Open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex with coracoid process fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YAO Xiaoke ¹ , WU Lingna ² , LI Jianhua ¹ , HUANG Wengang ¹ , DUAN Xin ¹ , GU Zuchao ¹ ,  WANG Yue ³

1. Department of Orthopedics, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China;
2. Intensive Care Unit, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China;
3. Department of Orthopedics, Sichuan Academy of Medical Science · Sichuan Provincial People’s Hospital, Chengdu Sichuan, 610072, P.R.China;

Corresponding?author：

WANG Yue, Email: wang669yue@163.com

Keywords：

Coracoid process fracture; superior shoulder suspensory complex; multiple injuries; open reduction; internal fixation

DOI：

10.7507/1002-1892.201908098

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Objective To investigate the effectiveness of open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex (SSSC) with coracoid process fracture.Methods Between January 2014 and October 2018, 22 patients with multiple injuries of SSSC with coracoid process fracture were treated by open reduction and internal fixation. There were 16 males and 6 females, aged from 24 to 72 years with an average age of 36.6 years. There were 10 cases of falling injury, 5 cases of traffic accident injury, and 7 cases of falling from height injury. All of them were fresh closed injuries. The time from injury to operation ranged from 2 to 17 days with an average of 6.9 days. Both X-ray film and CT showed the coracoid process fracture complicated with clavicular fracture in 14 cases, acromioclavicular joint dislocation in 12 cases, and acromioclavicular fracture in 5 cases. There were 14 cases of two places of SSSC, 7 cases of three places of SSSC, and 1 case of four places of SSSC.Results All incisions healed in primary stage after operation. All patients were followed up 10-24 months with an average of 14.1 months. X-ray films showed that all fractures healed and the acromioclavicular joint was normal. The healing time ranged from 6 to 12 months, with an average of 6.2 months. No complications such as internal fixation failure and nonunion occurred. According to University of California Los Angeles (UCLA) shoulder scoring system, the shoulder joint function was rated as excellent in 15 cases, good in 5 cases, and poor in 2 cases at last follow-up. The excellent and good rate was 90.9%.Conclusion Open reduction and internal fixation for treatment of multiple injuries of SSSC with coracoid process fracture is firm and reliable. Combined with active postoperative rehabilitation program intervention, it can accelerate the recovery of shoulder joint function and achieve satisfactory effectiveness.

Citation： YAO Xiaoke, WU Lingna, LI Jianhua, HUANG Wengang, DUAN Xin, GU Zuchao, WANG Yue. Open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex with coracoid process fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(3): 347-351. doi: 10.7507/1002-1892.201908098 Copy

1.	Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma, 1993, 7(2): 99-106.
2.	楊英果, 朱冬承, 戈兵, 等. 肩部上方懸吊復合體雙重損傷的手術治療. 中華創傷雜志, 2012, 28(2): 140-143.
3.	張金利, 曹清, 袁天祥, 等. 肩關節上方懸吊復合體兩部分以上損傷的治療. 中華骨科雜志, 2011, 31(7): 729-733.
4.	Ogawa K, Matsumura N, Ikegami H. Coracoid fractures: Therapeutic strategy and surgical outcomes. J Trauma Acute Care Surg, 2012, 72(2): E20-26.
5.	Harris RI, Wallace AL, Harper GD, et al. Structural properties of the intact and the reconstructed coracoclavicular ligament complex. Am J Sports Med, 2000, 28(1): 103-108.
6.	Fukuda K, Craig EV, An KN, et al. Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg (Am), 1986, 68(3): 434-440.
7.	Ogawa K, Yoshida A, Takahashi M, et al. Fractures of the coracoid process. J Bone Joint Surg (Br), 1997, 79(1): 17-19.
8.	敖榮廣, 禹寶慶, 施繼飛, 等. 切開復位內固定治療合并上肢懸吊復合體損傷的復雜肩胛盂骨折. 中華創傷雜志, 2016, 32(8): 707-709.
9.	Owens BD, Goss TP. The floating shoulder. J Bone Joint Surg (Br), 2006, 88(11): 1419-1424.
10.	曹耀威, 余國榮, 余黎, 等. 浮肩損傷植入物固定方案選擇與骨折移位的關系. 中國組織工程研究, 2016, 20(9): 1329-1335.
11.	吳曉明, 高偉, 王秋根, 等. 喙突骨折的診斷與治療的初步探討. 中華創傷骨科雜志, 2009, 11(8): 705-709.
12.	Carcia-Elias M, Salo JM. Non-union of a fractured coracoid process after dislocation of the shoulder. A case report. J Bone Joint Surg (Br), 1985, 67(5): 722-723.
13.	Montgomery SP, Loyd RD. Avulsion fracture of the coracoid epiphysis with acromioclavicular separation. Report of two cases in adolescents and review of the literature. J Bone Joint Surg (Am), 1977, 59(7): 963-965.
14.	劉宏智, 邱長茂, 劉兆杰, 等. 喙突 Eyres Ⅴ型骨折合并肩關節上方懸吊復合體損傷的特點及手術療效分析. 中國修復重建外科雜志, 2014, 28(12): 1469-1473.
15.	李豪青, 吳曉明, 王秋根, 等. 上肩胛懸吊帶復合體雙重損傷的臨床分型和手術治療策略. 中華骨科雜志, 2009, 29(5): 404-409.
16.	陳杭, 胡曉川, 楊國勇, 等. 手術治療喙突骨折合并肩鎖關節脫位. 中國骨與關節雜志, 2015, 4(7): 522-525.
17.	荊兆峰, 趙以瑜, 王瑞國, 等. 微創治療重度肩鎖關節脫位合并喙突骨折. 中國骨傷, 2010, 23(1): 46-48.
18.	Kim SH, Chung SW, Kim SH, et al. Triple disruption of the superior shoulder suspensory complex. Int J Shoulder Surg, 2012, 6(2): 67-70.
19.	Anavian J, Gauger EM, Schreder LK, et al. Surgical and functional outcomes after operative management of complex and displaced intra-articular glenoid fractures. J Bone Joint Surg (Am), 2012, 94(7): 645-653.
20.	Kim KC, Rhee KJ, Shin HD, et al. Displaced fracture of the coracoid process associated with acrommioclavicular dislocation: a two-bird-one-stone solution. J Trauma, 2009, 67(2): 403-405.
21.	Chaudry SN, Waseem M. Clavicular hook plate: complications of retaining the implant. Injury, 2006, 37(7): 665-670.
22.	褚楷, 陳旭, 魯興, 等. Eyres ⅢA 型喙突骨折的手術治療. 中國修復重建外科雜志, 2016, 30(6): 789-791.
23.	錢光, 董有海, 黃漢偉, 等. 肩胛骨喙突骨折手術治療 10 例報告. 中國骨與關節雜志, 2015, 4(6): 481-484.
24.	蘇登, 陽波, 米寧, 等. 早期聯合固定對上肩胛懸吊復合體雙重損傷的療效觀察. 頸腰痛雜志, 2017, 38(1): 55-59.
25.	田科, 王丹, 張川, 等. 切開復位內固定治療 Tossy Ⅲ型肩鎖關節脫位合并喙突基底部骨折. 中華創傷骨科雜志, 2015, 17(4): 351-353.
26.	Page RS, Bhatia DN. Noncomminuted lateral end clavicle fractures associated with coracoclavicular ligament disruption: technical considerations for optimal anatomic fixation and stability. Int J Shoulder Surg, 2014, 8(3): 86-89.
27.	張磊, 陳亨樹, 祁冀, 等. 喙突的解剖形態學測量及其臨床意義. 中國臨床解剖學雜志, 2018, 36(6): 606-610.

1. Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma, 1993, 7(2): 99-106.
2. 楊英果, 朱冬承, 戈兵, 等. 肩部上方懸吊復合體雙重損傷的手術治療. 中華創傷雜志, 2012, 28(2): 140-143.
3. 張金利, 曹清, 袁天祥, 等. 肩關節上方懸吊復合體兩部分以上損傷的治療. 中華骨科雜志, 2011, 31(7): 729-733.
4. Ogawa K, Matsumura N, Ikegami H. Coracoid fractures: Therapeutic strategy and surgical outcomes. J Trauma Acute Care Surg, 2012, 72(2): E20-26.
5. Harris RI, Wallace AL, Harper GD, et al. Structural properties of the intact and the reconstructed coracoclavicular ligament complex. Am J Sports Med, 2000, 28(1): 103-108.
6. Fukuda K, Craig EV, An KN, et al. Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg (Am), 1986, 68(3): 434-440.
7. Ogawa K, Yoshida A, Takahashi M, et al. Fractures of the coracoid process. J Bone Joint Surg (Br), 1997, 79(1): 17-19.
8. 敖榮廣, 禹寶慶, 施繼飛, 等. 切開復位內固定治療合并上肢懸吊復合體損傷的復雜肩胛盂骨折. 中華創傷雜志, 2016, 32(8): 707-709.
9. Owens BD, Goss TP. The floating shoulder. J Bone Joint Surg (Br), 2006, 88(11): 1419-1424.
10. 曹耀威, 余國榮, 余黎, 等. 浮肩損傷植入物固定方案選擇與骨折移位的關系. 中國組織工程研究, 2016, 20(9): 1329-1335.
11. 吳曉明, 高偉, 王秋根, 等. 喙突骨折的診斷與治療的初步探討. 中華創傷骨科雜志, 2009, 11(8): 705-709.
12. Carcia-Elias M, Salo JM. Non-union of a fractured coracoid process after dislocation of the shoulder. A case report. J Bone Joint Surg (Br), 1985, 67(5): 722-723.
13. Montgomery SP, Loyd RD. Avulsion fracture of the coracoid epiphysis with acromioclavicular separation. Report of two cases in adolescents and review of the literature. J Bone Joint Surg (Am), 1977, 59(7): 963-965.
14. 劉宏智, 邱長茂, 劉兆杰, 等. 喙突 Eyres Ⅴ型骨折合并肩關節上方懸吊復合體損傷的特點及手術療效分析. 中國修復重建外科雜志, 2014, 28(12): 1469-1473.
15. 李豪青, 吳曉明, 王秋根, 等. 上肩胛懸吊帶復合體雙重損傷的臨床分型和手術治療策略. 中華骨科雜志, 2009, 29(5): 404-409.
16. 陳杭, 胡曉川, 楊國勇, 等. 手術治療喙突骨折合并肩鎖關節脫位. 中國骨與關節雜志, 2015, 4(7): 522-525.
17. 荊兆峰, 趙以瑜, 王瑞國, 等. 微創治療重度肩鎖關節脫位合并喙突骨折. 中國骨傷, 2010, 23(1): 46-48.
18. Kim SH, Chung SW, Kim SH, et al. Triple disruption of the superior shoulder suspensory complex. Int J Shoulder Surg, 2012, 6(2): 67-70.
19. Anavian J, Gauger EM, Schreder LK, et al. Surgical and functional outcomes after operative management of complex and displaced intra-articular glenoid fractures. J Bone Joint Surg (Am), 2012, 94(7): 645-653.
20. Kim KC, Rhee KJ, Shin HD, et al. Displaced fracture of the coracoid process associated with acrommioclavicular dislocation: a two-bird-one-stone solution. J Trauma, 2009, 67(2): 403-405.
21. Chaudry SN, Waseem M. Clavicular hook plate: complications of retaining the implant. Injury, 2006, 37(7): 665-670.
22. 褚楷, 陳旭, 魯興, 等. Eyres ⅢA 型喙突骨折的手術治療. 中國修復重建外科雜志, 2016, 30(6): 789-791.
23. 錢光, 董有海, 黃漢偉, 等. 肩胛骨喙突骨折手術治療 10 例報告. 中國骨與關節雜志, 2015, 4(6): 481-484.
24. 蘇登, 陽波, 米寧, 等. 早期聯合固定對上肩胛懸吊復合體雙重損傷的療效觀察. 頸腰痛雜志, 2017, 38(1): 55-59.
25. 田科, 王丹, 張川, 等. 切開復位內固定治療 Tossy Ⅲ型肩鎖關節脫位合并喙突基底部骨折. 中華創傷骨科雜志, 2015, 17(4): 351-353.
26. Page RS, Bhatia DN. Noncomminuted lateral end clavicle fractures associated with coracoclavicular ligament disruption: technical considerations for optimal anatomic fixation and stability. Int J Shoulder Surg, 2014, 8(3): 86-89.
27. 張磊, 陳亨樹, 祁冀, 等. 喙突的解剖形態學測量及其臨床意義. 中國臨床解剖學雜志, 2018, 36(6): 606-610.

Chinese Journal of Reparative and Reconstructive Surgery

Open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex with coracoid process fracture

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