Coracoid or Clavicle Fractures Associated With Coracoclavicular Ligament Reconstruction

Abstract

Background: Coracoclavicular (CC) ligament reconstruction is a commonly performed procedure for high-grade acromioclavicular (AC) joint separations. Although distal clavicle and coracoid process fractures represent potential complications, they have been described in only case reports and small case series. Purpose: To identify the incidence and characteristics of clavicle and coracoid fractures after CC ligament reconstruction. Study Design: Case series; Level of evidence, 4. Methods: The US Military Health System Data Repository was queried for patients with a Current Procedural Terminology code for CC ligament repair or reconstruction between October 2013 and March 2020. The electronic health records, including patient characteristics, radiographs, operative reports, and clinical notes, were evaluated for intraoperative or postoperative clavicle or coracoid fractures. Initial operative technique, fracture management, and subsequent clinical outcomes were reviewed for these patients. Results: A total of 896 primary CC ligament repairs or reconstructions were performed during the study period. There were 21 postoperative fractures and 1 intraoperative fracture in 20 patients. Of these fractures, 12 involved the coracoid and 10 involved the clavicle. The overall incidence of fracture was 3.81 fractures per 1000 person-years. In 5 patients who sustained a fracture, bone tunnels were not drilled in the fractured bone during the index procedure. A total of 17 fractures were ultimately treated operatively, whereas 5 fractures had nonoperative management. Of the 16 active-duty servicemembers who sustained intraoperative or postoperative fractures, 11 were unable to return to full military duty after their fracture care. Conclusion: Fracture of the distal clavicle or coracoid process after CC ligament repair or reconstruction is a rare but serious complication that can occur independent of bone tunnels created during the index procedure. Fractures associated with CC ligament procedures occurred at a rate of 2.46 per 100 cases. Most patients were ultimately treated surgically with open reduction and internal fixation or revision CC ligament reconstruction. Although the majority of patients with intraoperative or postoperative fractures regained full range of motion, complications such as anterior shoulder pain, AC joint asymmetry, and activity-related weakness were common sequelae resulting in physical limitations and separation from military service.

Proximal Tibia Fracture Through Suture Augmentation Sites Following ACL/MCL Repairs

“…Despite this low incidence, suture anchors or cortical buttons were present at the fracture site in 25% of cases. Contrary to this, in coracoclavicular repair and reconstruction for acromioclavicular joint dislocation, postoperative clavicle or coracoid fractures have been documented irrespective of bone tunnel drilling, suggesting that there may be other considerations involved to include level of activity and bone health 15 .…”

Treatment of acromioclavicular dislocations with a concomitant coracoid fracture: a systematic review of 37 patients

“…Literature shows that if ligament reconstruction is needed for future surgery and the CP is not suited as a point of fixation, the lateral clavicula is a complex alternative site and therefore fixation on the scapula should be considered. 34 The last notable finding is the complication rate of 33.3% in patients treated with sole fixation of the AC. However, these are only 3 patients, and considering that none of the complications involve the CP, no conclusions can be drawn from this.…”

Acromioclavicular Joint Injuries in Sport

“…They report an incidence of 3.81 per 1000 person-years and a fracture rate of 2.46 per 100 cases. While rare, these fractures are a common indication for revision surgery and often result in persistent anterior shoulder pain, activity-related weakness, and physical limitation among young active patients (96,99).…”

“…Intraoperative clavicle and coracoid fractures are other known complications of CC joint reconstruction (59,93,98). Panarello et al (99) conducted a retrospective review of intraoperative and postoperative clavicle and coracoid fractures during CC ligament reconstruction among military personnel. They report an incidence of 3.81 per 1000 person-years and a fracture rate of 2.46 per 100 cases.…”