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Avulsion fracture of the coracoid process in a patient with chronic anterior shoulder instability treated with the Latarjet procedure: a case report.

Schneider MM, Balke M, Koenen P, Bouillon B, Banerjee M - J Med Case Rep (2014)

Bottom Line: He was able to return to his job.We opted for a coracoid transfer and achieved an optimal reconstruction, as shown on the postoperative computed tomography scan.An avulsion fracture of the coracoid process with dislocation of the conjoined tendons can not only be found in patients suffering a direct trauma as pointed out in the literature, but also in patients with anterior shoulder instability with recurrent anterior shoulder dislocation.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Traumatology and Sports Medicine, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str, 200, D-51109 Cologne, Germany. marco.schneider@orthopia.com.

ABSTRACT

Introduction: Shoulder dislocations can cause acute and chronic instabilities that need to be addressed in order to restore joint functioning. The transfer of the coracoid process has become a feasible surgical procedure in patients with shoulder instability. Several concomitant injuries after recurrent dislocations have been described.

Case presentation: A 32-year-old German man presented to our department with a history of recurrent shoulder dislocations. He was diagnosed with an avulsion fracture of the coracoid process and dislocation of an osseous piece with attachment to the conjoined tendons during the surgical transfer of the coracoid process. Therefore, we performed an open Latarjet procedure and reattached the bony piece with the conjoined tendons to the glenoid rim. Three months after the operation the patient presented with a satisfying range of motion and without instabilities or pain. He was able to return to his job.

Conclusions: Patients suffering from anterior shoulder dislocation might develop accompanying lesions after numerous dislocations that are not present upon first visit. Different techniques for the reconstruction of the glenoid rim and the restoration of shoulder joint stability have been described in the literature. We opted for a coracoid transfer and achieved an optimal reconstruction, as shown on the postoperative computed tomography scan. An avulsion fracture of the coracoid process with dislocation of the conjoined tendons can not only be found in patients suffering a direct trauma as pointed out in the literature, but also in patients with anterior shoulder instability with recurrent anterior shoulder dislocation.

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Fixation of the coracoid process with the attached osseous piece to the glenoid rim.
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Fig5: Fixation of the coracoid process with the attached osseous piece to the glenoid rim.

Mentions: The examination under anesthesia confirmed the anterior shoulder instability. The operation was performed in the beach chair position. After sterile cleaning and draping we used the deltopectoral approach. After preparation and sectioning of the clavipectoral fascia we displayed the coracoid bone. At that stage we noticed that the conjoined tendons were not attached to the coracoid process. The tendon of the pectoralis minor, the short head of the biceps brachii and the coracobrachialis muscle were proximally ossified about 2cm lateral of the coracoid process. We concluded that he suffered an avulsion fracture of the coracoid process. The coracoid process was then transferred in an open Latarjet procedure, with re-fixation of the avulsion fracture with attached conjoined tendons to the glenoid rim. We used two 4mm screws (length 26mm and 32mm) for re-fixation of the coracoid process and the bone fragment (FiguresĀ 4 and 5).


Avulsion fracture of the coracoid process in a patient with chronic anterior shoulder instability treated with the Latarjet procedure: a case report.

Schneider MM, Balke M, Koenen P, Bouillon B, Banerjee M - J Med Case Rep (2014)

Fixation of the coracoid process with the attached osseous piece to the glenoid rim.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4265481&req=5

Fig5: Fixation of the coracoid process with the attached osseous piece to the glenoid rim.
Mentions: The examination under anesthesia confirmed the anterior shoulder instability. The operation was performed in the beach chair position. After sterile cleaning and draping we used the deltopectoral approach. After preparation and sectioning of the clavipectoral fascia we displayed the coracoid bone. At that stage we noticed that the conjoined tendons were not attached to the coracoid process. The tendon of the pectoralis minor, the short head of the biceps brachii and the coracobrachialis muscle were proximally ossified about 2cm lateral of the coracoid process. We concluded that he suffered an avulsion fracture of the coracoid process. The coracoid process was then transferred in an open Latarjet procedure, with re-fixation of the avulsion fracture with attached conjoined tendons to the glenoid rim. We used two 4mm screws (length 26mm and 32mm) for re-fixation of the coracoid process and the bone fragment (FiguresĀ 4 and 5).

Bottom Line: He was able to return to his job.We opted for a coracoid transfer and achieved an optimal reconstruction, as shown on the postoperative computed tomography scan.An avulsion fracture of the coracoid process with dislocation of the conjoined tendons can not only be found in patients suffering a direct trauma as pointed out in the literature, but also in patients with anterior shoulder instability with recurrent anterior shoulder dislocation.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Traumatology and Sports Medicine, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str, 200, D-51109 Cologne, Germany. marco.schneider@orthopia.com.

ABSTRACT

Introduction: Shoulder dislocations can cause acute and chronic instabilities that need to be addressed in order to restore joint functioning. The transfer of the coracoid process has become a feasible surgical procedure in patients with shoulder instability. Several concomitant injuries after recurrent dislocations have been described.

Case presentation: A 32-year-old German man presented to our department with a history of recurrent shoulder dislocations. He was diagnosed with an avulsion fracture of the coracoid process and dislocation of an osseous piece with attachment to the conjoined tendons during the surgical transfer of the coracoid process. Therefore, we performed an open Latarjet procedure and reattached the bony piece with the conjoined tendons to the glenoid rim. Three months after the operation the patient presented with a satisfying range of motion and without instabilities or pain. He was able to return to his job.

Conclusions: Patients suffering from anterior shoulder dislocation might develop accompanying lesions after numerous dislocations that are not present upon first visit. Different techniques for the reconstruction of the glenoid rim and the restoration of shoulder joint stability have been described in the literature. We opted for a coracoid transfer and achieved an optimal reconstruction, as shown on the postoperative computed tomography scan. An avulsion fracture of the coracoid process with dislocation of the conjoined tendons can not only be found in patients suffering a direct trauma as pointed out in the literature, but also in patients with anterior shoulder instability with recurrent anterior shoulder dislocation.

Show MeSH
Related in: MedlinePlus