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

Journal of Medical Case Reports

Marc Banerjee²  Bertil Bouillon²  Paola Koenen²  Maurice Balke³  Marco Michael Schneider¹ 

[1] Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland;Department of Orthopaedic Surgery, Traumatology and Sports Medicine, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109 Cologne, Germany;Sportsclinic Cologne – Practice for Sportstraumatology, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109 Cologne, Germany

关键词: Recurrent shoulder dislocation;    Latarjet;    Anterior shoulder instability;    Coracoid process;    Avulsion fracture;   

Others  :  1180959
DOI  :  10.1186/1752-1947-8-394

 received in 2014-03-19, accepted in 2014-09-17,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Schneider et al.; licensee BioMed Central Ltd.

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【 参考文献 】

• [1]Neyton L, Young A, Dawidziak B, Visona E, Hager JP, Fournier Y, Walch G: Surgical treatment of anterior instability in rugby union players: clinical and radiographic results of the Latarjet-Patte procedure with minimum 5-year follow-up. J Shoulder Elb Surg 2012, 21:1721-1727.
• [2]Yamamoto N, Muraki T, An KN, Sperling JW, Cofield RH, Itoi E, Walch G, Steinmann SP: The stabilizing mechanism of the latarjet procedure: a cadaveric study. J Bone Joint Surg Am 2013, 95:1390-1397.
• [3]Giles JW, Boons HW, Elkinson I, Faber KJ, Ferreira LM, Johnson JA, Athwal GS: Does the dynamic sling effect of the Latarjet procedure improve shoulder stability? A biomechanical evaluation. J Shoulder Elb Surg 2013, 22:821-827.
• [4]Stevens KJ, Preston BJ, Wallace WA, Kerslake RW: CT imaging and three-dimensional reconstructions of shoulders with anterior glenohumeral instability. Clin Anat 1999, 12:326-336.
• [5]Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A: Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am 2003, 85-A:878-884.
• [6]Bigliani LU, Newton PM, Steinmann SP, Connor PM, McLlveen SJ: Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med 1998, 26:41-45.
• [7]D’Elia G, Di Giacomo A, D’Alessandro P, Cirillo LC: Traumatic anterior glenohumeral instability: quantification of glenoid bone loss by spiral CT. La Radiologia Medica 2008, 113:496-503.
• [8]Griffith JF, Antonio GE, Tong CW, Ming CK: Anterior shoulder dislocation: quantification of glenoid bone loss with CT. AJR Am J Roentgenol 2003, 180:1423-1430.
• [9]Griffith JF, Antonio GE, Yung PS, Wong EM, Yu AB, Ahuja AT, Chan KM: Prevalence, pattern, and spectrum of glenoid bone loss in anterior shoulder dislocation: CT analysis of 218 patients. AJR Am J Roentgenol 2008, 190:1247-1254.
• [10]Eyres KS, Brooks A, Stanley D: Fractures of the coracoid process. J Bone Joint Surg (Br) 1995, 77:425-428.
• [11]Kalicke T, Andereya S, Gekle J, Muller EJ, Muhr G: Coracoid pseudarthrosis caused by anterior shoulder dislocation with concomitant coracoid fracture. Unfallchirurg 2002, 105:843-844.
• [12]Asbury S, Tennent TD: Avulsion fracture of the coracoid process: a case report. Injury 2005, 36:567-568.
• [13]Goss TP: The scapula: coracoid, acromial, and avulsion fractures. Am J Orthop (Belle Mead NJ) 1996, 25:106-115.
• [14]Kim DS, Yoon YS, Yi CH: Prevalence comparison of accompanying lesions between primary and recurrent anterior dislocation in the shoulder. Am J Sports Med 2010, 38:2071-2076.
• [15]Schmid SL, Farshad M, Catanzaro S, Gerber C: The Latarjet procedure for the treatment of recurrence of anterior instability of the shoulder after operative repair: a retrospective case series of forty-nine consecutive patients. J Bone Joint Surg Am 2012, 94:e75.