Dual fixation for coracoid fracture with acute acromioclavicular joint disruption: a case series

Abstract

Introduction
The management of acute disruption of the acromioclavicular joint (ACJ) in conjunction with a concomitant coracoid fracture has been discussed. This combined orthopedic injury is uncommon because radiographs alone may not always be enough to identify the coracoid component clearly. There are different options for management, ranging from nonsurgical, single, or double fixation strategy. The purpose of this study was to evaluate the results of a clavicular hook plate combined with a coracoid screw fixation in patients who engage in high-demand activities and athletes over a minimum of a year of follow-up.


Patients and methods
Following the dual fixation strategy, seven patients were followed clinically and radiologically with a mean follow-up 16 weeks, through which a rehabilitation program was adhered to. The range of motion around the shoulder, American Shoulder & Elbow Surgeons, and constant scores were utilized to evaluate patients clinically during their last follow-up visit. Furthermore, radiological assessment of the reduction of the ACJ according to coracoclavicular distance (CCD) and CCD ratio.


Results
The findings in this study showed a statistically significant improvement between the 3, 6, and 12-month American Shoulder & Elbow Surgeons scores, which were 39.1 ± 14, 67.4 ± 1, and 86.7 ± 5, respectively (P<0.001). The mean range of motions for active shoulder abduction and forward elevation was 171.4 ± 6.3° and 156.4 ± 12.8°, respectively. 9 ± 0.9 mm was the mean CCD, and 1.07% was the mean CCD ratio.


Conclusion
A stable fixation construct with significant functionality can be successfully achieved through the dual fixation strategy using a coracoid screw and hook plate with no coracoclavicular ligament reconstruction in the treatment of concomitant coracoid fracture and acute ACJ injuries in athletes and high-demand patients.