Abstract
BackgroundFractures of the base of the coracoid process are relatively rare, but an increasing number of studies have reported using screws to fix coracoid process base fractures. This study was performed to simulate the surgical procedure and obtain the ideal diameter, length, insertion point and angle of the screw from a 3-D axial perspective in Chinese patients.MethodsWe randomly collected right scapula computed tomography (CT) scans from 100 adults. DICOM-formatted CT scan images were imported into Mimics software. A 3D digital model of the right scapula was established. Two virtual cylinders representing two screws were placed from the top of the coracoid process to the neck of the scapula and across the base of the coracoid process to fix the base of the coracoid process. The largest secure diameters and lengths of the virtual screws were measured. The positions of the insertion points and the directions of the screws were also examined.ResultsThe screw insertion safe zone can exhibit an irregular fusiform shape according to the reconstructed scapula model. The mean maximum diameters of the medial and lateral screws were 7.08 ± 1.19 mm and 7.34 ± 1.11 mm, respectively. The mean maximum lengths of the medial and lateral screws were 43.11 ± 6.31 mm and 48.16 ± 6.94 mm, respectively. A screw insertion corridor with a diameter of at least 4.5 mm was found in all patients. We found sex-dependent differences in the mean maximum diameters and maximum lengths of the two screws. The positions of the two insertion points were statistically different across sexes.ConclusionsThe study provides a valuable guideline for determining the largest secure corridor for two screws in fixing a fracture at the base of the coracoid process. For ideal screw placement, we suggest individualised preoperative 3D reconstruction simulations. Further biomechanical studies are needed to verify the function of the screws.
Highlights
Fractures of the base of the coracoid process are relatively rare, but an increasing number of studies have reported using screws to fix coracoid process base fractures
Bhatia et al described percutaneous coracoid base fixation using orthogonal biplanar fluoroscopic guidance techniques. They noted that theoretical complications such as articular perforation, neurovascular injury and damage to coracoclavicular ligaments may emerge even when the surgery is performed by an experienced shoulder surgeon [12]
Kawasaki et al reported a new screw fixation technique for coracoid base fractures under fluoroscopic guidance and considered anatomic information on the cross-sectional size of the coracoid base obtained in a computed tomography (CT) study [7]
Summary
Fractures of the base of the coracoid process are relatively rare, but an increasing number of studies have reported using screws to fix coracoid process base fractures. Bhatia et al described percutaneous coracoid base fixation using orthogonal biplanar fluoroscopic guidance techniques. They noted that theoretical complications such as articular perforation, neurovascular injury and damage to coracoclavicular ligaments may emerge even when the surgery is performed by an experienced shoulder surgeon [12]. Kawasaki et al reported a new screw fixation technique for coracoid base fractures under fluoroscopic guidance and considered anatomic information on the cross-sectional size of the coracoid base obtained in a computed tomography (CT) study [7]
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