RESUMO
Objective: To explore the research progress of the coracoid transfer surgery using suture button fixation, particularly focusing on the technique known as Chinese unique Inlay Bristow (Cuistow surgery). Methods: Extensive literature review was conducted to summarize and analyze the utilization of suture button fixation in the Cuistow surgery, comparing its biomechanical and clinical outcomes with those of traditional screw fixation. Results: Utilizing suture button fixation in coracoid transfer surgery helps circumvent certain metal-related complications associated with traditional screw fixation. While its biomechanical stability and effectiveness have been preliminarily confirmed, debates persist regarding its graft healing rate and postoperative recurrence rate compared to traditional screw fixation. The Cuistow surgery based on the Inlay structure is a solution to improve the healing rate of graft after suture button fixation. Conclusion: Suture button fixation, as a novel approach in coracoid transfer surgery, remains to have its advantages and disadvantages compared to traditional screw fixation not entirely elucidated, underscoring the need for further in-depth clinical and fundamental research. Cuistow surgery is the Chinese experience of coracoid transfer surgery, and its biomechanical stability and clinical advantages have been preliminarily confirmed.
Assuntos
Técnicas de Sutura , Humanos , Fenômenos Biomecânicos , Processo Coracoide/cirurgia , Parafusos Ósseos , Suturas , Transplante Ósseo/métodosRESUMO
Objective: To evaluate the early-term effectiveness of Latarjet procedure with double EndoButtons fixation for recurrent anterior shoulder dislocation by coracoid osteotomy with preserving coracoacromial ligament. Methods: Between January 2021 and June 2023, 19 patients with recurrent anterior shoulder dislocations were treated by arthroscopic Latarjet procedure with double EndoButtons fixation, all of which underwent coracoid osteotomy with preserving the coracoacromial ligament. There were 11 males and 8 females, with an average age of 23.3 years (range, 17-32 years). Shoulder dislocations ranged from 3 to 11 times, with an average of 6.4 times. The disease duration ranged from 3 to 35 months, with an average of 12.9 months. All apprehension tests were positive. Imaging examination showed that the defect width of the ipsilateral glenoid bone was 13%-26%, with an average of 19.8%. After operation, the shoulder range of motion was examined, including flexion lift, lateral external rotation, extension 90° external rotation, and internal rotation. Shoulder joint function was evaluated by Walch-Duplay score, American Association for Shoulder and Elbow Surgery (ASES) score, and Rowe score. Imaging examinations were taken to observe the position and shaping of coracoid. Results: All incisions healed by first intention and no nerve or vessel injury occurred. All patients were followed up 9-24 months (mean, 14.5 months). There was no recurrence of shoulder dislocation and the apprehension tests were negative during follow-up. There was no significant difference in the shoulder range of motion (flexion lift, lateral external rotation, extension 90° external rotation, and internal rotation) between preoperation and at last follow-up ( P>0.05). The Walch-Duplay score, ASES score, and Rowe score significantly improved when compared with those before operation ( P<0.05). Postoperative imaging showed that coracoid graft was at the same level with the glenoid in all cases; the center of coracoid graft was located between 3 to 5 o'clock. During follow-up, there was no glenohumeral joint degeneration, the acromiaohumeral distance was not reduced when compared with preoperation, and the coracoid bone gradually formed concentric circles with the humeral head. Conclusion: The Latarjet procedure with double EndoButtons fixation can effectively treat recurrent anterior shoulder dislocation by coracoid osteotomy with preserving coracoacromial ligament, and the early-term effectiveness is satisfactory.
Assuntos
Processo Coracoide , Ligamentos Articulares , Osteotomia , Amplitude de Movimento Articular , Luxação do Ombro , Humanos , Luxação do Ombro/cirurgia , Masculino , Feminino , Adulto , Osteotomia/métodos , Adolescente , Adulto Jovem , Processo Coracoide/cirurgia , Ligamentos Articulares/cirurgia , Recidiva , Artroscopia/métodos , Resultado do TratamentoRESUMO
Objective: To investigate the early effectiveness of the limited unique coracoid osteotomy suture button fixation Latarjet (LU-tarjet)-congruent-arc (CA) technique (LU-tarjet-CA) in treating recurrent shoulder dislocations with huge glenoid defect. Methods: The clinical data of 12 patients with recurrent shoulder dislocation and huge glenoid defect who met the selection criteria and treated with arthroscopic LU-tarjet-CA between January 2021 and December 2023 were retrospectively analyzed. The cohort included 8 males and 4 females, aged 20-40 years with an average age of 30.4 years. The range of glenoid bone loss was 30%-40%, with an average of 35.5%. The time from symptom onset to hospital admission ranged from 1 to 36 months, with an average of 18.5 months. The University of California Los Angeles (UCLA) score, American Association for Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, and Rowe score were used to evaluate shoulder function preoperatively and at 3, 6, and 12 months postoperatively. CT three-dimensional (3D) reconstruction was used to assess coracoid healing and plasticity at 3, 6, and 12 months postoperatively. Subjective satisfaction of patient was recorded at last follow-up. Results: All incisions healed by first intention, with no incision infection or nerve injury. All 12 patients were followed up 12 months. One patient developed Propionibacterium acnes infection within the joint postoperatively and recovered after initial arthroscopic debridement and anti-inflammatory treatment. At 3 months after operation, CT 3D-reconstruction showed 1 case of complete coracoid absorption; neither of these two patients experienced redislocation. The remaining patients exhibited partial coracoid absorption but displayed local reshaping, filling the preoperative defect area, and bony fusion between the coracoid and the glenoid. At last follow-up, 9 patients (75%) were very satisfied with the outcome, and 3 patients (25%) were satisfied; the satisfied patients experienced postoperative shoulder stiffness caused by suboptimal functional exercise but did not have impaired daily life activities. The UCLA score, ASES score, Walch-Duplay score, and Rowe score at 3, 6, and 12 months postoperatively were significantly better than preoperative scores, and each score improved further over time postoperatively, with significant differences between different time points ( P<0.05). Conclusion: The arthroscopic LU-tarjet-CA technique for treating recurrent shoulder dislocations with huge glenoid defect can achieve the surgical objective of bony blockade and filling bone defects to prevent shoulder dislocation, thereby improving patients' quality of life and shoulder joint function and stability.
Assuntos
Artroscopia , Osteotomia , Recidiva , Luxação do Ombro , Humanos , Masculino , Feminino , Adulto , Luxação do Ombro/cirurgia , Artroscopia/métodos , Osteotomia/métodos , Adulto Jovem , Resultado do Tratamento , Amplitude de Movimento Articular , Articulação do Ombro/cirurgia , Processo Coracoide/cirurgia , Técnicas de SuturaRESUMO
OBJECTIVES: This study aims to assess the association between isolated subscapularis tears and coracoid morphology using magnetic resonance imaging (MRI) and to calculate the optimal cut-off values of the significant predictor to predict subscapularis tears. PATIENTS AND METHODS: Between January 2018 and December 2022, a total of 60 patients (29 males, 31 females; mean age: 58.4±8.4 years; range, 18 to 80 years) diagnosed with subscapularis tendon tears who were treated as Group A and 60 patients (29 males, 31 females; mean age: 46.8±11.5 years; range, 18 to 80 years) without subscapularis tendon tears who were treated as Group B were included. Axial coracoid-humeral distance (aCHD), sagittal coracoid-humeral distance (sCHD), coracoid overlap (CO) and coracoid angle (CA) of all patients were measured. Logistic regression was used to investigate the association between subscapularis tears as variables including aCHD, sCHD, CO and CA. Receiver operating characteristic curve analysis was used to determine the diagnostic values of coracoid morphology for subscapularis tears. RESULTS: The mean values of CO, aCHD and sCHD in Group A were 22.16 mm, 5.13 mm, and 5.56 mm, respectively. The mean values in Group B were 16.99 mm, 7.18 mm, and 7.29 mm, respectively. The degree of CA in Group A was 95.81 and 111.69 in Group B. The differences in the above measurement values were significant between two Groups. The CO was found to be associated with higher odds of subscapularis tears. The optimal cut-off value of CO was 19.79 mm. CONCLUSION: Based on our study results, CO is positively associated with isolated subscapularis tears. In addition, coracoid bursa effusion, cysts in the lesser tuberosity or a tear and malposition of long head of the biceps tendon on MRI may predict the presence of a clinically significant subscapularis tear.
Assuntos
Processo Coracoide , Imageamento por Ressonância Magnética , Lesões do Manguito Rotador , Humanos , Masculino , Feminino , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Adulto , Idoso , Adolescente , Processo Coracoide/diagnóstico por imagem , Adulto Jovem , Idoso de 80 Anos ou mais , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/patologia , China , Estudos Retrospectivos , População do Leste AsiáticoRESUMO
The coracoclavicular joint is a diarthrodial synovial joint that is eventually located between the upper surface of the horizontal part of the coracoid process and the conoid tubercle of the clavicle, and is considered an unusual anatomical alteration. The coracoclavicular joint has a low prevalence and can be diagnosed by imaging tests - radiography and computed tomography. Treatment can be performed both conservatively and surgically. We report a case of an 81-year-old female patient presenting of pain in her left shoulder due to coracoclavicular joint arthrosis. A radiograph of the left shoulder was performed, which detected a deformity in the lower portion of the middle third of the clavicle and the upper portion of the coracoid process, corresponding to the coracoclavicular joint, a finding confirmed by computed tomography. The patient was treated conservatively with analgesics (Dipyrone) and anti-inflammatories (Ibuprofen) with improvement in symptoms.
Assuntos
Dor de Ombro , Humanos , Feminino , Idoso de 80 Anos ou mais , Dor de Ombro/etiologia , Dor de Ombro/diagnóstico , Processo Coracoide , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND Coracoid process fractures are uncommon and are often complicated by many types of shoulder girdle injuries. Previous reports have shown that osteosynthesis for isolated coracoid process fractures results in favorable outcomes and high bone union rates. However, owing to the rarity of coracoid process fractures combined with distal clavicle fractures, there are limited data to guide treatment strategies. We report a case of symptomatic nonunion despite performing osteosynthesis for fractures of the coracoid process and distal clavicle. CASE REPORT A 60-year-old man presented with left shoulder pain after falling from the back of a truck. Radiography and computed tomography (CT) findings revealed fractures of the left distal clavicle and coracoid process. We performed plate and costoclavicular fixation using a suture button for the distal clavicle fracture and cannulated cancellous screw fixation for the coracoid process fracture. However, the patient experienced severe pain around the coracoid and had limited shoulder range of motion 1 year postoperatively. CT revealed nonunion of the coracoid process, prompting a recommendation for surgery. However, despite severe persistent functional impairment, the patient refused surgery 1.5 years postoperatively. CONCLUSIONS This case suggests the potential for symptomatic nonunion of the coracoid process when using a suture-button device for a distal clavicle fracture. To prevent postoperative nonunion of the coracoid process, postoperative CT evaluation is necessary. If a symptomatic delayed bone union of coracoid process is observed, considering early removal of the suture button is recommended.
Assuntos
Clavícula , Fraturas Ósseas , Masculino , Humanos , Pessoa de Meia-Idade , Clavícula/diagnóstico por imagem , Clavícula/cirurgia , Clavícula/lesões , Processo Coracoide/diagnóstico por imagem , Processo Coracoide/cirurgia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Fixação Interna de Fraturas/métodos , Suturas , Resultado do TratamentoRESUMO
PURPOSE: To analyze radiographic outcomes by conventional radiography, computed tomography (CT), or both and complication rates of open coracoid transfer at a minimum of 12-months follow-up. METHODS: A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Medline (Ovid), and EMBASE library databases. Inclusion criteria were clinical studies reporting on open Latarjet as the primary surgical procedure(revision coracoid transfer after failed prior stabilization excluded) with postoperative radiographic outcomes at a minimum mean 1-year follow-up. Patient demographics, type of postoperative imaging modality, and radiographic outcomes and complications including graft union, osteoarthritis, and osteolysis were systematically reviewed. Data were summarized as ranges of reported values for each outcome metric. Each radiographic outcome was graphically represented in a Forest plot with point estimates of the incidence of radiographic outcomes with corresponding 95% confidence intervals and I2. RESULTS: Thirty-three studies met inclusion criteria, with a total of 1,456 shoulders. The most common postoperative imaging modality was plain radiography only (n = 848 [58.2%]), both CT and radiography (n = 287 [19.7%]), and CT only (n = 321 [22.1%]). Overall, the reported graft union rate ranged from 75% to 100%, of which 79.8% (n = 395) were detected on plain radiography. The most common reported postoperative radiographic complications after the open coracoid transfer were osteoarthritis (range, 0%-100%, pooled mean 28%), graft osteolysis (range, 0%-100%, pooled mean 30%), nonunion (range, 0%-32%, pooled mean 5.1%), malpositioned graft (range, 0%-75%, pooled mean 14.75%), hardware issues (range, 0%-9.1%, pooled mean 5%), and bone block fracture (range, 0%-8%, pooled mean 2.1%). Graft healing was achieved in a majority of cases (range, 75%-100%). CONCLUSION: Postoperative radiographic outcomes after open coracoid transfer vary greatly in definition, classification, and imaging modality of choice. Greater consistency in postoperative radiographic outcomes is essential to evaluate graft healing, osteolysis, and nonunion. LEVEL OF EVIDENCE: Level IV, systematic review of Level III-IV studies.
Assuntos
Fraturas Ósseas , Instabilidade Articular , Osteoartrite , Osteólise , Luxação do Ombro , Articulação do Ombro , Humanos , Articulação do Ombro/cirurgia , Instabilidade Articular/cirurgia , Ombro/cirurgia , Luxação do Ombro/cirurgia , Osteoartrite/diagnóstico por imagem , Osteoartrite/cirurgia , Osteoartrite/complicações , Fraturas Ósseas/complicações , Processo Coracoide/cirurgia , Processo Coracoide/transplanteRESUMO
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.
Assuntos
Acrômio , Fraturas Ósseas , Masculino , Humanos , Pessoa de Meia-Idade , Acrômio/diagnóstico por imagem , Acrômio/cirurgia , Acrômio/lesões , Processo Coracoide/diagnóstico por imagem , Processo Coracoide/cirurgia , Escápula/lesões , Escápula/cirurgia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Fixação Interna de FraturasRESUMO
Abstract Anterior dislocations represent about 96% of total shoulder dislocations, with recurrence/instability being more common in young patients. Injury of other shoulder structures is frequent, namely bony Bankart lesion. However, the association with coracoid apophysis fracture is very rare. The present article describes the clinical case of a 67-year-old man who presented to the emergency department with complaints of persistent omalgia, with acute episodes, beginning after a fall from his own height. The patient also presented history of shoulder trauma 3 months earlier, which was evaluated at another hospital. Shoulder anterior dislocation was observed radiographically, and the computed tomography (CT) confirmed bone erosion of the anteroinferior part of the glenoid (bone loss of about 50% of the anteroposterior diameter in the lower region of the glenoid), with almost complete resorption of the bony Bankart lesion (apparent in later analysis of the radiography of the initial traumatic episode). Connectedly, a transverse fracture of the coracoid apophysis (type II in the Ogawa classification) was diagnosed. The patient was submitted to surgical treatment, with anterior bone stop confection using the remnant of the fractured fragment of the coracoid supplemented by tricortical autologous iliac graft, fixed with cannulated screws (according to the Bristow-Latarjet and Eden-Hybinett techniques). In the postoperative follow-up, a good functional result was observed, with no new episodes of dislocation and no significant pain complaints. A rare association of shoulder lesions is described, and the challenge of their treatment is highlighted, given the late diagnosis, as in the case presented.
Resumo As luxações anteriores representam cerca de 96% do total de luxações do ombro, sendo a recidiva/instabilidade mais comum em pacientes jovens. A lesão de outras estruturas do ombro é frequente, nomeadamente a lesão óssea de Bankart. Contudo, a associação com a fratura da apófise coracoide é muito rara. Este artigo descreve o caso clínico de um homem de 67 anos que recorreu ao serviço de urgência com queixas de omalgia persistente, com episódios de agudização, iniciados após queda da própria altura. O paciente apresentava ainda histórico de trauma do ombro 3 meses antes, avaliado em outro hospital. A luxação anterior do ombro foi constatada radiograficamente, e a tomografia computorizada (TC) do ombro confirmou erosão óssea da vertente anteroinferior da glenoide (perda óssea de cerca de 50% do diâmetro anteroposterior na região inferior da glenoide), com reabsorção quase completa de lesão óssea de Bankart (aparente em análise a posteriori da radiografia do episódio traumático inicial). Associadamente, foi diagnosticada uma fratura transversa da apófise coracoide (tipo II da classificação de Ogawa). O paciente foi submetido ao tratamento cirúrgico, com confecção do batente ósseo anterior utilizando remanescente do fragmento fraturado do coracoide suplementado por enxerto autólogo tricortical do ilíaco, fixados com parafusos canulados (de acordo com as técnicas de Bristow-Latarjet e Eden-Hybinett). No seguimento pós-operatório, foi observado um bom resultado funcional, sem novos episódios de luxação e sem queixas álgicas significativas. Descreve-se uma associação rara de lesões do ombro, e salienta-se o desafio do tratamento das mesmas dado o seu diagnóstico tardio, como no caso apresentado.
Assuntos
Humanos , Masculino , Idoso , Luxação do Ombro/cirurgia , Fraturas do Ombro/cirurgia , Processo CoracoideRESUMO
BACKGROUND: The injury mechanism of acromioclavicular (AC) dislocation combined with coracoid process (CP) fracture is not clear, and there is no consensus on its treatment. This study was performed to evaluate the diagnosis of CP fractures combined with AC dislocation and the effectiveness of operative treatment using a clavicular hook plate. METHODS: Eighteen patients with CP fractures combined with AC dislocation were treated with a clavicular hook plate from May 2012 to June 2021. The patients comprised 10 male and 8 female patients with an average age of 38 years (range, 16-54 years). The injury was caused by falling in 15 patients, traffic accidents in 2 patients, and falling from a height in 1 patient. The Eyres type of CP fracture was type II in 1 patient, type III in 11 patients, type IV in 3 patients, and type V in 3 patients. The Ogawa type of CP fracture was type I in 17 patients and type II in 1 patient. The Rockwood type of AC dislocation was type V in 1 patient, variation type III in 15 patients, and variation type V in 2 patients. The interval from injury to the operation was 3 days (range, 1-7 days). Postoperative complications and CP fracture healing were recorded. Functional assessment at the last follow-up was performed by an independent reviewer using the Constant score and visual analog scale score. RESULTS: All 18 patients were followed up for a mean period of 49 months (range, 12-123 months). Nine patients had acromion osteolysis and 3 patients had CP fracture nonunion (Eyres type II, III, and V in 1 patient each); however, no patients developed shoulder pain, incision infection, limitation of shoulder movement, clinical symptoms of subcoracoid impingement, or AC dislocation relapse. At the last follow-up, the mean Constant score was 99 (range, 94-100). CONCLUSIONS: The possibility of CP fracture should be considered in patients with AC dislocation to avoid a missed diagnosis. Fixation with a clavicular hook plate is a feasible treatment for CP fracture combined with AC dislocation and provides a satisfactory outcome. CP fracture healing may be related to the fracture morphology.
Assuntos
Articulação Acromioclavicular , Fraturas Ósseas , Luxações Articulares , Luxação do Ombro , Humanos , Masculino , Feminino , Adulto , Articulação Acromioclavicular/diagnóstico por imagem , Articulação Acromioclavicular/cirurgia , Articulação Acromioclavicular/lesões , Processo Coracoide , Fixação Interna de Fraturas , Luxação do Ombro/cirurgia , Fraturas Ósseas/complicações , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Luxações Articulares/complicações , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Placas Ósseas , Resultado do TratamentoRESUMO
BACKGROUND This retrospective study from a single center aimed to evaluate 24 patients with coracoid process fractures of the scapula treated by baseplate three-column glenoid fixation of the 3 columns attached to the glenoid, or the scapula-glenoid construct, which includes the base of the coracoid, the scapular spine, and the lateral/scapular pillar. MATERIAL AND METHODS Twenty-four patients with 24 coracoid process fractures were treated from March 2018 to August 2020 in our hospital; 11 cases were treated with the modified technique and 13 with the conventional technique. The patients had comparable screw length, bone union time, fracture reduction, and Constant-Murley shoulder outcome scores. The significant differences between variables were tested using the t test and Fisher's exact test, while bone union and reduction position were confirmed with X-ray and CT scans. The average follow-up time was 12 months. RESULTS The mean Constant-Murley shoulder outcome score and fracture reduction did not differ significantly (P>0.05), and all patients returned to their previous occupations and levels of activity, with no loss of reduction or surgical revision at the last follow-up. Bone union time for the modified group was longer than that of the conventional group (P<0.05). However, 1 patient had a screw broken at 5 months from heavy manual labor and showed delayed union at 8 months. The lengths of the coracoid process screws in the modified group were longer than in the conventional group (P<0.01). CONCLUSIONS The findings from this retrospective study showed that baseplate three-column glenoid fixation of the coracoid process was a good surgical option for coracoid process fractures.
Assuntos
Fraturas Ósseas , Articulação do Ombro , Humanos , Processo Coracoide/cirurgia , Estudos Retrospectivos , Escápula/cirurgia , Fraturas Ósseas/cirurgia , Articulação do Ombro/cirurgiaRESUMO
The coracoclavicular joint (CCJ) is a synovial joint that forms between the conoid tubercle of the clavicle and the coracoid process of the scapula in approximately 2.5% of the population. The number of bilateral to unilateral cases is almost equal. The number of right-sided and left-sided cases is also almost equal. It is found in both males and females but most often in male adults. Very few cases have been identified in juveniles. Found in populations all over the world, the highest frequencies of CCJ are in Asia. The etiology is unknown but it is most likely caused by metaplastic change of the trapezoid and surrounding tissue due to compression and friction of the coracoacromial ligament between the clavicle and coracoid process. Typically asymptomatic, but if so, the most common complaint is anterior should pain exacerbated by extreme abduction. Successful treatment includes steroid injection and surgical excision.
Assuntos
Articulação Acromioclavicular , Clavícula , Processo Coracoide , Dor de Ombro , Articulação Acromioclavicular/anatomia & histologia , Clavícula/anatomia & histologia , Relevância Clínica , Processo Coracoide/anatomia & histologia , Dor de Ombro/etiologia , Escápula , HumanosRESUMO
A fracture of the tip of the coracoid is a rare but challenging fracture. A surgical indication is required in case of a displaced fracture. Screws and suture anchors often do not offer a reliable fixation in the case of very small fragments. We describe our hardwareless technique that consists of an osteosuture with a 90-degree suture threads configuration that we called the x-mas box technique. This procedure is cost-effective and it provides stable fixation and low complications rate.
Assuntos
Processo Coracoide , Fraturas Ósseas , Humanos , Processo Coracoide/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Extremidade Superior , Âncoras de SuturaRESUMO
INTRODUCTION: Coracoid fractures after arthroscopic treatment of acromioclavicular (AC) joint separations lead to poor clinical outcomes. In this study, different configurations of bone tunnels in the lateral clavicle and coracoid were examined concerning the amount of stress induced in the coracoid. METHODS: An authentic 3D finite element model of an ac joint was established. Three 2.4 mm bone tunnels were inserted in the lateral clavicle, which were situated above, medially and laterally of the coracoid. Then, two 2.4 mm bone tunnels were inserted in the latter, each simulating a proximal and a distal suture button position. Von Mises stress analyses were performed to evaluate the amount of stress caused in the coracoid process by the different configurations. Then, a clinical series of radiographs was examined, the placement of the clavicle drill hole was analyzed and the number of dangerous configurations was recorded. RESULTS: The safest configuration was a proximal tunnel in the coracoid combined with a lateral bone tunnel in the clavicle, leading to an oblique traction at the coracoid. A distal bone tunnel in the coracoid and perpendicular traction as well as a proximal tunnel in the coracoid with medial traction caused the highest stresses. Anatomical placement of the clavicle drill hole does lead to configurations with smaller stresses. CONCLUSION: The bone tunnel placement with the smallest amount of shear stresses was found when the traction of the suture button was directed slightly lateral, towards the AC joint. Anatomical placement of the clavicle drill hole alone was not sufficient in preventing dangerous configurations. LEVEL OF EVIDENCE: Controlled laboratory study.
Assuntos
Articulação Acromioclavicular , Fraturas Ósseas , Luxações Articulares , Procedimentos de Cirurgia Plástica , Humanos , Processo Coracoide/cirurgia , Análise de Elementos Finitos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Fraturas Ósseas/etiologia , Articulação Acromioclavicular/diagnóstico por imagem , Articulação Acromioclavicular/cirurgia , Clavícula/cirurgia , Ligamentos Articulares/cirurgia , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/etiologia , Luxações Articulares/cirurgiaRESUMO
El pinzamiento subcoracoideo es un cuadro poco frecuente y, por lo tanto, su diagnóstico plantea un reto al cirujano ortopédico. Se manifiesta con un dolor sordo en la región subcoracoidea y dolor a la palpación en el proceso coracoideo, como resultado del pinzamiento del músculo subescapular entre el proceso coracoideo y el troquín del húmero. El objetivo de esta nota técnica es describir una alternativa diagnóstica y la inyección guiada por ecografía para atletas lanzadores con pinzamiento subcoracoideo. Nivel de Evidencia: IV
Subcoracoid impingement is a rare condition, therefore, its diagnosis poses a challenge to the orthopedic surgeon. It manifests with dull pain in the subcoracoid region and pain on palpation in the coracoid process as a result of impingement of the subscapularis muscle between the coracoid process and the lesser tubercle of the humerus. The objective of this technical note is to describe an alternative diagnosis and ultrasound-guided injection for throwing athletes with subcoracoid impingement. Level of Evidence: IV
Assuntos
Adolescente , Traumatismos em Atletas , Articulação do Ombro , Síndrome de Colisão do Ombro , Processo CoracoideRESUMO
Glenohumeral joint is the most frequently dislocated joint of the human body. Concomitant fractures of the coracoid process and tuberculum majus in humeral dislocation of the shoulder joint are rarely described. Concomitant fractures are results of a significant contraction of the surrounding muscles and rotator cuff during a cerebral paroxysm. Due to the small number of cases, the treatment of such injuries is not simple and it is based on an algorithm for treatment of isolated injuries of these anatomical structures. In this case report, we describe a concomitant fracture of the coracoid process and tuberculum majus during an anterior shoulder dislocation in 25-year-old patient after an epileptic seizure. The injury was treated in our department surgically, with a good functional result. The absolute Constant score for the operated arm is 95 points, the relative Constant score is 97%, DASH score 0, VAS score 0.
Assuntos
Fraturas Ósseas , Luxação do Ombro , Articulação do Ombro , Humanos , Adulto , Luxação do Ombro/complicações , Luxação do Ombro/cirurgia , Processo Coracoide , Úmero , Fraturas Ósseas/complicaçõesRESUMO
Successful Latarjet procedures depend on many factors including graft union and subsequent restoration of the glenoid surface. Coracoid graft union has been studied; however, remodelling of the glenoid has not been studied extensively. We present two Latarjet cases in which coracoid screws were removed due to hardware issues, at 12 months postoperatively in one patient and at six months in another. We share our observations on the coracoid graft and the restoration of the glenoid shape. Prior to screw removal, done by a mini-open approach, we performed arthroscopic examination of the glenohumeral joint in both patients. Our arthroscopic and open findings with respect to graft union, screw prominence, and glenoid remodelling, are presented. Both cases showed good union of the coracoid graft and restoration of the native glenoid shape. Key Words: Shoulder dislocation, Surgery, Complications, Coracoid process.
Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Artroscopia/efeitos adversos , Artroscopia/métodos , Processo Coracoide/transplante , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Escápula/cirurgia , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVE: An agreement has not been reached on optimal locations of bone tunnels for coracoclavicular ligament (CCL) reconstruction for acromioclavicular joint dislocation (ACD). This study aims to identify the convergence point (cP) between the coracoid process and clavicle in the Chinese population to assist surgeons in reconstructing the CCL for ACD. METHODS: From 2014 to 2020, 483 CT scans of the shoulders of 270 male and 213 female patients (247 right and 236 left shoulders) were collected and studied retrospectively. By overlapping the images of the transverse plane of the coracoid process and the clavicle, points a and b, and the midpoint ab (cP) were determined. Then, a series of parameters through point cP in the transverse and sagittal planes were measured. In the transverse plane this included the distance from point cP to the tip of the coracoid process (cP-cor),the distance between the medial and lateral margins of the coracoid process through point cP (Med-lat cor), the distance from point cP to the acromioclavicular joint (cP-ac), and the distance between the anteroposterior margin of the clavicle through point cP (Ap-clav). In the sagittal plane, this included the craniocaudal segment of the coracoid process (Cc-cor), and the craniocaudal segment of the clavicle (Cc-clav). The sex and side differences of these measurements were also analyzed by two radiologists. RESULTS: Based on the following measurements, point cP was determined. For male patients, the cP-cor was 28.02 ± 3.43 mm, Med-lat cor was 22.78 ± 2.80 mm, Cc-cor was 15.11 ± 2.13 mm, cP-ac was 29.24 ± 3.84 mm, Ap-clav was 18.27 ± 2.46 mm, and Cc-clav was 10.09 ± 1.56 mm. For female patients, the cP-cor was 25.20 ± 3.26 mm, Med-lat cor was 20.21 ± 2.97 mm, Cc-cor was 13.03 ± 1.77 mm, cP-ac was 26.66 ± 3.45 mm, Ap-clav was 16.10 ± 2.30 mm, and Cc-clav was 8.91 ± 1.40 mm. All the measurements of female patients were lower than those of male patients (p < 0.01). Between sides, only cP-ac of the left shoulders was significantly lower than those of the right shoulders (p < 0.05), with no significant differences in other parameters between sides (p > 0.05). CONCLUSION: The results of this study identified the locations of bone tunnel-cP in the coracoid process and clavicle for the CCL reconstruction in ACD. Moreover, the findings indicated that surgeons should be more cautious in operating on female patients and that the cP-ac of left shoulders should be set lower than that of right shoulders.
Assuntos
Articulação Acromioclavicular , Luxação do Ombro , Articulação Acromioclavicular/diagnóstico por imagem , Articulação Acromioclavicular/cirurgia , Clavícula/diagnóstico por imagem , Clavícula/cirurgia , Processo Coracoide/diagnóstico por imagem , Processo Coracoide/cirurgia , Feminino , Humanos , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/cirurgia , Masculino , Estudos Retrospectivos , Luxação do Ombro/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Objective: To evaluate the short-term effectiveness of modified arthroscopic Latarjet procedure with double EndoButtons for recurrent anterior shoulder dislocation. Methods: Between January 2019 and November 2020, 36 patients with recurrent anterior shoulder dislocation were treated by modified arthroscopic Latarjet procedure with double EndoButtons. There were 26 males and 10 females, with an average age of 27.8 years (range, 18-36 years). The number of shoulder dislocations ranged from 3 to 12 times, with an average of 6.5 times. The disease duration ranged from 5 to 36 months, with an average of 16.2 months. Preoperative shoulder fear test was positive, and the Beighton score of joint relaxation was 0-4, with an average of 1.3. Imaging examination showed that the defect width of the ipsilateral glenoid bone was 16%-28%, with an average of 21.5%. Postoperative complications, recurrent dislocation, subluxation, and instability of shoulder joint were recorded. Shoulder range of motion was examined, including forward flexion, external rotation at side, external rotation at 90° abduction, and internal rotation. Shoulder joint function was evaluated by Walch-Duplay score, American Association for Shoulder and Elbow Surgery Score (ASES), and ROWE score. X-ray film and CT images were taken to observe the shaping of coracoid process graft. Results: All incisions healed by first intention, and no vascular or nerve injury occurred. All patients were followed up 12-28 months, with an average of 19.9 months. During follow-up, no shoulder dislocation recurred, and shoulder fear test was negative. At last follow-up, there was no significant difference in shoulder forward flexion, external rotation at side, external rotation at 90° abduction, and internal rotation when compared with preoperative values (P>0.05). The Walch-Duplay score, ASES score, and ROWE score of shoulder function significantly improved (P<0.05). Postoperative imaging examination showed that coracoid process graft was at the same level with the glenoid in 33 cases (91.7%), medial in 1 case (2.8%), and lateral in 2 cases (5.6%); the center of coracoid process graft was mainly located between 3 to 5 o'clock in 33 cases (91.7%), higher than 3 o'clock in 1 case (2.8%), and lower than 5 o'clock in 2 cases (5.6%). There was no obvious glenohumeral joint degeneration during follow-up, and the coracoid process graft gradually formed concentric circles with the humeral head. Conclusion: The modified arthroscopic Latarjet procedure with double EndoButtons can effectively treat recurrent anterior shoulder dislocation, and the short-term effectiveness is satisfactory, and the position of coracoid process graft is accurate.