The lateral impaction of the shoulder

Case Reports in Orthopedics

Takahashi

2016

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.

Section: Discussionmentioning

confidence: 52%

Avulsion Fracture of the Coracoid Process at the Coracoclavicular Ligament Insertion: A Report of Three Cases

Morioka

Case Reports in Orthopedics

Takahashi

2016

“…Two patients had iatrogenic fractures, and it is feared that the number of unreported cases is increasing because the number of shoulder surgeries has increased in recent years. The mechanism of fracture at this site has been reported to be a direct blow [ 26 , 84 ], the impact caused by falling on the elbow [ 84 ], avulsion fracture of the origin of the deltoid muscle [ 24 ], and indirect force on the shoulder from the lateral direction [ 26 , 85 ]. However, among the cases in the present study, the mechanism of injury was clear in only two cases [ 37 , 61 ].…”

Section: Discussionmentioning

confidence: 99%

Nonunion of the so-called acromion: a systematic review with consideration of the terminology

Arch Orthop Trauma Surg

Matsumura

Yoshida

et al. 2023

Introduction There is no widely accepted standard for the classification and treatment of traumatic acromion/scapular spine fracture nonunion due to the scarcity of this condition and the confusion of terminology. Materials and methods PubMed and Scopus were searched using “scapular fracture” and “acromion fracture” or “scapular spine fracture” as search terms. The inclusion criteria were English full-text articles concerning acromion/scapular spine fracture nonunion that described patient characteristics and presented appropriate images. The exclusion criteria were cases without appropriate images. Citation tracking was conducted to find additional articles and notable full-text articles written in other languages. Fractures were classified using our newly proposed classification system. Results Twenty-nine patients (19 men, 10 women) with 29 nonunions were identified. There were four type I, 15 type II, and 10 type III fracture nonunions. Only 11 fractures were isolated. The mean period from initial injury to final diagnosis was 35.2 ± 73.2 months (range 3–360 months) (n = 25). The most frequent cause of delayed diagnosis was conservative treatment for fracture in 11 patients, followed by oversight by the physician in 8. The most common reason for seeking medical advice was shoulder pain. Six patients received conservative therapy, and 23 received operative treatment. Fixation materials included various plates in 15 patients, and tension band wiring in 5. Bone grafting was performed in 16 patients (73%, 16/22). Of the 19 surgically treated patients with adequate follow-up, the outcome was rated excellent in 79%. Conclusions Isolated acromion/scapular spine fracture nonunion is rare. Fracture type II and III, arising in the anatomical scapular spine, accounted for 86% of the fractures. Computed tomography is required to prevent fracture oversight. Surgical therapy produces good stable results. However, it is important to select the appropriate surgical fixation method and material after considering the anatomical characteristics of the fracture and stress on the fractured portion. Level of evidence V

“…2,4,5,21,22 It is reasonable to assume that, in the majority of cases, a variety of injuries arise through the mechanism in which the impaction force exerted on the lateral shoulder is transmitted via the humeral head to the scapula and clavicle, thereby producing lateral impaction injuries. 23 In type II fractures, traction injuries (avulsion fracture) caused by muscular violence (conjoint tendon or minor pectoral muscle or both) are considered to represent the true nature of fractures without involving anterior shoulder dislocation. 1,10,19,20,24 Even in cases with associated anterior shoulder dislocation, no evidence has been provided to objectively demonstrate direct impaction of the humeral head and the coracoid.…”

Section: Discussionmentioning

confidence: 99%

Defining Impairment and Treatment of Subacute and Chronic Fractures of the Coracoid Process

Journal of Trauma: Injury, Infection &Amp; Critical Care

Ikegami

Takeda

et al. 2009

In the overlooked and untreated type I fracture with persistent pain and functional impairment, reduction and fixation of the coracoid fracture aimed at reconstruction of the firm scapuloclavicular connection and structural restoration of the coracoacromial arch results in gratifying outcomes. In the cases of type II fracture, conservative treatment is indicated. When presenting with atypical manifestations of subcoracoid impingement, releasing of the coracoacromial ligament proves effective.