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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.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.

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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Postoperative computed tomography scan for determination of the position of the coracoid process with attached osseous piece taken immediately after the intervention.
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Fig6: Postoperative computed tomography scan for determination of the position of the coracoid process with attached osseous piece taken immediately after the intervention.

Mentions: His immediate postoperative CT scan showed an optimal position of the coracoid process as well as the osseous piece attached to the conjoined tendons (Figure 6). After the procedure, his shoulder was immobilized in an arm sling for two weeks. Passive physiotherapy (90° anteversion, 90° abduction, 30° outer rotation) was recommended for six weeks. After completing this course of physiotherapy he was allowed to move his shoulder actively in every direction. Contact sports were allowed approximately four months after verification of proper bone remodeling.


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)

Postoperative computed tomography scan for determination of the position of the coracoid process with attached osseous piece taken immediately after the intervention.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig6: Postoperative computed tomography scan for determination of the position of the coracoid process with attached osseous piece taken immediately after the intervention.
Mentions: His immediate postoperative CT scan showed an optimal position of the coracoid process as well as the osseous piece attached to the conjoined tendons (Figure 6). After the procedure, his shoulder was immobilized in an arm sling for two weeks. Passive physiotherapy (90° anteversion, 90° abduction, 30° outer rotation) was recommended for six weeks. After completing this course of physiotherapy he was allowed to move his shoulder actively in every direction. Contact sports were allowed approximately four months after verification of proper bone remodeling.

Bottom Line: He was able to return to his job.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.

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