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Qalib YO, Medagam SR, Dachepalli S. Ipsilateral fractures of the acromion and coracoid processes of the scapula. Chin J Traumatol 2024; 27:121-124. [PMID: 37210253 PMCID: PMC11075102 DOI: 10.1016/j.cjtee.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/28/2023] [Accepted: 03/03/2023] [Indexed: 05/22/2023] Open
Abstract
A fracture of the acromion and coracoid processes of scapula is rarely seen in the outpatient clinic, due to the acromion's anatomical position and shape, as well as the strong ligaments and muscles that are attached to it. These fractures are caused by either direct or indirect high-energy trauma injuries to the shoulder joint, leading to severe pain and a grossly restricted range of motion. Several acromial classifications were reported, but this type of longitudinal plane fracture of the acromion process in our case is yet to be described in the current literature. We present a rare combination of the coracoid process and unstable acromion bony projection fractures that have not previously been noted for this type of fracture. The closest to this is Kuhn's type III classification. A 51-year-old male presented to our emergency department complaining of the right shoulder pain and difficulty raising his arm following a 2-wheeler accident. The patient was managed by open reduction and internal fixation with 3 cannulated cancellous screws fixation and progressed well with no postoperative complications. He was asymptomatic postoperatively and regained full range of motion after 4 months.
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Affiliation(s)
- Yusuf Omar Qalib
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Srinivasa Reddy Medagam
- Department of Orthopaedics, Yashoda Hospitals, Somajiguda, Hyderabad, Telangana, 500082, India
| | - Sunil Dachepalli
- Department of Orthopaedics, Yashoda Hospitals, Somajiguda, Hyderabad, Telangana, 500082, India.
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Assiotis A, Uppal HS, Rumian A, Yeoh C. A Unique Presentation of the Glenoid, Coracoid, and Proximal Humerus Fractures. Cureus 2023; 15:e40358. [PMID: 37456475 PMCID: PMC10339778 DOI: 10.7759/cureus.40358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Fractures of the proximal humerus are common injuries with a bimodal age distribution. They usually present in younger patients after high-energy trauma and in elderly patients after lower-energy trauma. Fractures of the proximal humerus are rarely associated with concomitant fractures of the glenoid, and this is a complex injury pattern that indicates the presence of significant instability. Such injuries are usually treated surgically. Even more rarely, patients may present with proximal humerus fractures and fractures of the coracoid process. A male patient presented to our emergency department (ED) after a fall off the loading platform of his heavy goods vehicle (HGV), resulting in a right shoulder injury. During his initial assessment in ED, a computerised tomography (CT) scan demonstrated the presence of a comminuted proximal humerus fracture, a comminuted anterior glenoid wall fracture, and a coracoid process displaced fracture. Surgical fixation of all three fractures was undertaken in the same sitting. This is the first case described in the literature with a combination of the above injuries and serves as a reminder that as trauma complexity and incidence continue to increase, we should maintain a high index of diagnostic suspicion when dealing with such patients. Furthermore, we present our treatment approach for this case and the rationale behind it.
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Affiliation(s)
| | - Harpal S Uppal
- Trauma and Orthopaedics, Lister Hospital, Stevenage, GBR
| | - Adam Rumian
- Trauma and Orthopaedics, Lister Hospital, Stevenage, GBR
| | - Clarence Yeoh
- Trauma and Orthopaedics, Lister Hospital, Stevenage, GBR
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Wang Y, Li Q, Zhang Q. Modified Double-Row and Double-Pulley Technique for the Treatment of Type Ia Scapular Glenoid Fractures. Orthop Surg 2022; 14:1518-1526. [PMID: 35638594 PMCID: PMC9251277 DOI: 10.1111/os.13305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the efficacy of the double‐row and double‐pulley technique in treating anterior shoulder glenoid fracture (Ideberg type Ia) using shoulder arthroscopy. Methods Thirty‐six patients with Ideberg type Ia admitted from March 1, 2017, to March 1, 2020, were retrospectively reviewed. Data of the patients' history included age, sex, side of the affected arm, the mean time from injury to surgery, the surgical duration, the average blood loss, and the average total duration of hospital stay. The double‐row and double‐pulley technique was used to repair the scapular glenoid fracture under arthroscopy. Computed tomography (CT) was used to evaluate fracture healing after surgery. The American Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder joint scoring system, and the Constant–Murley shoulder function score were used to assess the function of the affected shoulder. Results The surgical duration was 90–150 min, with a mean of 127 min. The average blood loss was 90 mL (range, 60–120 mL), and the average total duration of hospital stay was 9.2 days (range, 3 to 14 days). At 9 months after surgery, the CT results showed that all fractures healed, and all patients returned to their previous levels of activity and regained an excellent range of motion. The visual analog scale (VAS) score was 7.55 ± 1.32 before surgery, and the VAS score significantly decreased to 1.24 ± 0.72 at 12 months after the operation (p < 0.05). The Constant, ASES, and UCLA shoulder function scores were 44.38 ± 2.16, 43.47 ± 12.76, and 21.80 ± 1.16 before the surgery, respectively, which improved to 93.52 ± 2.82, 91.34 ± 8.28, and 33.24 ± 1.64, respectively, in the following 12 months. One patient experienced fat liquefaction. However, no cases of deep venous thrombosis, iatrogenic neurovascular compromise, wound infection, or neurovascular injury were identified. Conclusion The double‐row and double‐pulley technique for treating Ideberg type Ia under shoulder arthroscopy has minor surgical trauma, reliable fracture reduction and fixation, less postoperative pain, and fewer postoperative complications and significantly improves the patient's shoulder joint function.
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Affiliation(s)
- Yizhong Wang
- Department of Sports medicine, Honghui Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qingxian Li
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qingsong Zhang
- Department of Sports Medicine, Wuhan Forth Hospital, Wuhan, 430033, China
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Doğar F, Dere Kİ, Gürbüz K, Topak D, Özdemir MA, Kuşcu B, Bilal Ö. Rare coracoid fractures presenting with superior shoulder suspensory complex injury: A case series. Jt Dis Relat Surg 2021; 32:804-809. [PMID: 34842118 PMCID: PMC8650649 DOI: 10.52312/jdrs.2021.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/18/2021] [Indexed: 11/14/2022] Open
Abstract
Although coracoid fractures are rare fractures, their treatment is critical as they form the coracoacromial arch and superior shoulder suspensory complex (SSSC), which are important structures for shoulder biomechanics. In this case series, clinical, radiological, and demographic characteristics of three male patients who received treatment due to coracoid fracture presenting with traumatic injuries were discussed. The fractures were classified according to the Ogawa and Eyres classifications, and fracture fixation was achieved surgically with the cannulated screws. All patients had a right coracoid fracture. The Constant-Murley Score and the Disabilities of the Arm, Shoulder and Hand scores the patients in the final follow-up visit at 12 months were calculated. In conclusion, good clinical and functional outcomes can be achieved by anatomical reduction and fixation through surgery for displaced coracoid fractures presenting with multiple traumatic injuries located in multiple regions of the SSSC.
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Affiliation(s)
- Fatih Doğar
- Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, 46040 Onikişubat, Kahramanmaraş, Türkiye.
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Bishai SK, Maceroni M, King CN, Martinez MM. A case report presenting 3 cases of anterior shoulder dislocations with coracoid fractures each with similar glenoid bone loss patterns. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:430-437. [PMID: 37588706 PMCID: PMC10426488 DOI: 10.1016/j.xrrt.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
| | - Michael Maceroni
- Henry Ford Health System, Henry Ford Macomb Hospital, Clinton Township, MI, USA
| | - Cameron N. King
- Henry Ford Macomb Orthopedic Surgery Residency, Clinton Township, MI, USA
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Jia X, Zhou FL, Zhu YH, Jin DJ, Liu WX, Yang ZC, Liu RP. Treatment of lower part of glenoid fractures through a novel axillary approach: A case report. World J Clin Cases 2021; 9:7558-7563. [PMID: 34616826 PMCID: PMC8464446 DOI: 10.12998/wjcc.v9.i25.7558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/09/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Based on the location and size of the fracture block, open reduction and internal fixation can be employed or assisted for shoulder arthroscopy in the treatment of glenoid fractures. However, the treatment of lower part of glenoid fractures through a novel axillary approach has not been reported so far.
CASE SUMMARY A 22-year-old right-handed man was transferred to our outpatient clinic because of right shoulder injury during a traffic accident. X-ray examination after admission suggested the fracture of the lower part of the right glenoid and an ipiselial proximal humeral fracture. Three-dimensional (3D) computed tomography (CT) further suggested that the size of the fracture block of the lower part of the right glenoid was 3.4 mm × 16.2 mm. The patient was diagnosed as the fracture of the lower part of the glenoid, also known as bony Bankart lesion without shoulder dislocation. After general anesthesia, the patient was surgically treated with the open reduction internal fixation through a novel axillary approach. 3D CT and shoulder joint function were reexamined at 12 mo of follow-up, showing acceptable recovery.
CONCLUSION This case report describes a novel axillary approach adopted in an open reduction with cannulated screw and wire anchor internal fixation. After a follow-up for more than 12 mo, 3D CT and shoulder joint function examinations display a good recovery.
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Affiliation(s)
- Xing Jia
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
- The Graduate School of Dalian Medical University, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Fu-Lin Zhou
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
| | - Yu-Hua Zhu
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
| | - Dan-Jie Jin
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
| | - Wei-Xi Liu
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
| | - Zhi-Cheng Yang
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
| | - Rui-Ping Liu
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
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Ogawa K, Matsumura N, Yoshida A, Inokuchi W. Fractures of the coracoid process: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:171-178. [PMID: 37588963 PMCID: PMC10426686 DOI: 10.1016/j.xrrt.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Although fracture of the coracoid process (CF) used to be considered rare, it is now more commonly encountered due to increased awareness and advances in imaging methods. This review aimed to analyze reported cases of CF to determine its mechanism and appropriate treatment. Methods PubMed and Scopus were searched using the terms "scapula fracture" and "coracoid fracture." The inclusion criteria were English full-text articles concerning CF that described patient characteristics with appropriate images. The exclusion criteria included cases without appropriate images and those with physeal injury or nonunion. Citation tracking was conducted to find additional articles and notable full-text articles in other languages. Fractures were mainly classified using Ogawa's classification. Results Ninety-seven studies were identified, including 197 patients (131 men, 33 women; average age 37.0±16.9 years). CF was classified as type I in 77%, type II in 19%, and avulsion fracture at the angle in 5%. Concurrent shoulder girdle injuries included acromioclavicular injury in 33%, clavicular fracture in 17%, acromion or lateral scapular spine fracture in 15%, and anterior shoulder instability in 11%. Among patients with type I CF, 69% had multiple disruptions of the superior shoulder suspensory complex. Conservative treatment was applied in 71% of isolated type I CF, while surgical treatment was applied in 76% of type I CF with multiple disruptions. Although the evaluation methods varied, 60% of patients were followed up for more than 6 months, and the outcomes were generally satisfactory for both conservative and surgical treatments. Conclusion CF occurred commonly in the age group with higher social activity. The most common fracture type was type I. The possible mechanism of CF is violent traction of the attached muscles, except for avulsion fracture at the angle. Type I CF with multiple disruptions of the superior shoulder suspensory complex requires surgical treatment, whereas conservative care is recommended for isolated type I and type II CFs.
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Affiliation(s)
- Kiyohisa Ogawa
- Department of Orthopedic Surgery, Eiju General Hospital, Taito-ku, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopedic Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Atsushi Yoshida
- Department of Orthopedic Surgery, National Hospital Organization Saitama Hospital, Wako City, Saitama, Japan
| | - Wataru Inokuchi
- Department of Orthopedic Surgery, Eiju General Hospital, Taito-ku, Tokyo, Japan
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Pan X, Yao Y, Yan H, Wang J, Dai L, Qu X, Fang Z, Feng F, Zhou Y. Iatrogenic fracture during shoulder dislocation reduction: characteristics, management and outcomes. Eur J Med Res 2021; 26:73. [PMID: 34247652 PMCID: PMC8274043 DOI: 10.1186/s40001-021-00545-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/05/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Shoulder dislocation and the cases of iatrogenic fractures during manual reduction are becoming increasingly common. The aim of this study was to investigate the characteristics, management, and patient outcomes of iatrogenic proximal humeral fracture during the manual reduction of shoulder dislocation. METHODS A retrospective and multi-center study was performed to identify all patients presenting with shoulder dislocation from January 2010 to January 2020. The sex and age of patients, associated injuries, first-time or habitual shoulder dislocation, type of anesthesia, time from injury to revision surgery, and functional outcomes were analyzed. RESULTS A total of 359 patients with a mean age of 62.1 ± 7.3 years (range 29-86 years) were included. Twenty-one patients (female/male ratio 17:4) with an average age of 66.3 ± 9.7 years (range 48-86 years) were identified with a post-reduction iatrogenic fracture. Female cases with greater tuberosity fractures (GTF) were more likely than male cases to have iatrogenic fractures during reduction (P = 0.035). Women aged 60 years or older experienced more iatrogenic fractures during manual reduction (P = 0.026). Closed reduction under conscious sedation was more likely than that under general anesthesia to have iatrogenic fractures (P = 0.000). A total of 21 patients underwent open reduction and internal fixation (ORIF) when iatrogenic fractures occurred. The mean follow-up period was 19.7 ± 6.7 months (range 12-36 months). The mean Neer scores were 80.5 ± 7.6 (range 62-93), and the mean visual analog score (VAS) was 3.3 ± 1.5 (range 1-6). Significant differences were observed in the Neer score and VAS with the time (more or less 8 h) from injury to revision surgery (P < 0.05). CONCLUSION A high risk of iatrogenic proximal humeral fracture is present in shoulder dislocation with GTF in senile females without general anesthesia. ORIF performed in a timely manner may help improve functional outcomes in the case of iatrogenic injury.
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Affiliation(s)
- Xiaohui Pan
- Department of Orthopedics, Luotian County People's Hospital, Luotian, 438600, Hubei, People's Republic of China
| | - Yong Yao
- Department of Orthopedics, The Central Hospital of Enshi Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi, 445000, Hubei, People's Republic of China
| | - Hongyong Yan
- Department of Orthopedics, Jiangxia District Hospital of Traditional Chinese Medicine, Jiangxia, 430200, Hubei, People's Republic of China
| | - Jun Wang
- Department of Orthopedics, Huangshi Second People's Hospital, Huangshi, 435000, Hubei, People's Republic of China
| | - Lei Dai
- Department of Orthopedics, Huangmei County Hospital of Traditional Chinese Medicine, Huangmei, 438500, Hubei, People's Republic of China
| | - Xincong Qu
- Department of Orthopedics, Luotian County People's Hospital, Luotian, 438600, Hubei, People's Republic of China
| | - Zuyi Fang
- Department of Orthopedics, Luotian County People's Hospital, Luotian, 438600, Hubei, People's Republic of China
| | - Feng Feng
- Department of Orthopedics, Luotian County People's Hospital, Luotian, 438600, Hubei, People's Republic of China
| | - Yan Zhou
- Department of Orthopedics, Renmin Hospital of Wuhan University, #238 Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China.
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van Doesburg PG, El Saddy S, Alta TD, van Noort A, van Bergen CJA. Treatment of coracoid process fractures: a systematic review. Arch Orthop Trauma Surg 2021; 141:1091-1100. [PMID: 32507949 DOI: 10.1007/s00402-020-03496-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/31/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The coracoid process is a small hook-shaped feature on the scapula and a key structure of the superior shoulder suspensory complex (SSSC). Fractures of the coracoid are rare. Therefore, no consensus exists regarding treatment of coracoid process fractures. Systematically review indications, outcomes and complications of traumatic coracoid process fractures in adults, and to provide a treatment algorithm. MATERIALS AND METHODS A systematic review was performed to identify all relevant studies on the treatment of coracoid process fractures. The methodological quality of the studies was scored using the Methodological Index for Non-Randomized Studies (MINORS). RESULTS Eight case series, with a total of 110 coracoid process fractures, were included. All studies were of moderate methodological quality. Of the fractures, 78% were Ogawa type I fractures, 13% Ogawa type II and 9% were unclassified. Conservative treatment showed good results in most Ogawa type II fractures and type I fractures without associated disruptions of the SSSC. Most Ogawa type I fractures with associated disruptions of the SSSC received surgical treatment showing good results. CONCLUSION Based on moderate quality studies, surgical treatment may be considered in Ogawa type I fractures with multiple disruptions of the SSSC. A conservative treatment seems sufficient in other fracture types.
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Affiliation(s)
- Peter G van Doesburg
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands.
| | - Salih El Saddy
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Tjarco D Alta
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Arthur van Noort
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
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Zhang Q, Xiang M, Li YP, Yang JS. Arthroscopic Management of Glenoid and Greater Tuberosity Bipolar Fractures. Orthop Surg 2020; 12:1405-1412. [PMID: 33078582 PMCID: PMC7670139 DOI: 10.1111/os.12786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/16/2020] [Accepted: 07/26/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To report the clinical and radiological outcomes of arthroscopically assisted surgery for combination of glenoid and greater tuberosity fractures after traumatic shoulder dislocation. METHODS From December 2013 to December 2018, patients with concomitant fracture of the greater tuberosity and glenoid who underwent arthroscopically assisted surgery were retrospectively reviewed. Fifteen patients were included. Preoperative computed tomography (CT) scans with 3D reconstruction were performed to evaluate the fracture configuration and associated fractures. All patients underwent arthroscopically assisted surgery under general anesthesia with brachial plexus anesthesia in the lateral position. Under the arthroscopic approach, a comprehensive inspection of the joints was firstly conducted to examine the injury of bones and other tissues. With arthroscopy support, closed reduction and internal fixation of both fractures were performed with suture anchors, with or without additional cannulated screws. At the same time, other injuries were also repaired under the arthroscope. Patients were followed up (6 weeks,8 weeks,3 months,6 months,1 year after surgery) regularly for at least 1 year. At the follow-up, clinical outcomes (Constant score, ASES score, range of motion, and VAS score) and radiological outcomes were analyzed. RESULTS Of the 15 patients, there are seven cases of men, eight cases of women; aged 22-66 years, with an average age of 48 years; left shoulder for five cases, 10 cases of the right shoulder. The injury mechanisms were: a simple fall (n = 9), an epileptic seizure (n = 1), a high fall injury (n = 2), and a traffic accident (n = 3). Of the 15 cases of glenoid fracture, 11 cases were type Ia and four cases were type II according to the Ideberg Classification System. The mean size of the glenoid fracture fragment was 28.4% (range, 8.7%-47.2%). According to the Mutch classification system, the fractures of the greater tuberosity were divided into: five cases of avulsion, one case of compression, and nine cases of split. Average time of follow-up was 38.2 months (range, 12-70 months), and one case was lost to follow-up. With fractures healing well, almost all patients had a good joint function. At the final follow-up, mean anterior flexion was 157°; mean external rotation was 40°; mean internal rotation was T11 level; the mean Constant-Murley score was 94.6 points (range, 70-100 points); the mean ASES score was 94.6 points (range, 79-100 points); and the mean VAS score was 0.4 points (range, 0-2 points). No recurrent instability or re-dislocation occurred. No patient had revision surgery. CONCLUSION Arthroscopic management of glenoid and greater tuberosity bipolar fractures was useful and effective with minimal injury, and it achieved satisfactory clinical and radiological outcomes at a mean follow-up time of more than 3 years.
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Affiliation(s)
- Qing Zhang
- Department of Upper Limb, Sichuan Provincial Orthpaedics Hospital, Chengdu, China
| | - Ming Xiang
- Department of Upper Limb, Sichuan Provincial Orthpaedics Hospital, Chengdu, China
| | - Yi-Ping Li
- Department of Upper Limb, Sichuan Provincial Orthpaedics Hospital, Chengdu, China
| | - Jin-Song Yang
- Department of Upper Limb, Sichuan Provincial Orthpaedics Hospital, Chengdu, China
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Dai F, Xiang M, Yang JS, Chen H, Hu XC, Zhang Q, Li YP. Injury Mechanism of Acute Anterior Shoulder Dislocation Associated with Glenoid and Greater Tuberosity Fractures: A Study Based on Fracture Morphology. Orthop Surg 2020; 12:1421-1429. [PMID: 32812705 PMCID: PMC7670144 DOI: 10.1111/os.12767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 12/02/2022] Open
Abstract
Objective Based on the morphological characteristics of glenoid and greater tuberosity (GT) fractures and the relationship between them, we explored the injury mechanism of acute anterior shoulder dislocation associated with glenoid and GT fractures. Methods From December 2013 to December 2019, we retrospectively reviewed the clinical data of patients who were diagnosed with acute anterior shoulder dislocation associated with glenoid and GT fractures in our hospital. According to the fracture site, a glenoid fracture group and a greater tuberosity fracture (GT) group were established, and the morphological characteristics of both glenoid and GT fractures were measured and statistically analyzed. Results A total of 41 patients (43 shoulders) met the inclusion criteria (39 unilateral shoulders and 2 bilateral shoulders). The mean age was 50.21 years (range, 22–71 years). A total of 27 shoulder injuries (62.8%) were split GT fractures and 33 shoulder injuries (76.7%) were combined with rotator cuff tears. The mean size of glenoid fragments was 30.16% and the mean displacement was 8.85 mm. The mean size of GT fragments was 28.43 mm. The mean superoinferior and anteroposterior displacements of the GT fragment were 6.77 mm and 4.96 mm, respectively. There was a negative correlation between the size of glenoid and GT fracture fragments (r = −0.64, P < 0.05). The glenoid fragments in the Ideberg type Ia glenoid fracture group were smaller than those in the Ideberg type II glenoid fracture group (28.41% and 40.95%, respectively), while the size of GT fragments in the type Ia group were larger than those in the type II group (29.77 mm and 20.21 mm, respectively) (P < 0.05). The GT fragments in the split GT fracture group were larger than those in the avulsion or depression GT fracture group (33.69 mm, 19.07 mm and 21.12 mm, respectively), while the size of glenoid fragments in the split GT fracture group were smaller than those in the avulsion or depression GT fracture group (23.57%, 41.37%, and 43.42%, respectively) (P < 0.05). As for the displacement direction of GT fragments, depression fractures were mainly inferior displacements, avulsion fractures were mainly anterosuperior displacements, while split fractures were mainly posteroinferior displacements (P < 0.05). Multiple regression analysis suggested that the type and the fragment size of GT fractures have a significant influence on the size of glenoid fragments. Conclusion Acute anterior shoulder dislocations associated with glenoid and GT fractures are often combined with rotator cuff tears. There is a negative correlation between the size of glenoid and GT fragments, and split GT fractures are most common. Such injuries are highly correlated to the relative spatial location between the GT and the glenoid when the shoulder dislocates.
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Affiliation(s)
- Fei Dai
- Department of Upper Limb, Sichuan Provincial Orthopaedic Hospital, Chengdu, China
| | - Ming Xiang
- Department of Upper Limb, Sichuan Provincial Orthopaedic Hospital, Chengdu, China
| | - Jin-Song Yang
- Department of Upper Limb, Sichuan Provincial Orthopaedic Hospital, Chengdu, China
| | - Hang Chen
- Department of Upper Limb, Sichuan Provincial Orthopaedic Hospital, Chengdu, China
| | - Xiao-Chuan Hu
- Department of Upper Limb, Sichuan Provincial Orthopaedic Hospital, Chengdu, China
| | - Qing Zhang
- Department of Upper Limb, Sichuan Provincial Orthopaedic Hospital, Chengdu, China
| | - Yi-Ping Li
- Department of Upper Limb, Sichuan Provincial Orthopaedic Hospital, Chengdu, China
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Fractures of the coracoid process - pathoanatomy and classification: based on thirty nine cases with three dimensional computerised tomography reconstructions. INTERNATIONAL ORTHOPAEDICS 2020; 45:1009-1015. [PMID: 32435954 DOI: 10.1007/s00264-020-04634-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Until now, classifications of coracoid fractures have been based on plain radiographs, without use of 3D CT reconstructions. Therefore, the aim of the present study has been to describe the pathoanatomy of these fractures and their associated injuries to the shoulder girdle, on the basis of 3D CT reconstructions. METHODS The cohort comprised 39 patients, who each sustained a coracoid fracture investigated with 3D CT reconstructions. The patients were assessed in terms of age, gender, pathoanatomy of the coracoid fracture, fractures of other parts of the scapula, and associated injuries to the shoulder girdle. RESULTS We identified 24 fractures of the base, one fracture of the beak body, eight fractures of the apex, and six comminuted fractures of the coracoid process. A total of 22 associated injuries were found (7 fractures of the acromion, 5 fractures of the anterior glenoid rim, 3 fractures of the superior glenoid, 1 fracture of the inferior glenoid, 4 fractures of the surgical neck, 2 fractures of the scapular body) and 18 other associated injuries to the shoulder girdle (8 AC dislocations, 5 proximal humeral fractures, and 5 clavicular fractures). CONCLUSION On the basis of 3D CT reconstructions, four basic coracoid fracture patterns were identified. The authors´ findings and literature review have shown that a considerable number of coracoid fractures are combined with injuries to other parts of scapula and shoulder girdle. These associated injuries must be taken into account and targeted when taking the patient's history, and during clinical and primarily radiological examinations.
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Min SG, Kim DH, Lee HS, Lee HJ, Park KH, Yoon JP. Concomitant Coracoid Process Fracture with Bony Bankart Lesion Treated with the Latarjet Procedure. Clin Shoulder Elb 2020; 23:31-36. [PMID: 33330231 PMCID: PMC7714321 DOI: 10.5397/cise.2019.00423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/21/2020] [Accepted: 01/29/2020] [Indexed: 11/25/2022] Open
Abstract
Bony lesions of the glenoid and Hill-Sachs lesions are the most common injuries after a first-time traumatic shoulder dislocation. However, fracture of the coracoid process after traumatic shoulder dislocation is rare. A single, open surgical procedure could be performed by a Latarjet procedure using a fractured fragment of the coracoid process. If a fracture of the coracoid process is associated with a traumatic anterior shoulder dislocation, the Latarjet procedure may be the most appropriate surgical option.
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Affiliation(s)
- Seung Gi Min
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong Hyun Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho Seok Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Joo Lee
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyeong Hyeon Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Königshausen M, Mempel E, Rausch V, Gessmann J, Schildhauer TA, Seybold D. Combined fractures of the humeral head and the glenoid. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s11678-019-0508-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Korakoid- und Akromionfrakturen. ARTHROSKOPIE 2018. [DOI: 10.1007/s00142-017-0171-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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