Bilateral Coracoid Avulsion Fractures with Unilateral Anterior Instability with Glenoid Bone Loss: Use of Avulsed Fragment for Reconstruction of Glenoid.

Abstract

Introduction:Coracoid fractures are often missed since the fracture is not visualized in a routine anteroposterior view of the shoulder and special views are not ordered. Shoulder dislocation is common but it is rare to have a dislocation with a coracoid fracture. The purpose of this paper is to present the rare occurrence of bilateral coracoid fractures in a patient with unilateral anterior shoulder instability managed using the same fractured coracoid fragment by the latarjet procedure.Case Report:We report a case of 48 -year -old male who presented to us with a history of recurrent dislocations of the left shoulder. He had frequent episodes of tonic–clonic seizures 5 years back. He was diagnosed to be suffering from neurocysticercosis of the brain for which he was successfully treated. He did not have any episode of seizure later, but he continued to have repeated episodes of dislocation on his left side only. On examination of his left shoulder, he had normal range of motion. He was found to be very apprehensive, even in the midrange. This made us to suspect glenoid bone loss and hence both magnetic resonance imaging and three -dimensional computed tomography (CT) scan of the left shoulder were ordered. The CT scan revealed bilateral coracoid fractures along with glenoid bone loss. An open bony procedure including iliac crest bone graft was planned after a diagnostic arthroscopy keeping in mind that the latarjet procedure may not be possible due to the coracoid fracture. During the operation, we found that the coracoid fragment was large enough to perform a latarjet procedure rather than doing an iliac crest bone graft. This itself provided stability of the shoulder on abduction and external rotation by providing a bony block not requiring any further procedure for the Hill -Sachs lesion.Conclusion:Epileptic patients should undergo CT scan evaluation for glenoid bone loss, large Hill -Sachs lesion and to rule out coracoid fractures to plan for bony stabilization procedure and since we have used the same fractured coracoids fragment for latarjet procedure and found to be successful, this add on the knowledge to the orthopedic community.