of the shoulder by an abduction brace allowing limited rotation for 6 weeks.This treatment resulted in complete recovery after 8 weeks and return to full sports on first league level after 3 month.In conclusion, non-operative treatment of coracoid base fractures with concomitant AC-joint injury in the adolescent can result in excellent functional results and early recovery.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University of Munich , Germany.

ABSTRACT
Coracoid process fractures are rare and often associated with dislocations of the acromioclavicular (AC) joint. There is little evidence about the treatment of these injuries in adolescents, but the few case reports published recommend surgery. We report a case of a dislocated epiphyseal fracture to the base of the coracoid process with AC joint dislocation in a 14-year-old ice-hockey player following direct impact to his left shoulder. Since magnetic resonance tomography revealed intact AC and coracoclavicular ligaments, we initiated non-operative treatment with immobilization and unloading of the shoulder by an abduction brace allowing limited rotation for 6 weeks. This treatment resulted in complete recovery after 8 weeks and return to full sports on first league level after 3 month. In conclusion, non-operative treatment of coracoid base fractures with concomitant AC-joint injury in the adolescent can result in excellent functional results and early recovery.

No MeSH data available.


Related in: MedlinePlus

Functional, cosmetic and radiographic outcome 8 weeks after trauma. Full pain free range of motion was achieved as shown in A-D. A slight prominence is seen at the left lateral clavicle (E). Complete bony healing was confirmed by magnetic resonance imaging 6 month after trauma (F-G).
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fig003: Functional, cosmetic and radiographic outcome 8 weeks after trauma. Full pain free range of motion was achieved as shown in A-D. A slight prominence is seen at the left lateral clavicle (E). Complete bony healing was confirmed by magnetic resonance imaging 6 month after trauma (F-G).

Mentions: We started non-operative treatment on first presentation with immobilization in a Camo®Shoulder brace (OPED, Valley/Oberlaindern, Germany). This device allows resting of the 90° flexed elbow on a pad, thereby partially unloading the shoulder girdle, with fixed abduction of 15° and internal rotation of 45° (Figure 2A). At clinical and radiological follow-up 2 weeks later, the patient presented with persisting tenderness over the coracoid process but less tenderness over the AC joint. Active ROM was still markedly restricted (Abd/Add: 60-0-10°; F/E: 60-0-30°; ER/IR: 40-0-80°). The radiographs ruled out a secondary dislocation of the coracoid process. Passive rotation of the shoulder within the dynamic brace was allowed between 30 and 60° IR from week 4 and between 20 to 80° IR from week 5 (Figure 2B). At 8 weeks follow-up the patient presented completely pain-free with full ROM (Figure 3A-D) and without tenderness on palpation over the coracoid or the AC joint. Clinical tests for the AC joint, rotator cuff and long biceps tendon revealed to be normal. After week 8 the patient resumed ice-hockey training and regained sports activity on first league level after 12 weeks. After 5 months he presented with mild symptoms of subcoracoid impingement which was successfully treated with physiotherapy within 6 weeks. A MRI confirmed complete bony healing of the coracoid fracture without malalignement, a coracohumeral distance of 13mm and signs of a mild subcoracoid bursitis (Figure 3F,G).


Non-operative treatment of a fracture to the coracoid process with acromioclavicular dislocation in an adolescent.

Pedersen V, Prall WC, Ockert B, Haasters F - Orthop Rev (Pavia) (2014)

Functional, cosmetic and radiographic outcome 8 weeks after trauma. Full pain free range of motion was achieved as shown in A-D. A slight prominence is seen at the left lateral clavicle (E). Complete bony healing was confirmed by magnetic resonance imaging 6 month after trauma (F-G).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4195993&req=5

fig003: Functional, cosmetic and radiographic outcome 8 weeks after trauma. Full pain free range of motion was achieved as shown in A-D. A slight prominence is seen at the left lateral clavicle (E). Complete bony healing was confirmed by magnetic resonance imaging 6 month after trauma (F-G).
Mentions: We started non-operative treatment on first presentation with immobilization in a Camo®Shoulder brace (OPED, Valley/Oberlaindern, Germany). This device allows resting of the 90° flexed elbow on a pad, thereby partially unloading the shoulder girdle, with fixed abduction of 15° and internal rotation of 45° (Figure 2A). At clinical and radiological follow-up 2 weeks later, the patient presented with persisting tenderness over the coracoid process but less tenderness over the AC joint. Active ROM was still markedly restricted (Abd/Add: 60-0-10°; F/E: 60-0-30°; ER/IR: 40-0-80°). The radiographs ruled out a secondary dislocation of the coracoid process. Passive rotation of the shoulder within the dynamic brace was allowed between 30 and 60° IR from week 4 and between 20 to 80° IR from week 5 (Figure 2B). At 8 weeks follow-up the patient presented completely pain-free with full ROM (Figure 3A-D) and without tenderness on palpation over the coracoid or the AC joint. Clinical tests for the AC joint, rotator cuff and long biceps tendon revealed to be normal. After week 8 the patient resumed ice-hockey training and regained sports activity on first league level after 12 weeks. After 5 months he presented with mild symptoms of subcoracoid impingement which was successfully treated with physiotherapy within 6 weeks. A MRI confirmed complete bony healing of the coracoid fracture without malalignement, a coracohumeral distance of 13mm and signs of a mild subcoracoid bursitis (Figure 3F,G).

Bottom Line: Since magnetic resonance tomography revealed intact AC and coracoclavicular ligaments, we initiated non-operative treatment with immobilization and unloading of the shoulder by an abduction brace allowing limited rotation for 6 weeks.This treatment resulted in complete recovery after 8 weeks and return to full sports on first league level after 3 month.In conclusion, non-operative treatment of coracoid base fractures with concomitant AC-joint injury in the adolescent can result in excellent functional results and early recovery.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University of Munich , Germany.

ABSTRACT
Coracoid process fractures are rare and often associated with dislocations of the acromioclavicular (AC) joint. There is little evidence about the treatment of these injuries in adolescents, but the few case reports published recommend surgery. We report a case of a dislocated epiphyseal fracture to the base of the coracoid process with AC joint dislocation in a 14-year-old ice-hockey player following direct impact to his left shoulder. Since magnetic resonance tomography revealed intact AC and coracoclavicular ligaments, we initiated non-operative treatment with immobilization and unloading of the shoulder by an abduction brace allowing limited rotation for 6 weeks. This treatment resulted in complete recovery after 8 weeks and return to full sports on first league level after 3 month. In conclusion, non-operative treatment of coracoid base fractures with concomitant AC-joint injury in the adolescent can result in excellent functional results and early recovery.

No MeSH data available.


Related in: MedlinePlus