Proximity of the Coracoid Process to the Neurovascular Structures in Various Patient and Shoulder Positions: A Cadaveric Study

Maliwankul

2021

Arthroscopy Techniques

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The acromioclavicular (AC) joint injury is a common shoulder injury in sports medicine. Combined coracoclavicular stabilization with AC capsule repair is 1 of 2 preferred treatments in acute high-grade AC joint injury. In East-Asian populations, the surgeon prefers to pass the first suture under the coracoid base, which is difficult using only basic surgical tools. We propose using a modified K-wire to pass the first suture under the coracoid base.

“…In this step, the surgeon must be careful because the neurovascular structure is located medially to the coracoid base. 4 The No. 2 ETHIBOND is replaced with a shuttle loop.…”

Section: Surgical Technique (With Video Illustration)mentioning

confidence: 99%

Using a Modified Kirschner Wire to Pass the First Suture Under the Coracoid Base in Coracoclavicular Stabilization

Maliwankul

2021

Arthroscopy Techniques

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“…In this step, the surgeon must be careful because of the neurovascular structures (subclavian artery, subclavian vein, and brachial plexus) located medially and close to the coracoid process. 6 The suture was then replaced with a shuttle loop using a shuttle relay technique.…”

Section: Surgical Technique and Postoperative Carementioning

confidence: 99%

Functional and Radiographic Outcomes of Intraoperatively Decreasing the Coracoclavicular Distance to 50% of the Unaffected Side in Stabilization of Acute Acromioclavicular Joint Injury: A Retrospective Evaluation

Orthopaedic Journal of Sports Medicine

2021

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Background: The postoperative failure rate of acromioclavicular (AC) joint fixation using the coracoclavicular (CC) stabilization technique is high. Studies have reported that compared with normal intraoperative anatomic reduction, intraoperative overreduction of the AC joint is more successful in achieving a satisfactory anatomic radiographic outcome at 1- to 2-year follow-up. Purpose: To evaluate the functional and radiographic outcomes and complications in patients with acute AC joint injury who underwent combined CC stabilization and AC capsular repair in which the CC distance was intraoperatively decreased to 50% of the unaffected side. Study Design: Case series; Level of evidence, 4. Methods: In this retrospective study, we collected and analyzed the data of patients with an acute AC joint injury (Rockwood type 5) who underwent combined CC stabilization and AC capsular repair during which the CC distance was decreased 50% compared with the unaffected side. At 2-year follow-up, we evaluated functional outcomes (American Shoulder and Elbow Surgeons [ASES] score), radiographic outcomes (alignment of the AC joint in the vertical and horizontal planes, tunnel widening), and complications (infection, clavicular fracture). Results: The study included 20 patients with a mean ± SD age of 42.20 ± 10.10 years. The mean follow-up period was 33.75 ± 11.50 months. At the 2-year follow-up, the mean ASES score was 95.13 ± 5.61. The overreduction alignment, anatomic alignment, and loss reduction alignment rates were 0% (0/20 patients), 95% (19/20 patients), and 5% (1/ 20 patients), respectively. No statistically significant difference was found in the mean CC distance between the affected and unaffected sides on radiographic evaluation. The mean medial clavicular tunnel width and lateral clavicular tunnel width were 5.03 ± 0.68 mm and 4.47 ± 0.67 mm, respectively. None of the patients experienced fractures or infections. Conclusion: Excellent functional and radiographic outcomes and no complications were seen at 2-year follow-up in patients with acute AC joint injury who underwent combined CC stabilization and AC capsular repair with the CC distance intraoperatively decreased to 50% of the unaffected side.

“…In this step, the surgeon must continually keep in mind the neurovascular structures (subclavian artery, subclavian vein and brachial plexus) located medially and close to the coracoid process. 3 The Ethibond No. 2 is replaced with a shuttle loop using the shuttle relay technique (Fig 3C).…”

Section: Surgical Techniquementioning

confidence: 99%

Coracoclavicular Stabilization With Two Loops of Equal Tension Using a Double O Loops Technique in the Distal Clavicle Fracture

Duangnumsawang

et al. 2020

Arthroscopy Techniques

Self Cite

The distal clavicle fracture is one of the most common injuries around the shoulder joint. There is no consensus regarding a gold standard treatment. Each technique has advantages and disadvantages. Currently, coracoclavicular (CC) stabilization is one of the most popular techniques because this operative procedure provides good stability of the fracture and has few complications. The CC stabilization is a suspensory fixation that consists of many two-CC-loop arrangements. It is, however, difficult to gain equal tension in both CC loops because one loop is always tighter and has greater action in maintaining bone alignment than the other loop. To solve this problem, we propose a double O loops technique to achieve two equal tension loops.