Using a Modified Kirschner Wire to Pass the First Suture Under the Coracoid Base in Coracoclavicular Stabilization

Using a modified recycled corkscrew suture anchor to pass a suture under the coracoid base

INTRODUCTION

A common shoulder injury is a distal clavicle fracture which can be treated with various methods such as coracoclavicular (CC) stabilization, fixation with a distal clavicular locking plate, hook plate or tension band wiring. In CC stabilization, the most difficult step is passing a suture under the coracoid base because there is no standard instrument matched to the shape of the coracoid process. We propose a technique using a modified recycled corkscrew suture anchor to pass a suture under the coracoid base.

CASE PRESENTATION

A 30-year-old Thai female with a left clavicle fracture was scheduled for CC stabilization. In the step of passing a suture under the coracoid base, we used a modified recycled corkscrew suture anchor to quickly and easily perform this step.

CLINICAL DISCUSSION

There are some specialized commercial tools which are designed to pass a suture under the coracoid base but all are very expensive (∼ $1400-1500 per piece). To overcome this problem, we modified a used sterilized corkscrew suture anchor to pass a suture under the coracoid base, normally done from the medial to lateral sides, recycling a device usually discarded after use.

Using a modified J-shaped Y-knot all-suture anchor to pass a suture under the coracoid process in coracoclavicular stabilization

Introduction

The distal clavicle fracture is a common shoulder injury. There are several treatment methods which can achieve good outcomes, of which coracoclavicular (CC) stabilization is one of the most popular surgical options. In CC stabilization, the step of passing a suture under the coracoid base is the most difficult step because the standard surgical tool is not designed for passing a suture under the coracoid process. To solve this problem, there are commercial tools for use in this step but all of them are expensive, and thus of limited availability in developing or low-resource settings. We propose a modified J-shaped Y-knot all-suture anchor for use in passing a suture under the coracoid process.

Case presentation

A 45-year-old Thai male who had a left distal clavicle fracture was scheduled for CC stabilization. We modified a sterile Y-knot all-suture anchor to loop underneath the coracoid base which was easy to use and can design individually.

Discussion

In CC stabilization, there are many specialized commercial tools specially designed to easily pass the suture under the coracoid base but they are very expensive. The surgeon can use this technique to modify J-shaped Y-knot all-suture anchor for use in CC stabilization, recycling a Y-knot all-suture anchor normally discarded after use.

Conclusion

A modified J-shaped Y-knot all-suture anchor can use in passing a suture under the coracoid process.

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The step of passing a suture under the coracoid base is the most difficult step.

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A Y-knot suture anchor is easy to modify for use in passing a suture under the coracoid process.

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A modified J-shaped Y-knot suture anchor can re-sterile to use in cases of coracoclavicular stabilization.

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A modified J-shaped Y-knot suture can adjust according to the shape of the individual coracoid process in each patient.