Combined Clavicular Hook Plate and Coracoid Screw Fixation for Coracoid Process Fractures Associated with Acromioclavicular Joint Dislocation

TL;DR

This study evaluates a surgical technique for rare shoulder fractures combined with joint dislocation, showing successful recovery and alignment in patients.

Contribution

The study introduces a combined fixation method for rare coracoid fractures with AC joint dislocation and reports favorable outcomes.

Findings

All patients achieved CT-confirmed union of coracoid process fractures.

No residual acromioclavicular joint subluxation was observed in any patient.

Patients returned to sports and daily activities with high Constant scores and low pain.

Abstract

Background and Objectives: Coracoid process (CP) fractures combined with acromioclavicular (AC) joint dislocation are extremely rare, and evidence guiding optimal surgical management remains limited. This retrospective, single-center case series study evaluated clinical and radiologic outcomes after simultaneous fixation of both lesions using a clavicular hook plate and a coracoid screw. Materials and Methods: We retrospectively reviewed 15 consecutive patients with Ogawa type I CP fractures combined with AC joint dislocation who underwent clavicular hook plate and coracoid screw fixation between March 2019 and May 2024. Clinical outcomes at final follow-up included shoulder range of motion (ROM), visual analog scale (VAS) for pain, and the Constant score. Radiologic outcomes included CP union confirmed by computed tomography (CT) and residual AC joint subluxation. Results: The cohort comprised 13 men and 2 women with a mean age of 55.2 years, and the mean final follow-up was 40.2 months. At final follow-up, mean ROM was 168° for forward elevation, 161° for abduction, and 69° for external rotation at the side, with internal rotation to L1. The mean VAS score was 0.4 and the mean Constant score was 97. CT-confirmed union of the CP fracture was achieved in all patients, and no residual AC joint subluxation was observed. All patients returned to sports and activities of daily living. Conclusions: In this series, simultaneous fixation using a clavicular hook plate and a coracoid screw provided reliable stabilization for CP fractures with AC joint dislocation, achieving consistent CP union, restoration of AC joint alignment, and favorable clinical outcomes. However, given the retrospective, non-comparative study design, these findings should be interpreted with caution, and further comparative studies are warranted.

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