An innovative fixation technique by osteosuture in a young athletic female patient with coracoid process fracture: a case report

Abstract

Coracoid process fractures are uncommon lesions but are frequently associated with an acromioclavicular dislocation. The aim of this article is to report our experience of an innovative fixation technique by osteosuture in a young athletic female patient presenting a displaced fracture of the coracoid process on the insertion footprint of coracoclavicular ligaments, with no breach of continuity of the lower coracoid cortex. She also had a roockwood type 3 acromioclavicular dislocation. After a deltopectoral approach, the fracture was reduced to the anatomical position and stabilized by a first lacing, using a non-absorbable large caliber thread passing under the mid part of the coracoid process between the 2 coracoclavicular ligaments. A second lacing passing under the coracoid process and through the trapezoid ligament, and a third one through the conoïd ligament. At 6 months, the fracture was consolidated and the constant score was 100/100. This innovative fixation provides good clinical and radiological results in the short and medium term.

Keywords: Fracture avulsion; case report; coracoclavicular joint; fracture fixation; shoulder injuries.

Figure 1

preoperative imaging, A) AP X-rays; B) lateral X-rays; C) CT-scan coronal view; D) and sagittal view

Figure 2

prototype representation of the fracture line (in red) and of the 3 lacings performed, A) AP view of the first lacing; B) AP view with representation of a “gull winged” node; C) and lateral view

Figure 3

A) post-operative X-rays on day 1, AP; B) and lateral view

Figure 4

A) post-operative X-rays on day 45, AP; B) and lateral view

Figure 5

bilateral active mobility 3 months postoperatively, A) flexion; B) external rotation; C) internal rotation

Figure 6

CT-scan views 3 months post operatively, A) coronal view; B) sagittal view

Figure 7

three-dimensional reconstruction showing the reduction and the callus of the coracoid process at 6 months