Coracoid Process Avulsion Fracture at the Coracoclavicular Ligament Attachment Site in an Osteoporotic Patient with Acromioclavicular Joint Dislocation
Abstract:Coracoid fractures are uncommon, mostly occur at the base or neck of the coracoid process (CP), and typically present with ipsilateral acromioclavicular joint (ACJ) dislocation. However, CP avulsion fractures at the coracoclavicular ligament (CCL) attachment with ACJ dislocation have not been previously reported. A 59-year-old woman receiving glucocorticoid treatment fell from bed and complained of pain in her shoulder. Radiographs revealed an ACJ dislocation with a distal clavicle fracture. Three-dimensional … Show more
“…Where there is an avulsion fracture of the coracoid tip, evidence has shown that these injuries can be treated non-operatively. 19…”
Section: Discussionmentioning
confidence: 99%
“…Where there is an avulsion fracture of the coracoid tip, evidence has shown that these injuries can be treated non-operatively. 19 A case report by Zhang et al 20 describes their management of a patient with a combined coracoid fracture with an ACJ dislocation. This patient underwent fixation using a lateral clavicle hook plate to address the ACJ dislocation and a 3.5 mm cannulated screw for the coracoid fracture.…”
Introduction Concomitant acromioclavicular joint (ACJ) disruptions with coracoid base fractures are rare high energy injuries. The management of these injuries can be challenging. The aim of this study is to assess the functional and radiographic outcomes of a retrospective case series of patients presenting with concomitant ACJ and coracoid base injuries managed with a clavicle hook plate with subsequent hardware removal at a later stage. Methods Six patients were identified for inclusion in the study. Radiographic and clinical data were available which allowed for collection of demographic information as well as classification of the fractures. Telephone consultation with patients allowed for collection of functional scores which included the Oxford shoulder score (OSS), QuickDASH (Q-DASH), Euroqol-5 Dimension (EQ-5D) and the SF-12 score. Results All patients were male with a mean age of 39.8 years and a median follow-up period of 34 months. All patients underwent a successful operative procedure with a median time to union of 3.75 months. Good functional outcomes were reported by all patients: mean OSS 45.0, mean Q-DASH 4.8, mean EQ-VAS 82.8 and encouraging SF-12 scores (mean PCS 56.0, mean MCS 56.4). Conclusion The use of a lateral clavicle hook plate can achieve good healing and functional outcomes when managing patients with acromioclavicular joint disruptions associated with a coracoid base fracture.
“…Where there is an avulsion fracture of the coracoid tip, evidence has shown that these injuries can be treated non-operatively. 19…”
Section: Discussionmentioning
confidence: 99%
“…Where there is an avulsion fracture of the coracoid tip, evidence has shown that these injuries can be treated non-operatively. 19 A case report by Zhang et al 20 describes their management of a patient with a combined coracoid fracture with an ACJ dislocation. This patient underwent fixation using a lateral clavicle hook plate to address the ACJ dislocation and a 3.5 mm cannulated screw for the coracoid fracture.…”
Introduction Concomitant acromioclavicular joint (ACJ) disruptions with coracoid base fractures are rare high energy injuries. The management of these injuries can be challenging. The aim of this study is to assess the functional and radiographic outcomes of a retrospective case series of patients presenting with concomitant ACJ and coracoid base injuries managed with a clavicle hook plate with subsequent hardware removal at a later stage. Methods Six patients were identified for inclusion in the study. Radiographic and clinical data were available which allowed for collection of demographic information as well as classification of the fractures. Telephone consultation with patients allowed for collection of functional scores which included the Oxford shoulder score (OSS), QuickDASH (Q-DASH), Euroqol-5 Dimension (EQ-5D) and the SF-12 score. Results All patients were male with a mean age of 39.8 years and a median follow-up period of 34 months. All patients underwent a successful operative procedure with a median time to union of 3.75 months. Good functional outcomes were reported by all patients: mean OSS 45.0, mean Q-DASH 4.8, mean EQ-VAS 82.8 and encouraging SF-12 scores (mean PCS 56.0, mean MCS 56.4). Conclusion The use of a lateral clavicle hook plate can achieve good healing and functional outcomes when managing patients with acromioclavicular joint disruptions associated with a coracoid base fracture.
“…Avulsion fractures at the angle, 41,51,64,68,73 including the abovementioned horizontal fracture, are functionally classified as type I CF because they destroy the firm scapuloclavicular connection. 51,62,71 Although CF may occur independently, most CF are reportedly associated with neighboring musculoskeletal injuries such as AC dislocation, shoulder dislocation, and J o u r n a l P r e -p r o o f fractures of the acromion, scapular spine, clavicle, and scapular neck.…”
Section: Discussionmentioning
confidence: 99%
“…4 ); 71 we classified this atypical fracture as an avulsion fracture at the angle. Avulsion fractures at the angle, 41 , 51 , 64 , 68 , 73 including the above mentioned horizontal fracture, are functionally classified as type I CF because they destroy the firm scapuloclavicular connection. 51 , 62 , 71 Figure 4 Atypical fracture of the coracoid in a 31-year-old man.…”
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“…However, avulsion fracture at the site where the coracoclavicular ligament (CCL) attaches to the coracoid process is very rare; an extensive literature search found only six such cases [3–8]. Four of these cases were adolescents in whom avulsion fracture of the coracoid apophysis attached by the CCL occurred [5–7].…”
Avulsion fracture at the site of attachment of the coracoid process of the coracoclavicular ligament (CCL) is extremely rare. We presented three adult cases of this unusual avulsion fracture associated with other injuries. Case 1 was a 25-year-old right-handed male with a left distal clavicular fracture with an avulsion fracture of the coracoid attachment of the CCL; this case was treated surgically and achieved an excellent outcome. Case 2 was a 39-year-old right-handed male with dislocation of the left acromioclavicular joint with two avulsion fractures: one at the posteromedial surface of the coracoid process at the attachment of the conoid ligament and one at the inferior surface of the clavicle at the attachment site of the trapezoid ligament; this case was treated conservatively, and unfavorable symptoms such as dull pain at rest and sharp pain during some daily activities remained. Case 3 was a 41-year-old right-handed female with a right distal clavicular fracture with an avulsion fracture of the coracoid attachment of the conoid ligament; this case was treated conservatively, and the distal clavicular fracture became typical nonunion. These three cases corresponded to type I fractures according to Ogawa's classification as the firm scapuloclavicular connection was destroyed and also to double disruption of the superior shoulder suspensory complex. We recommend surgical intervention when treating patients with this type of acute or subacute injury, especially in those engaging in heavy lifting or overhead work.
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