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.	杨英果, 朱冬承, 戈兵, 等. 肩部上方悬吊复合体双重损伤的手术治疗. 中华创伤杂志, 2012, 28(2): 140-143.
3.	张金利, 曹清, 袁天祥, 等. 肩关节上方悬吊复合体两部分以上损伤的治疗. 中华骨科杂志, 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.	敖荣广, 禹宝庆, 施继飞, 等. 切开复位内固定治疗合并上肢悬吊复合体损伤的复杂肩胛盂骨折. 中华创伤杂志, 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, 余国荣, 余黎, 等. 浮肩损伤植入物固定方案选择与骨折移位的关系. 中国组织工程研究, 2016, 20(9): 1329-1335.
11.	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.
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.	刘宏智, 邱长茂, 刘兆杰, 等. 喙突 Eyres Ⅴ型骨折合并肩关节上方悬吊复合体损伤的特点及手术疗效分析. 中国修复重建外科杂志, 2014, 28(12): 1469-1473.
15.	李豪青, 吴晓明, 王秋根, 等. 上肩胛悬吊带复合体双重损伤的临床分型和手术治疗策略. 中华骨科杂志, 2009, 29(5): 404-409.
16.	陈杭, 胡晓川, 杨国勇, 等. 手术治疗喙突骨折合并肩锁关节脱位. 中国骨与关节杂志, 2015, 4(7): 522-525.
17.	荆兆峰, 赵以瑜, 王瑞国, 等. 微创治疗重度肩锁关节脱位合并喙突骨折. 中国骨伤, 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, 陈旭, 鲁兴, 等. Eyres ⅢA 型喙突骨折的手术治疗. 中国修复重建外科杂志, 2016, 30(6): 789-791.
23.	钱光, 董有海, 黄汉伟, 等. 肩胛骨喙突骨折手术治疗 10 例报告. 中国骨与关节杂志, 2015, 4(6): 481-484.
24.	苏登, 阳波, 米宁, 等. 早期联合固定对上肩胛悬吊复合体双重损伤的疗效观察. 颈腰痛杂志, 2017, 38(1): 55-59.
25.	田科, 王丹, 张川, 等. 切开复位内固定治疗 Tossy Ⅲ型肩锁关节脱位合并喙突基底部骨折. 中华创伤骨科杂志, 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.	张磊, 陈亨树, 祁冀, 等. 喙突的解剖形态学测量及其临床意义. 中国临床解剖学杂志, 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. 杨英果, 朱冬承, 戈兵, 等. 肩部上方悬吊复合体双重损伤的手术治疗. 中华创伤杂志, 2012, 28(2): 140-143.
3. 张金利, 曹清, 袁天祥, 等. 肩关节上方悬吊复合体两部分以上损伤的治疗. 中华骨科杂志, 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. 敖荣广, 禹宝庆, 施继飞, 等. 切开复位内固定治疗合并上肢悬吊复合体损伤的复杂肩胛盂骨折. 中华创伤杂志, 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, 余国荣, 余黎, 等. 浮肩损伤植入物固定方案选择与骨折移位的关系. 中国组织工程研究, 2016, 20(9): 1329-1335.
11. 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.
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. 刘宏智, 邱长茂, 刘兆杰, 等. 喙突 Eyres Ⅴ型骨折合并肩关节上方悬吊复合体损伤的特点及手术疗效分析. 中国修复重建外科杂志, 2014, 28(12): 1469-1473.
15. 李豪青, 吴晓明, 王秋根, 等. 上肩胛悬吊带复合体双重损伤的临床分型和手术治疗策略. 中华骨科杂志, 2009, 29(5): 404-409.
16. 陈杭, 胡晓川, 杨国勇, 等. 手术治疗喙突骨折合并肩锁关节脱位. 中国骨与关节杂志, 2015, 4(7): 522-525.
17. 荆兆峰, 赵以瑜, 王瑞国, 等. 微创治疗重度肩锁关节脱位合并喙突骨折. 中国骨伤, 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, 陈旭, 鲁兴, 等. Eyres ⅢA 型喙突骨折的手术治疗. 中国修复重建外科杂志, 2016, 30(6): 789-791.
23. 钱光, 董有海, 黄汉伟, 等. 肩胛骨喙突骨折手术治疗 10 例报告. 中国骨与关节杂志, 2015, 4(6): 481-484.
24. 苏登, 阳波, 米宁, 等. 早期联合固定对上肩胛悬吊复合体双重损伤的疗效观察. 颈腰痛杂志, 2017, 38(1): 55-59.
25. 田科, 王丹, 张川, 等. 切开复位内固定治疗 Tossy Ⅲ型肩锁关节脱位合并喙突基底部骨折. 中华创伤骨科杂志, 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. 张磊, 陈亨树, 祁冀, 等. 喙突的解剖形态学测量及其临床意义. 中国临床解剖学杂志, 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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