Anatomic Restoration of Triple Disruption of the Superior Shoulder Suspensory Complex: A Case Report and Review of the Literature

Abstract

Background: Multiple disruptions of the superior shoulder suspensory complex (SSSC) involving more than two components are extremely rare. In some extreme situations, three components of the SSSC structure can be involved. The ideal treatment for this type of injury is debatable. Case presentation: A 21-year-old woman was referred to our emergency center following a traffic accident. A threedimensional CT scan showed triple disruption of the SSSC involving concomitant ipsilateral fractures of the coracoid, the acromion, and the distal clavicle. The connection between the upper limber and the axial skeleton was destroyed. There was no evidence of associated injury and the neurovascular examination of the injured upper limb was normal. The patient underwent an open reduction and internal fixation to restore the anatomic integrity of the SSSC. The arm was supported in a broad arm sling for 2 weeks after surgery. Gentle passive range of motion activity under analgesic was encouraged from the second day postoperatively. One year and half after the operation, the patient had regained pain free and unrestricted shoulder stability and mobility. Conclusion: The manifestations of multiple disruptions of the SSSC may be variable. This case illustrated the challenges of treating the multiple disruption of the SSSC structure. It also showed that surgical intervention for this rare combination injury yields an excellent functional result. The good outcome achieved in this patient demonstrates that surgical intervention might be an optional resolution for multiple disruptions of the SSSC.

Rare coracoid fractures presenting with superior shoulder suspensory complex injury: A case series

“…[1,10] As coracoid fractures are usually nondisplaced or minimally displaced, they may be overlooked on routine X-ray examinations. [10][11][12] Therefore, special direct radiograms, computed tomography and magnetic resonance imaging are frequently used in the diagnosis. [10,12,13] Ogawa et al [5] classified coracoid fractures based on clinical and functional characteristics.…”

“…[10][11][12] Therefore, special direct radiograms, computed tomography and magnetic resonance imaging are frequently used in the diagnosis. [10,12,13] Ogawa et al [5] classified coracoid fractures based on clinical and functional characteristics. This classification was originally developed considering the relationship between the fracture and attachment sites of the CC ligament, and the fractures were divided into two types.…”

“…[ 1 ] Another important function of the coracoid process is that it contributes to the anterior superior stability of the shoulder joint by forming the coracoacromial arch and the superior shoulder suspensory complex (SSSC). [ 2 , 3 ]…”

“…[1] Another important function of the coracoid process is that it contributes to the anterior superior stability of the shoulder joint by forming the coracoacromial arch and the superior shoulder suspensory complex (SSSC). [2,3] Coracoid fractures are usually associated with other fractures and dislocations of the scapula and the shoulder area, and they are occasionally observed after high-energy traumas.…”

Shoulder and Elbow Surgery Special Issue

“…Traumatology is well‐represented and specific specialized solutions are described by highly qualified colleagues from different centers in Quingdao, Shanghai, Tianjin, and Chengdu 8–11 . Technical improvements and solutions in humeral nailing are described by Xiao‐ming Wu from Shanghai 12 .…”