Management of Traumatic Coracoid Fracture and Anterior Shoulder Instability With a Modified Arthroscopic Latarjet Technique

Abstract

Coracoid fractures are an uncommon injury and typically occur in the setting of high-energy trauma. Isolated injury to the coracoid is rare; therefore, a high suspicion for concomitant shoulder injuries should exist. These associated injuries have been shown to be acromioclavicular dislocations, clavicular and acromial fractures, scapular spine fractures, rotator cuff tears, and anterior shoulder dislocations. Although most of these shoulder injuries respond to nonsurgical treatment, there are case reports and literature reviews that present more complicated injuries requiring surgical intervention. Shoulder dislocations with associated coracoid fractures can also manifest glenoid bone loss resulting in continued instability. In this scenario, the fractured coracoid can be used to address the glenoid bone loss, as well as the continued instability. Regarding technique, other authors have described an open procedure with screw or anchor fixation. This Technical Note describes our technique for treating a displaced Ogawa type II coracoid process fracture with concomitant anterior shoulder dislocation by an arthroscopic Latarjet procedure using the fractured coracoid.

Fig 1

Radiographic axillary view of left shoulder showing displacement of coracoid fracture (red arrow), bony Bankart lesion, and loss of anterior glenoid contour (yellow arrow).

Fig 2

Sagittal T2 magnetic resonance imaging of left shoulder showing edema surrounding coracoid base fracture (red arrow).

Fig 3

Axial T2-weighted magnetic resonance image of left shoulder showing displaced bony Bankart lesion (red arrow).

Fig 4

Three-dimensional reconstruction (A) and axial imaging (B) from computed tomography scan of left shoulder showing anterior bone loss (red arrow), as well as fracture of coracoid base (green arrows).

Fig 5

The patient is placed in the modified beach-chair position with the right shoulder exposed and the portal sites labeled for reference only (red arrow). [Courtesy of Matthew Ravenscroft, M.B.B.S., F.R.C.S.(Tr&Orth).]

Fig 6

Arthroscopic visualization of left anterior glenoid rim from portal D (anterolateral portal), with patient placed in modified beach-chair position, showing anterosuperior and anteroinferior bone loss of glenoid (red arrow).

Fig 7

Arthroscopic visualization of left coracoid from portal J (placed midway on arc between portals M and D), with patient placed in modified beach-chair position, showing skeletonized coracoid on profile (red arrow) and spinal needle showing location for portal H (yellow arrow) directly superior to coracoid.

Fig 8

Arthroscopic visualization of left anterior glenoid rim from portal J (placed midway on arc between portals M and D), with patient placed in modified beach-chair position, showing coracoid graft fixation to glenoid in 2- to 5-o’clock position with 4.5-mm cannulated screws (red arrow).

Fig 9

Postoperative radiographic axillary view (A) and scapular-Y view (B) of left shoulder showing intact coracoid graft and proper screw placement (red arrows) postoperatively. (L, left.)

Fig 10

Computed tomography scan with 3-dimensional reconstruction and humeral subtraction at 3 months postoperatively showing incorporation of graft (red arrow) in left shoulder.