Recurrent Anterior Shoulder Dislocation After Trauma with Coracoid Apophysis Fracture – A Rare Association^[*]

Abstract

Anterior dislocations represent about 96% of total shoulder dislocations, with recurrence/instability being more common in young patients. Injury of other shoulder structures is frequent, namely bony Bankart lesion. However, the association with coracoid apophysis fracture is very rare.

The present article describes the clinical case of a 67-year-old man who presented to the emergency department with complaints of persistent omalgia, with acute episodes, beginning after a fall from his own height. The patient also presented history of shoulder trauma 3 months earlier, which was evaluated at another hospital. Shoulder anterior dislocation was observed radiographically, and the computed tomography (CT) confirmed bone erosion of the anteroinferior part of the glenoid (bone loss of about 50% of the anteroposterior diameter in the lower region of the glenoid), with almost complete resorption of the bony Bankart lesion (apparent in later analysis of the radiography of the initial traumatic episode). Connectedly, a transverse fracture of the coracoid apophysis (type II in the Ogawa classification) was diagnosed. The patient was submitted to surgical treatment, with anterior bone stop confection using the remnant of the fractured fragment of the coracoid supplemented by tricortical autologous iliac graft, fixed with cannulated screws (according to the Bristow-Latarjet and Eden-Hybinett techniques).

In the postoperative follow-up, a good functional result was observed, with no new episodes of dislocation and no significant pain complaints.

A rare association of shoulder lesions is described, and the challenge of their treatment is highlighted, given the late diagnosis, as in the case presented.

Keywords

shoulder dislocation - shoulder fractures - coracoid process

^* Work developed in the Department of Orthopedics and Traumatology of Unidade Local de Saude Alto Minho, Viana do Castelo, Portugal.

Financial Support

The authors declare that they have received no financial support for the research, authorship and/or publication of the present article.

Publication History

Received: 27 May 2020

Accepted: 01 December 2020

Article published online:
19 April 2021

• Referências

• 1 Colbenson K, Henry PDG, Kuhn JE. The True Recurrence Rate and Factors Predicting Recurrent Instability After Nonsurgical Management of Traumatic Primary Anterior Shoulder Dislocation: A Systematic Review. Arthrosc J Arthrosc Relat Surg 2018; 32 (12) 2616-2625
• 2 Owens BD, Duffey ML, Nelson BJ, DeBerardino TM, Taylor DC, Mountcastle SB. The incidence and characteristics of shoulder instability at the United States Military Academy. Am J Sports Med 2007; 35 (07) 1168-1173
• 3 Patel RM, Amin NH, Lynch TSMA, Miniaci A. Management of bone loss in glenohumeral instability. Orthop Clin North Am 2014; 45 (04) 523-539
• 4 Lavery KP, Mchale KJ, Rossy WH, Sanchez G, Provencher MT. Bony Augmentation for Anterior and Posterior Glenohumeral Instability in the Contact Athlete. Oper Tech Sports Med 2018; 24 (04) 300-309
• 5 McGinnis M, Denton JR. Fractures of the scapula: a retrospective study of 40 fractured scapulae. J Trauma 1989; 29 (11) 1488-1493
• 6 Beran MC, Donaldson CT, Bishop JY. Treatment of chronic glenoid defects in the setting of recurrent anterior shoulder instability: a systematic review. J Shoulder Elbow Surg 2010; 19 (05) 769-780
• 7 Montgomery Jr WH, Wahl M, Hettrich C, Itoi E, Lippitt SB, Matsen III FA. Anteroinferior bone-grafting can restore stability in osseous glenoid defects. J Bone Joint Surg Am 2005; 87 (09) 1972-1977
• 8 Yamamoto N, Muraki T, An KN. et al. The stabilizing mechanism of the Latarjet procedure: a cadaveric study. J Bone Joint Surg Am 2013; 95 (15) 1390-1397
• 9 Longo UG, Loppini M, Rizzello G, Ciuffreda M, Maffulli N, Denaro V. Latarjet, Bristow, and Eden-Hybinette procedures for anterior shoulder dislocation: systematic review and quantitative synthesis of the literature. Arthroscopy 2014; 30 (09) 1184-1211
• 10 Burkhart SS, De Beer JF, Barth JR, Cresswell T, Roberts C, Richards DP. Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss. Arthroscopy 2007; 23 (10) 1033-1041