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Management of Traumatic Coracoid Fracture and Anterior Shoulder Instability With a Modified Arthroscopic Latarjet Technique.

ABSTRACT: Coracoid fractures are an uncommon injury and typically occur in the setting of high-energy trauma. Isolated injury to the coracoid is rare; therefore, a high suspicion for concomitant shoulder injuries should exist. These associated injuries have been shown to be acromioclavicular dislocations, clavicular and acromial fractures, scapular spine fractures, rotator cuff tears, and anterior shoulder dislocations. Although most of these shoulder injuries respond to nonsurgical treatment, there are case reports and literature reviews that present more complicated injuries requiring surgical intervention. Shoulder dislocations with associated coracoid fractures can also manifest glenoid bone loss resulting in continued instability. In this scenario, the fractured coracoid can be used to address the glenoid bone loss, as well as the continued instability. Regarding technique, other authors have described an open procedure with screw or anchor fixation. This Technical Note describes our technique for treating a displaced Ogawa type II coracoid process fracture with concomitant anterior shoulder dislocation by an arthroscopic Latarjet procedure using the fractured coracoid.

SUBMITTER: Bishai SK

PROVIDER: S-EPMC7528615 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:PurposeTo evaluate the outcomes of arthroscopic Bankart repair with remplissage (ABRR) compared with the arthroscopic Latarjet (AL) procedure for anterior shoulder instability in patients with a labral tear and a concomitant engaging Hill-Sachs lesion.MethodsA retrospective review of patients who underwent either ABRR or the AL procedure for a diagnosis of anterior shoulder instability with a concomitant engaging Hill-Sachs lesion between 2011 and 2019 was performed. Recurrent instability, the visual analog scale score, the Subjective Shoulder Value, the Western Ontario Shoulder Instability score, patient satisfaction, willingness to undergo surgery again, and return to work or sport were evaluated.ResultsOur study included 41 patients treated with ABRR and 26 treated with the AL procedure. At final follow-up, there was no difference between patients who underwent ABRR and those who underwent the AL procedure in the reported Western Ontario Shoulder Instability score (21.8% vs 28.2%, P = .33) or any of its components, the visual analog scale score (0.9 vs 1.4, P = .32), the Subjective Shoulder Value (78.4 vs 74.5, P = .6062), the rate of satisfaction (81.6% vs 85.6%, P = .54), or whether patients would undergo surgery again (81.6% vs 96.1%, P = .16). Overall, 5 patients in the ABRR group and 2 patients in the AL group had recurrent instability events (12.2% vs 7.8%, P = .70), with no significant difference in the rate of recurrent dislocation (12.2% vs 3.8%, P = .39).ConclusionsIn patients with anterior shoulder instability and a concomitant Hill-Sachs lesion, both ABRR and the AL procedure were shown to be reliable treatments, with a low rate of recurrent instability and excellent patient-reported outcomes in appropriately selected patients. However, our study could not determine whether there was critical glenoid bone loss in patients undergoing ABRR, and surgeons should still exercise caution in performing ABRR in patients with high-grade glenoid bone loss or in those with failed prior stabilizations.Level of evidenceLevel III, retrospective cohort study.

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Management of Traumatic Coracoid Fracture and Anterior Shoulder Instability With a Modified Arthroscopic Latarjet Technique.

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