Korakoidpseudarthrose nach Fraktur des Processus coracoideus bei anteriorer Schulterluxation

Abstract

Fractures of the coracoid process are rare and represent only 2-5% of all fractures of the scapula. The most frequent cause of a coracoid fracture is direct trauma, but indirect trauma may also lead to a fracture of this kind. Avulsion injuries as part of an acromioclavicular dislocation are the most frequent forms of trauma. For the rare cases of an anterior shoulder dislocation with concomitant coracoid fracture, two different mechanism are discussed. One cause of the coracoid fracture could be direct impact of the dislocated head of the humerus on the coracoid process, another may be the occurrence of a sudden strong pull of the muscles inserting at the coracoid process during shoulder dislocation.In the majority of cases, conservative treatment with six weeks of immobilization is appropriate. If a pseudarthrosis occurs and there is persistent pain, we recommend the operative fixation of the distal coracoid fragment by insertion of cancellous bone graft taken from the iliac crest and stabilization with a cannulated AO titanium small fragment screw and PDS cord.

Defining Impairment and Treatment of Subacute and Chronic Fractures of the Coracoid Process

“…It is thus inferred that the same mechanism might have operated in the formation of symptoms in the painful cases of chronic coracoid fracture Ogawa et al The Journal of TRAUMA ® Injury, Infection, and Critical Care • Volume 67, Number 5, November 2009 reported in the past. 10,12,13 Reattachment of the fragment to the original site or, as in the present series, releasing of the coracoacromial ligament to enable changing the displaced direction of the fragment into a downward direction is considered a reasonable therapeutic approach. Our study has certain limitations.…”

Anterior Shoulder Instability in a Young Individual with Concomitant Coracoid Process Fracture Treated with the Latarjet Procedure – A Rare Case Report

“…Type 1 fracture of coracoid base, fracture line passes posterior to coracoclavicular ligament, needs operative fixation [ 1 ], whereas type 2 is avulsion type injury of coracoid tip fracture involving anterior to coracoclavicular ligament can be treated conservatively [ 1 ]. According to Goss et al, type 1 is avulsion type fracture anterior to coracoclavicular ligament, which may result in painful non-union or may prevent humeral head reduction [ 1 , 13 ]. Although there is conflict do exist literature regarding coracoid fracture management if coracoid fracture fixation is feasible in young active individuals prevent painful non-union, or if associated with glenoid deformity, AC joint injury, floating shoulder [ 1 , 6 ].…”

Concomitant Coracoid Process Fracture with Bony Bankart Lesion Treated with the Latarjet Procedure

“…A surgeon can consider operative treatment using either internal fixation or the Latarjet procedure when the acute glenoid rim defect is larger than 5% in an active patient [1]. A type II coracoid process fracture can be treated conservatively, but some studies report that a coracoid pseudoarthrosis can occur when there is a concomitant anterior shoulder dislocation [10]. A few cases of shoulder dislocations with a simultaneous fracture of the coracoid process have been previously reported in the literature [11].…”

“…Type II fractures (fractures distal to the coracoclavicular ligaments) can be treated conservatively. However, Kälicke et al [10] reported that a coracoid pseudoarthrosis could be caused by tension of the conjoined tendons in an anterior shoulder dislocation with a concomitant type II coracoid fracture. Therefore, surgical treatment should be considered to prevent pseudoarthrosis or nonunion in type II fractures with displacement greater than 5 mm.…”