Postoperative Radiographic Outcomes Following Primary Open Coracoid Transfer (Bristow-Latarjet) Vary in Definition, Classification, and Imaging Modality: A Systematic Review.

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.

Ipsilateral fractures of the acromion and coracoid processes of the scapula.

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.

Coracoclavicular Joint Arthrosis - An Uncommon Cause of Shoulder Pain.

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.

Coracoid Process Fractures of the Scapula Treated by Baseplate Three-Column Glenoid Fixation: A Retrospective Study of 24 Patients.

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.

Treatment of coracoid process fractures combined with acromioclavicular joint dislocation using clavicular hook plate.

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.

A review of the coracoclavicular joint: Description, etiology, and clinical significance.

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.

Bone tunnel placement influences shear stresses at the coracoid process after coracoclavicular ligament reconstruction: a finite element study and radiological analysis.

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.

The anatomy and variation of the coracoid attachment of the subclavius muscle in humans.

The functions of the subclavius muscle (SM) are described as stabilization of the sternoclavicular joint (SCJ) and resisting elevation of the lateral end of the clavicle. During systematic cadaveric dissections, we observed additional fibrous structures, previously described as variants of the anatomy, extending from the SM and inserting into the coracoid process (CP). Due to the high incidence of these structures in our dissections, we hypothesized that the attachment at the CP is more common than appreciated and that, as a corollary, the function of the SM was (or has been) more complex than simply depressing the clavicle and generating stability at the SCJ. For our investigation, fifty-two upper extremities of 26 human cadavers were dissected. The SM was demonstrated from costal to clavicular attachment. We documented additional fibrous structures apparently derived from the SM inserting into the CP. Measurements of the length of the SM, the length of its attachment, and the length of the clavicle were taken in situ, with the specimens supine and the upper extremity in the anatomical position. Variations in the anatomy of the SM and its coracoidal attachment were recorded, and potential correlations were investigated. For documentation purposes photographs and video sequences of passive motion of the shoulder girdle of the specimens were taken. In 49 of the 52 specimens we found additional fibrous structures passing from the SM to the CP. We differentiated three types: (1) a strong cord-like structure; (2) a small or thin cord-like structure or structures; and (3) a planar twisted sheet-like structure. The SM and its extension to the CP appears to contribute to a 'functional scapular suspension system' together with the other muscles enveloped by the clavipectoral fascia (pectoralis minor, coracobrachialis and the short head of the biceps brachii). This system assists in the control of the position of the scapula in relation to the thorax, particularly in elevated positions of the upper extremity. We speculate that the differentiation of the fibrous structure depends on the functional demands of the individual. Level of Evidence: Basic science study.

Transfer of the coracoid and conjoined tendon for failed, unstable, short clavicle following excessive outer clavicle resection.

Nineteen patients presented with an unsightly deformity of the shoulder, pain or discomfort at the medial scapular border, pseudo nonparalytic scapular winging, and thoracic outlet symptoms after excessive resection of the clavicle for either complete acromioclavicular separation or displaced fracture of the outer clavicle, which allows the scapula and shoulder to rotate anteriorly and inferiorly on the chest creating traction on the medial scapular muscles and the brachial plexus resulting in pseudo nonparalytic winging and thoracic outlet symptoms. RESULTS: All underwent transfer of the coracoid process with the attached conjoined tendon to the end of the clavicle, restoring length and alignment. Eighteen patients were evaluated at a mean of 13.3 years. Seventeen had resolution of symptoms, restored alignment of the clavicle with the shoulder, improved appearance, healed transfer, and were pleased with the outcome. One patient was lost to follow-up but was considered a failure at his last visit. In a second patient, the transfer healed in a tilted position and the patient was dissatisfied with the appearance but otherwise had resolution of his symptoms. The mean American Shoulder and Elbow Surgeons Outcome Score improved from 53.2 preoperatively to 87.4 postoperatively (P < .02). CONCLUSION: This is the first report of using this transfer to restore length and alignment of an excessively short, unstable clavicle. The transfer succeeded in improving the appearance and symptoms in this complication of an excessively short, unstable clavicle.

Morphology of the coracoid process as a predictor of articular-side tear at the upper border of the subscapularis.

BACKGROUND: Articular-side tear at the upper border of the subscapularis (SSC-AST) is often detected during shoulder arthroscopic surgery, although its exact pathology remains unknown. The purpose of this study was to investigate the correlation between various characteristics of the coracoid process, including classification of the morphology of the coracoid process tip, and the presence of SSC-AST. METHODS: This retrospective, case-controlled study included patients who underwent arthroscopic subacromial decompression with or without rotator cuff repair between January 2018 and September 2021. A total of 130 shoulders in 124 patients, including 77 male and 53 female shoulders (mean age at surgery, 64 years [range, 39-88 years]), were included in this study. Three-dimensional (3D) computed tomography examination was performed preoperatively, and the following indices were measured: coracoid proximal length, coracoid distal length, coracoid angle, coracoglenoid angle, offset of the coracoid process and glenoid (anterior, lateral, and superior offset), and coracoid base angle. The morphology of the tip of the coracoid process was classified into 3 types according to 3D reconstructed views: flat type, round type, and beak type. The presence of SSC-AST was intraoperatively evaluated arthroscopically via a posterior glenohumeral portal. Morphologic risk factors for SSC-AST were evaluated between SSC-AST cases (group T) and non-SSC-AST cases (group N) by multivariable logistic analysis. In addition, the correlation between the incidence of SSC-AST and classification of the tip of the coracoid process was analyzed. RESULTS: SSC-AST was present in 53 shoulders (40.8%). Group T patients were significantly older than group N patients (68.4 ± 10.0 years vs. 61.5 ± 11.8 years, P < .001). No sex difference was detected between the 2 groups (28 male and 25 female shoulders in group T vs. 49 male and 28 female shoulders in group N, P = .28). Multivariate analysis of morphologic parameters between the 2 groups detected a smaller superior offset as a risk factor for SSC-AST (odds ratio, 0.91; 95% confidence interval, 0.84-0.98; P = .01). No significant differences were found in the other parameters. Regarding classification of the tip of the coracoid process, round- and beak-type coracoid tips had a significantly higher rate of SSC-AST than flat-type tips (flat type, 21.8%; round type, 64.7%; and beak type, 46.3%) (P < .001). CONCLUSIONS: Evaluation of the correlation between the morphology of the coracoid process on 3D computed tomography and the presence of SSC-AST visualized during arthroscopy indicated a significant association between SSC-AST and the morphology of the coracoid process.

The base of coracoid process as a reference for glenoid reconstruction in primary or revision reverse shoulder arthroplasty: CT-based anatomical study.

INTRODUCTION: Joint replacement surgery as a treatment for glenohumeral arthritis with glenoid bone loss is challenging. The aim of this study is to offer an anatomical orientation for glenoid reconstruction. METHODS: In this study, we measured size, inclination and version of the glenoid surface, as well as the distance between the articular line of the glenoid, base of the coracoid process, and acromion using computer tomographic (CT) imaging of 131 study participants aged 19-88 years in the period of 2010-2013. RESULTS: We measured a mean distance of 6.5 ± 0.2 mm from the glenoid articular line to the base of the coracoid process in the transverse CT plane. Body height has shown no significant impact on the glenoid morphology. We observed significant differences between males and females: The glenoid appeared to be located 5.2 ± 0.9 mm higher and the humeral head was 4.5 ± 0.7 mm larger in male subjects compared with females (r = .699; p < .01). CONCLUSION: In our study, the base of the coracoid offers an anatomical reference during reconstruction of the glenoid in primary and revision shoulder arthroplasty. As only 2D-CT imaging allows for accurate assessment of glenoid bone defects, we consider conventional X-ray imaging insufficient for proper preoperative planning before shoulder arthroplasty. LEVEL OF EVIDENCE: III.

Anterior Shoulder Dislocation with Concomitant Fracture of processus coracoideus and tuberculum majus humeri - Case Report.

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.

Anatomy and Correlation of the Coracoid Process and Coracoclavicular Ligament Based on Three-Dimensional Computed Tomography Reconstruction and Magnetic Resonance Imaging.

BACKGROUND The anatomy of the coracoid process and coracoclavicular (CC) ligament have been described and the correlation between them has been assessed based on 3-dimensional computed tomography (CT) reconstruction and magnetic resonance imaging (MRI), which provide a guide for coracoclavicular ligament reconstruction. MATERIAL AND METHODS Data were collected from 300 patients who underwent both CT and MRI of the shoulder joint from January 2017 to January 2019 at the Jiang'an Hospital of Traditional Chinese Medicine. The coracoid process was observed and classified and parameters of the CC ligament were measured according to different corneal types. All of the statistics were collected and classified by 2 radiologists, and average values were determined.Measurements of segments were taken as follows: ab - In the coronal plane, the length of the CC ligament from the central point of the CC ligament at the clavicular attachment to the CC ligament at the center of the CC attachment); ac - The distance from the center point of the CC ligament at the supraclavicular attachment to the acromioclavicular joint; de - In the sagittal plane, the length of the CC ligament from the center of the clavicular attachment to the coracoid attachment point; fg - The maximum diameter of the CC ligament at the anterior and posterior margins of the clavicle attachment; hi - The largest diameter of the CC ligament at the anterior and posterior edge of the coracoid process attachment; dj - The distance of the coracoclavicular ligament from the center point of the coracoid process attachment to the coracoid process tip; kl - The distance in the supraclavicular plane from the coracoclavicular ligament to the subcoracoid process. RESULTS The analysis showed that there are 5 types of coracoid process: gourd (31%), short rod (20%), long rod (22.3%), wedge (10.3%), and water drop (6.3%). There were statistically significant differences between the lengths of the ac and hi segments in the among the wedge and gourd-type and the short rod and water drop-type coracoid processes. There were statistically significant differences between the lengths of the ab, de, and fg segments in the short rod, gourd, and long rod-type coracoid processes. There were statistically significant differences between the lengths of the ac, fg, hi, dj, and kl segments in the water drop, gourd, and long rod-type coracoid processes. CONCLUSIONS The present study indicated that measurement of the CC ligament and the different shapes of the coracoid process provide an anatomical basis for the diagnosis and treatment of shoulder diseases and the data can be used to improve the safety of CC ligament reconstruction.

The Shoulder Trans-pectoralis Arthroscopic Portal Is a Safe Approach to the Arthroscopic Latarjet Procedure: A Cadaveric Analysis.

PURPOSE: To assess the proximity of neurovascular structures in a layered approach during medial portal placement and determine standardized measurements for establishing a portal medial to the coracoid used in arthroscopic Latarjet-type procedures. METHODS: Twelve shoulders (6 right and 6 left) in 6 fresh frozen cadaveric torsos were mounted in the modified beach-chair position. A standard posterior portal and 3 anterior portals-central, lateral, and medial-were used. A long spinal needle was placed along the path of the medial portal to the lateral tip of the coracoid, superficial to the conjoined tendon and pectoralis minor. A second long spinal needle was directed toward the medial base of the coracoid, penetrating the pectoralis minor. Superficial and deep plane dissections were performed, and distances to surrounding neurovascular structures were recorded. RESULTS: In the superficial plane, the cephalic vein and lateral pectoral nerve were located a mean distance (± standard deviation) of 4.6 ± 1.9 mm and 9.4 ± 2.6 mm from the spinal needle, respectively. In the deep plane, the axillary nerve was 24.9 ± 7.4 mm from the needle; the lateral cord of the brachial plexus, 25.5 ± 8.1 mm; the axillary artery, 34.1 ± 6.0 mm; and the musculocutaneous nerve, 42.2 ± 9.2 mm. The portal was consistently established 45.0 to 50.0 mm distal and 30.0 to 35.0 mm medial to the coracoid, which was a minimum distance of 10 mm to the lateral pectoral nerve. CONCLUSIONS: In a cadaveric model, the creation of a medial trans-pectoralis major portal used in the arthroscopic Bankart-Bristow-Latarjet procedure can avoid compromise of vital neurovascular structures, alleviating concerns of creating a portal medial to the coracoid. Portal placement 45.0 to 50.0 mm distal and 30.0 to 35.0 mm medial to the palpable tip of the coracoid process may be a safe approach to perform the arthroscopic Bankart-Bristow-Latarjet procedure. CLINICAL RELEVANCE: Creation of a portal medial to the level of the coracoid may pose a risk to neurovascular structures. This cadaveric study establishes a working zone for medial trans-pectoralis portal placement, which avoids vital neurovascular structures, and provides standardized measurements for establishing this portal for use in the arthroscopic Bankart-Bristow-Latarjet procedure.

Long-term stability of coracoclavicular suture fixation for acute acromioclavicular joint separation.

PURPOSE: The optimal (SBJI) surgical treatment for acute acromioclavicular (AC) joint disruption remains controversial. What is being presented is the long-term functional outcomes of a double cross-looped coracoclavicular (CC) suture technique with the intention of restoring both anteroposterior and superior displacement of the clavicle. METHODS: Between 2007 and 2016, 81 patients underwent surgical reconstruction for acute acromioclavicular joint (AC) disruption in two orthopaedic centers. Two patients died for reasons unrelated to the treatment, and seven missed the final follow-up appointment, leaving 72 patients (67 males; 5 females; age 37 ± 12.4; range 15-64 years) for clinical and radiological assessments. All cases were classified according to the Rockwood classification as type III (n = 34), IV (n = 14) or V (n = 24). The dislocation was repaired with double cross-looped CC fixation using four Ethibond sutures passing underneath the coracoid and through a 4.5 mm drill hole in the clavicle in opposing directions to control both anteroposterior and vertical displacement. Radiological investigation preoperatively and at the last follow-up included anteroposterior and/or Zanca views, axillary or Alexander views, and comparative stress radiography of both AC joints. Patients were evaluated clinically with the Constant-Murley score (CMS) and Acromio Clavicular Joint Instability Score (ACJIS). Loss of reduction, subluxation, CC ligament ossification, post-traumatic arthritis, and peri-implant fractures were also recorded. RESULTS: Seventy-two patients were available for the last clinical and radiological evaluations. At a median follow-up period of 6.3 ± 2.1 years (range 3-12 years), the CMS and ACJIS were 92.1 ± 7.2 (range 60-100 points) and 90.4 ± 8.6 (range 45-100 points), respectively. Complications included 9 (12.5%) patients with slight loss of reduction, 2 (1.7%) with dislocation recurrence, 1 (1.3%) with superficial infection, 1 (1.3%) with a fracture of the lateral end of the clavicle, and 2 (1.7%) with persistent tenderness in the AC joint. The incidence of periarticular ossification was 22.4% and did not affect the final outcome. CONCLUSIONS: This technique represents an effective and low-cost treatment for acute AC joint separations. LEVEL OF EVIDENCE: IV.

All arthroscopic coracoclavicular button fixation is efficient for Neer type II distal clavicle fractures.

PURPOSE: Neer type II distal clavicle fractures are associated with a high rate of non-union or malunion due to impaired coracoclavicular ligament stability. The purpose of this study was to assess the clinical and radiological outcomes of arthroscopically assisted indirect osteosynthesis for type II distal clavicle fractures using a cortical suture button device. METHODS: Seventeen patients Neer type II fractures of the distal clavicle were treated surgically using cortical suture button fixation between 2012 and 2017. The clinical and radiological results were assessed using the American Shoulder and Elbow Surgeons Shoulder Score (ASES), Constant-Murley score and visual analogue scale (VAS) score. RESULTS: Anatomic reduction and bone healing were achieved in all patients at the final follow-up. The median age of the patients was 31 years (range 19-57). The mean follow-up was 25.9 months (range 14-64). The average delay before surgery was 2 days (range 1-4). At the final follow-up, the mean ASES, Constant-Murley score and VAS score were 92.6 ± 3.2 (range 84.9-96.6), 96.2 ± 2.4 (range 92-100) and 0.47 ± 0.51 (range 0-1), respectively. All patients were able to resume work as well as sport activities. The postoperative complications included two coracoid process fractures, and none of the patients required additional surgery related to the index procedure. CONCLUSION: All arthroscopic coracoclavicular button fixation of Neer type II distal clavicle fractures would provide sufficient stability and union with satisfactory radiological and clinical outcomes. This arthroscopic fixation technique would be more efficient than other osteosynthesis methods because it is a minimally invasive surgery with a low complication rate. LEVEL OF EVIDENCE: III.

A gender-based comparison of coracoid and glenoid anatomy: CT analysis and discussion of potential impact on the Latarjet procedure.

BACKGROUND: The success of the modified Latarjet procedure depends on proper sizing of the coracoid graft. There is no information available regarding the morphometric relationship between the glenoid cavity and the coracoid process for the South African population. This study aims at measuring the relationship between the glenoid and coracoid morphometries and investigates their gender-related differences. METHODS: Glenohumeral computerized tomography scans of 100 consecutive patients were considered for this study. Morphometric measurements were performed after aligning the coracoid and glenoid in their optimum orientation. These measurements were performed by 2 independent observers. The ratio between glenoid and coracoid measurements was calculated and statistically compared using the Mann-Whitney U test. Intraclass correlation coefficients were calculated to analyze interobserver reliability. All the statistical tests were performed in SPSS v.26, and power calculations in G∗Power v.3.1. RESULTS: An average intraclass correlation coefficient value of 0.79 suggested that the interobserver reliability was good. Except for coracoid length, statistically significant (P < .05) gender differences were observed for all the other morphometries. The coracoid width (16.5 ± 1.4 mm vs. 14.7 ± 1.4 mm) and height (13.6 ± 1.6 mm vs. 10.5 ± 1.5 mm) differed between genders by 1.8 and 3.1 mm, respectively. The glenoid anteroposterior (AP) (25.3 ± 2.9 mm vs. 23.2 ± 2.4 mm) and superioinferior (36.9 ± 1.9 mm vs. 33.7 ± 2.6 mm) measurements differed by 2.1 and 3.3 mm, respectively, between the males and the females. The ratio between the AP width of the glenoid and the coracoid height was also found to be significantly different (P < .05) between the gender groups. These morphometric ratios for the coracoid width (0.66 ± 0.09 mm vs. 0.64 ± 0.08 mm) and the coracoid height (0.55 ± 0.09 mm vs. 0.46 ± 0.07 mm) differed between genders by 0.02 and 0.09, respectively. CONCLUSION: Measurements taken from computerized tomography scans showed significant differences between genders in absolute measurements and in the ratio of the coracoid height to the glenoid AP distance. This could have implications on the ability of the Latarjet procedure to compensate for bone loss in female patients.

Fractures of the coracoid process - pathoanatomy and classification: based on thirty nine cases with three dimensional computerised tomography reconstructions.

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.

Treatment of coracoid process fractures: a systematic review.

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.

Nonunion of the coracoid process: a systematic review.

INTRODUCTION: Although the coracoid process seems to play an important anatomical role, there are few reports concerning fracture nonunion of the coracoid process (CN) and its disorders. Therefore, there is no widely accepted standard for the treatment of CN. MATERIALS AND METHODS: PubMed and Scopus were searched using "scapular fracture" and "coracoid fracture" as search terms. The inclusion criteria were English full-text articles concerning coracoid fracture, and articles that described patient characteristics and presented appropriate images. The exclusion criteria were descriptive cases, and cases without appropriate images. Citation tracking was conducted to find additional articles and notable full-text articles written in other languages. Fractures were classified using Ogawa's functional classification, with Eyres' anatomical classification used as a supplement when necessary. RESULTS: Twenty-nine patients (26 men, 3 women) with 30 CN were identified. Nine CN had a predisposing factor such as seizure disorder and renal osteodystrophy. The fracture types were 12 Ogawa type I and 18 type II. Concurrent shoulder girdle injuries at the time of initial trauma/accident were varied. There were six cases of double disruption and two of triple disruption of the superior shoulder suspensory complex (SSSC), all of which had Ogawa type I fracture. Only six CN were isolated. The most frequent cause of CN was oversight by the previous physician (n = 11), followed by conservative treatment (n = 7). Although 12 patients with 13 CN had symptoms attributable to CN, most of these symptoms were insignificant. Although the acromioclavicular dislocation or CN persisted in eight patients, these residual abnormalities did not significantly affect the outcomes. CONCLUSIONS: Physicians treating CN should recognize that CN itself is frequently asymptomatic, and a satisfactory outcome is achieved solely by treating the concurrent injuries, even if CN remains. When CN is suspected to produce symptoms, the physician must then determine the mechanism by which the symptoms are produced, and select a treatment strategy. LEVEL OF EVIDENCE: V.