Abstract
PurposeCoracoid fractures represent approximately 3–13% of all scapular fractures. Open reduction and internal fixation can be indicated for a coracoid base fracture. This procedure is challenging due to the nature of visualization of the coracoid with fluoroscopy. The aim of this study was to develop a fluoroscopic imaging protocol, which helps surgeons in finding the optimal insertion point and screw orientation for fixations of coracoid base fractures, and to assess its feasibility in a simulation study.MethodsA novel imaging protocol was defined for screw fixation of coracoid base fractures under fluoroscopic guidance. The method is based on finding the optimal view for screw insertion perpendicular to the viewing plane. In a fluoroscopy simulation environment, eight orthopaedic surgeons were invited to place a screw down the coracoid stalk through the coracoid base and into the neck of 14 cadaveric scapulae using anatomical landmarks. The surgeons placed screws before and after they received an e-learning of the optimal view. Results of the two sessions were compared and inter-rater reliability was calculated.ResultsScrew placement was correct in 33 out of 56 (58.9%) before, and increased to 50 out of 56 (89.3%) after the coracoid tunnel view was explained to the surgeons, which was a significant improvement (p < 0.001).ConclusionsOur newly developed fluoroscopic view based on simple landmarks is a useful addendum in the orthopaedic surgeon’s tool box to fixate fractures of the coracoid base.
Highlights
Scapula fractures occur at a rate of 0.7% of all fractures, with an approximate of 3–5% accounted for fractures of the shoulder girdle [5, 6, 17]
The primary aim of this study is to establish a new fluoroscopic view based on anatomical landmarks that facilitate the surgeon in screw fixation of Type I coracoid fractures
Six of eight surgeons showed an overall improvement in correct placement of virtual screws down the coracoid tunnel after receiving the instructions
Summary
Scapula fractures occur at a rate of 0.7% of all fractures, with an approximate of 3–5% accounted for fractures of the shoulder girdle [5, 6, 17]. It is estimated that fractures of the coracoid process represent 3–13% of all scapular fractures. Fractures of the coracoid are often categorized into two sub-types according to the Ogawa classification, based on their location relative to the coracoclavicular ligament attachment [14]. Good results are reported by managing Type I fractures with open reduction and internal fixation [1, 8, 13, 14]. Spatial awareness of the scapula and its surrounding structures is crucial. Fluoroscopy is used as guidance for screw fixation of a Type I coracoid fracture. Fluoroscopy in anterior–posterior view, axillary scapular view and lateral scapular view may be useful in guiding the
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