CLINICAL CHARACTERISTICS AND SURGICAL MANAGEMENT OF Eyres TYPE V CORACOID FRACTURE COMBINED WITH SUPERIOR SHOULDER SUSPENSORY COMPLEX INJURY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIUHongzhi ¹ , QIUChangmao ¹ , LIUZhaojie ² , ZHANGYinguang ² , TIANWei ² ,  JIAJian ²

1. Graduate School of Tianjin Medical University, Tianjin, 300070, P. R. China;
2. Area Ⅲ of Traumatic Orthopedic Department, Tianjin Hospital;

Corresponding author：

JIAJian, Email: jiajian1969@126.com

Keywords：

Shoulder; Coracoid fracture; Superior shoulder suspensory complex injury; Internal fixation

DOI：

10.7507/1002-1892.20140318

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Objective To investigate the cl inical characteristics of Eyres type V coracoid fracture combined with superior shoulder suspensory complex (SSSC) injuries, and the effectiveness of open reduction and fixation. Methods Between March 2004 and July 2012, 13 patients with Eyres type V coracoid fracture and SSSC injuries were treated. There were 10 males and 3 females with an average age of 41 years (range, 23-59 years). Injury was caused by fall ing from height in 4 cases, by traffic accident in 6 cases, and by impact of the heavy weight in 3 cases. The interval from injury to operation was 3-10 days (mean, 5.2 days). SSSC injuries included 9 cases of acromioclavicular joint dislocation, 5 cases of clavicular fractures, and 4 cases of acromion fractures. The coracoid fractures were fixed with cannulated screws; the acromioclavicular joint dislocations were fixed with hook plate (6 cases) or Kirschner wires (2 case) except 1 untreated case; the clavicular fractures were fixed with anatomical locking plate (3 cases) and hook plate (2 cases); the acromion fractures were fixed with cannulated screws (1 case), Kirschner wires (2 cases), or both of them (1 case). Results The mean operation time was 158.0 minutes (range, 100-270 minutes), and the mean intraoperative blood loss was 207.7 mL (range, 150-300 mL). The other patients obtained primary healing of incision except 1 patient who had inflammation around incision, which was cured after change dressing. All patients were followed up for 22.6 months on average (range, 17-35 months). All fractures achieved union at a mean time of 3.6 months (range, 2-6 months). No nerve injury and implant fixation failure complications were observed. At last follow-up, the Constant score and the disabil ity of the arm, shoulder, and hand (DASH) score had a significant improvement when compared with scores at pre-operation (P<0.05). The shoulder range of motion in flexion, abduction, and external rotation at last follow-up were significantly higher than those at pre-operation (P<0.05). Conclusion Eyres type V coracoid fracture associated with SSSC injuries usually results in the instabil ity of the shoulder. With individual surgical treatment, the satisfactory function and good effectiveness can be obtained.

Citation： LIUHongzhi, QIUChangmao, LIUZhaojie, ZHANGYinguang, TIANWei, JIAJian. CLINICAL CHARACTERISTICS AND SURGICAL MANAGEMENT OF Eyres TYPE V CORACOID FRACTURE COMBINED WITH SUPERIOR SHOULDER SUSPENSORY COMPLEX INJURY. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(12): 1469-1473. doi: 10.7507/1002-1892.20140318 Copy

1.	McGinnis M, Denton JR. Fractures of the scapula:a retrospective study of 40 fractured scapulae. J Trauma, 1989, 29(11):1488-1493.
2.	Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma, 1993, 7(2):99-106.
3.	Adam F. Surgical treatment of displaced fractures of the glenoid cavity. Int Orthop, 2002, 26(3):150-153.
4.	Robinson CM, Al-Hourani K, Malley TS, et al. Anterior shoulder instabil ity associated with coracoid nonunion in patients with a seizure disorder. J Bone Joint Surg (Am), 2012, 94(7):e40.
5.	Ban I, Troelsen A, Christiansen DH, et al. Standardised test protocol (Constant Score) for evaluation of functional ity in patients with shoulder disorders. Dan Med J, 2013, 60(4):A4608.
6.	Angst F, Schwyzer HK, Aeschlimann A, et al. Measures of adult shoulder function:Disabil ities of the Arm, Shoulder, and Hand Questionnaire (DASH) and its short version (QuickDASH), Shoulder Pain and Disabil ity Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disabil ity Questionnaire (SDQ), and Western Ontario Shoulder Instabil ity Index (WOSI). Arthritis Care Res (Hoboken), 2011, 63 Suppl 11:S174-S188.
7.	Eyres KS, Brooks A, Stanley D. Fractures of the coracoid process. J Bone Joint Surg (Br), 1995, 77(3):425-428.
8.	孔德海, 冯德香, 刘万军, 等. 喙突骨折的分类与治疗. 中华创伤骨科杂志, 2013, 15(1):80-82.
9.	Ideberg R, Grevsten S, Larsson S. Epidemiology of scapular fractures. Incidence and classification of 338 fractures. Acta Orthop Scand, 1995, 66(5):395-397.
10.	Goss TP. Fractures of the glenoid cavity. J Bone Joint Surg (Am), 1992, 74(2):299-305.
11.	Ogawa K, Matsumura N, Ikegami H. Coracoid fractures:Therapeutic strategy and surgical outcomes. J Trauma, 2011.[Epub ahead of print].
12.	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.
13.	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.
14.	Kim SH, Chung SW, Kim SH, et al. Tri ple disruption of the superior shoulder suspensory complex. Int J Shoulder Surg, 2012, 6(2):67-70.
15.	Scarlat MM, Cuny C, Goldberg BA, et al. The lateral impaction of the shoulder. Int Orthop, 1999, 23(5):302-307.
16.	Hill BW, Jacobson AR, Anavian J, et al. Surgical management of coracoid fractures:technical tricks and cl inical experience. J Orthop Trauma, 2014, 28(5):e114-e122.
17.	吴晓明, 高伟, 王秋根, 等. 喙突骨折的诊断与治疗的初步探讨. 中华创伤骨科杂志, 2009, 11(8):705-709.
18.	贾健. 移位肩盂骨折的手术治疗. 中华骨科杂志, 2003, 23(4):197-201.
19.	Nanno M, Sawaizumi T, Ito H. Double clavicular fractures associated with scapular neck and coracoid process fractures. J Orthop Surg (Hong Kong), 2012, 20(2):246-249.

1. McGinnis M, Denton JR. Fractures of the scapula:a retrospective study of 40 fractured scapulae. J Trauma, 1989, 29(11):1488-1493.
2. Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma, 1993, 7(2):99-106.
3. Adam F. Surgical treatment of displaced fractures of the glenoid cavity. Int Orthop, 2002, 26(3):150-153.
4. Robinson CM, Al-Hourani K, Malley TS, et al. Anterior shoulder instabil ity associated with coracoid nonunion in patients with a seizure disorder. J Bone Joint Surg (Am), 2012, 94(7):e40.
5. Ban I, Troelsen A, Christiansen DH, et al. Standardised test protocol (Constant Score) for evaluation of functional ity in patients with shoulder disorders. Dan Med J, 2013, 60(4):A4608.
6. Angst F, Schwyzer HK, Aeschlimann A, et al. Measures of adult shoulder function:Disabil ities of the Arm, Shoulder, and Hand Questionnaire (DASH) and its short version (QuickDASH), Shoulder Pain and Disabil ity Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disabil ity Questionnaire (SDQ), and Western Ontario Shoulder Instabil ity Index (WOSI). Arthritis Care Res (Hoboken), 2011, 63 Suppl 11:S174-S188.
7. Eyres KS, Brooks A, Stanley D. Fractures of the coracoid process. J Bone Joint Surg (Br), 1995, 77(3):425-428.
8. 孔德海, 冯德香, 刘万军, 等. 喙突骨折的分类与治疗. 中华创伤骨科杂志, 2013, 15(1):80-82.
9. Ideberg R, Grevsten S, Larsson S. Epidemiology of scapular fractures. Incidence and classification of 338 fractures. Acta Orthop Scand, 1995, 66(5):395-397.
10. Goss TP. Fractures of the glenoid cavity. J Bone Joint Surg (Am), 1992, 74(2):299-305.
11. Ogawa K, Matsumura N, Ikegami H. Coracoid fractures:Therapeutic strategy and surgical outcomes. J Trauma, 2011.[Epub ahead of print].
12. 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.
13. 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.
14. Kim SH, Chung SW, Kim SH, et al. Tri ple disruption of the superior shoulder suspensory complex. Int J Shoulder Surg, 2012, 6(2):67-70.
15. Scarlat MM, Cuny C, Goldberg BA, et al. The lateral impaction of the shoulder. Int Orthop, 1999, 23(5):302-307.
16. Hill BW, Jacobson AR, Anavian J, et al. Surgical management of coracoid fractures:technical tricks and cl inical experience. J Orthop Trauma, 2014, 28(5):e114-e122.
17. 吴晓明, 高伟, 王秋根, 等. 喙突骨折的诊断与治疗的初步探讨. 中华创伤骨科杂志, 2009, 11(8):705-709.
18. 贾健. 移位肩盂骨折的手术治疗. 中华骨科杂志, 2003, 23(4):197-201.
19. Nanno M, Sawaizumi T, Ito H. Double clavicular fractures associated with scapular neck and coracoid process fractures. J Orthop Surg (Hong Kong), 2012, 20(2):246-249.

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CLINICAL CHARACTERISTICS AND SURGICAL MANAGEMENT OF Eyres TYPE V CORACOID FRACTURE COMBINED WITH SUPERIOR SHOULDER SUSPENSORY COMPLEX INJURY

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