Looping a suture under the coracoid process using a modified pelvic suture needle in coracoclavicular stabilization

Abstract

Introduction: A distal clavicle fracture is a common shoulder injury. Coracoclavicular (CC) stabilization is a popular procedure for treating this injury. However, with this method, there is a technical difficulty in looping the suture under the coracoid base with instruments normally available in the operating room (OR). Herein, the authors describe modifying a pelvic suture needle to ease this process. Case presentation: An 18-year-old Thai female presented with left shoulder pain after a fall while cycling. The physical examination showed tenderness at the prominent distal clavicle. The radiograph of both clavicles showed a displaced distal clavicle fracture of the left shoulder. After discussing the treatment, she decided to have CC stabilization as the authors recommended. Clinical discussion: CC stabilization is one of the main surgical techniques used in treating an acute displaced distal clavicle fracture. The most important but difficult step of the CC stabilization is passing a suture under the coracoid base. To make this step easier, various commercial tools have been created, however, they are expensive ($1400–1500 per piece), and most operating rooms in resource-limited countries do not have them available. The authors modified a pelvic suture needle specifically for use in looping a suture under the coracoid process, which is hard to do with standard surgical tools.