Coracoid Width Research Articles

AN INTERPOPULATION COMPARISON AND CORRELATION OF 3D MORPHOMETRIC MEASUREMENTS OF THE SCAPULA

In patients with shoulder arthritis, the ability to accurately determine glenoid morphological alterations affects the outcomes of shoulder arthroplasty surgery significantly. This study was conducted to determine whether there is a correlation between scapular and glenoid morphometric components. Existence of such a correlation may help surgeons accurately estimate glenoid bone loss during pre-operative planning.The dimensions and geometric relationships of the scapula, scapula apophysis and glenoid were assessed using CT scan images of 37 South African and 40 Chinese cadavers. Various anatomical landmarks were marked on the 77 scapulae and a custom script was developed to perform the measurements. Intra-cohort correlation and inter-cohort differences were statistically analysed using IBM SPSS v28. The condition for statistical significance was p<0.05.The glenoid width and height were found to be significantly (p<0.05) correlated with superior glenoid to acromion tip distance, scapula height, acromion tip to acromion angle distance, acromion width, scapula width, and coracoid width, in both the cohorts. While anterior glenoid to coracoid tip distance was found to be significantly correlated to glenoid height and width in the South African cohort, it was only significantly correlated to glenoid height in the Chinese cohort. Significant (p<0.05) inter-cohort differences were observed for coracoid height, coracoid width, glenoid width, scapula width, superior glenoid to acromion tip distance, and anterior glenoid to coracoid tip distance.This study found correlations between the scapula apophyseal and glenoid measurements in the population groups studied. These morphometric correlations can be used to estimate the quantity of bone loss in shoulder arthroplasty patients.

Gender differences in Glenoid and Coracoid Dimensions evaluated through 3D Printed bone models in the context of Anterior Shoulder Instability Surgery – An exploratory study

IntroductionNonrecognition of smaller bone anatomy in the context of the Latarjet procedure may increase the chance of complications and worsen it outcomes, and this should be addressed preoperatively by accurate measuring of bone anatomy. Measurement of bone dimension can be performed through 3d printed bone models nowadays and therefore we aimed to evaluate glenoid and coracoid process dimensions obtained in 3D printed bone models, assess differences between genders, and compare the results with previously published anatomical studies. We hypothesized that the values obtained in the 3D models would be similar to those previously reported in other anatomical studies and gender differences would also be present. MethodsWe retrospectively retrieved shoulder computer tomography scans from 39 adult patients with uninjured scapula. Using the DICOM file of the CT, we performed three-dimensional reconstructions of the scapula, including the glenoid and coracoid. The resulting digital model was then printed in an FDM technology 3D printer. With the 3D Printed models, one of the authors measured the models using a digital caliper. The measurements collected on the Glenoid were Glenoid Superior-Inferior length (GlenSI); and Glenoid Antero-Inferior length (GlenAP) .On the coracoid, the measurements collected were the Coracoid Anterior-Posterior length (CoracAP), the Coracoid Medial-Lateral (CoracML) distance and the Coracoid Superior-Inferior (CoracSI) distance. Those measurements were summarized and underwent statistical comparison between genders. The results were compared with other anatomical studies in the same bone anatomy. ResultsWe recorded a mean glenoid length (GlenAP) of 28.03 mm (SD = 0.45) and mean glenoid height (GlenSI) of 37,18 mm (SD =0,55). The mean glenoid dimensions differ significantly between male and female gender (p=0,002 and p=0,001, respectively).The coracoid mean length was 22,35 mm (SD=0.47), mean coracoid width was 14,97 mm (SD=0,30), mean coracoid height was9,51 mm (SD=0,22), and those measures also differ significantly between genders. The observed mean values were similar to those previously reported in other anatomical studies. DiscussionWe observed that coracoid and glenoid dimensions significantly vary between genders for all of the measurements performed. Measurements obtained in this series are comparable with other similar anatomic studies. Although some limitations exists in our study, we consider 3D-printed bone models in the setting of anatomical studies as a relevant option to traditional cadaveric studies. ConclusionGender differences in coracoid and glenoid dimensions were observed and must be considered for the Latarjet procedure. Our results suggest that 3d printed bone models may be used for such evaluation with a good degree of reproducibility of the measurements observed in already published anatomic studies.

Poster 166: Distal Clavicle versus Traditional and Congruent Arc Latarjet: Comparison of Surface Area and Glenoid Apposition with 3-Dimensional CT and MRI

Objectives: Limited studies have compared graft-glenoid apposition and glenoid augmentation area between the latarjet and distal clavicle grafts in glenohumeral stabilization. Additionally, pre-operative planning is typically performed using computerized tomography (CT), and few studies have used 3- dimensional magnetic resonance imaging (3D-MRI) reformations to assess graft dimensions. The purpose of the study was two-fold: 1) compare bony apposition, glenoid augmentation, and graft width among coracoid and distal clavicle bone augmentation techniques and 2) to determine the viability of 3D-MRI to assess bone graft dimensions. Methods: Twenty-four patients with recurrent glenohumeral instability and bone loss were included in this study. 3D-CT and 3D-MRI reformations were utilized to measure pertinent dimensions for five orientations of coracoid and distal clavicle autografts: (1) standard Latarjet (SLJ), (2) congruent arc Latarjet (CLJ), and (3) distal clavicle attached by its posterior surface, (DCP) and (4) inferior surface (DCI), and (5) resected end (DCR). Glenoid augment area was defined as the graft surface area contributing to the glenoid. Bone-on-bone apposition was defined as the graft-glenoid contact area for bone healing potential, and graft width was pertinent for fixation technique. Paired t-tests were performed to compare graft sizes between patients and compare 3D-CT vs 3D-MRI measurements. Results: CLJ had the largest glenoid augmentation area (mean: 318mm2, sd: 74) while SLJ displayed the most apposition (mean: 318mm2, sd: 74). DCI had the largest graft width (mean: 21mm, sd: 4). Paired t- tests revealed no significant differences between Latarjet methods, whereas distal clavicle grafts varied significantly with orientation. All 3D-CT and 3D-MRI measurements were within 1mm of each other, and only two demonstrated statistically significant difference (coracoid width: 13.03 vs 13.98mm, p=0.010; distal clavicle thickness: 9.69 vs 10.77, p=0.002). 3D-CT and 3D-MRI measurements demonstrated strong positive correlation (r>0.6 and p<0.001 for all dimensions). Conclusions: Glenoid augmentation, bony apposition, and graft width can vary with coracoid or distal clavicle graft type and orientation. Differences between 3D-CT and 3D-MRI were small and likely not clinically significant.

Size and morphology of the coracoid and glenoid in pediatric and adolescent patients: implications for Latarjet procedure

Glenohumeral instability is a challenging problem in children and adolescents. For patients with anterior glenoid bone loss, the Latarjet procedure is an effective treatment option. However, concerns about coracoid size and morphology may limit its utilization within this patient population. The purpose of this study was to establish normative data on coracoid and glenoid size and morphology among a large cohort of adolescent patients and describe the anatomic relationships with demographic factors. This is a retrospective cross-sectional study of a consecutive series of 584 patients aged 12-21 years after a chest computed tomography scan for non-shoulder related trauma at a single level I trauma center. Demographic characteristics were collected from the electronic medical record, and the following coracoid anatomic measurements were obtained from computed tomography scans: coracoid length, coracoid thickness, coracoid width, glenoid height, and glenoid width. The ratio of coracoid thickness to glenoid width was calculated to estimate the percent bone loss that could be addressed with a traditional Latarjet coracoid transfer. To ensure reliability among 3 reviewers, all measured the same 25 scans and inter-rater reliability was excellent with all Kappa coefficients >0.81. The remaining scans were divided equally and assessed separately by these reviewers. Correlation coefficients were used to quantify the relationships between all anatomic measures and the age, weight, and height of individuals. Growth curves for each measurement were modeled using quantile regression with height and height∗height as predictors. Additionally, we stratified the growth curves by sex, when significant. Of the 584 subjects, 55% were male, and average age was 19 years (range 12, 21). All growth curves illustrated increase anatomic size across the height range of 145-190 cm. The growth curve including all patients (Fig.1) illustrated that the 50% percentile of median coracoid length increased from approximately 28 to 32 mm. In addition to height, sex was a significant predictor for coracoid width and glenoid width. The median coracoid width increased from approximately 9.5 to 10.2 mm for females compared to an increased width from approximately 10 to 11 mm for males. The median glenoid width for females increased from approximately 21 to 25 mm and for males the median glenoid width increased from just under 22 to 25.5 mm. Among children and adolescents, coracoid and glenoid size are correlated with patient height. These data can help guide patient selection for the Latarjet procedure.

Distal Clavicle Autograft Versus Traditional and Congruent Arc Latarjet Procedures: A Comparison of Surface Area and Glenoid Apposition With 3-Dimensional Computed Tomography and 3-Dimensional Magnetic Resonance Imaging

Background: Limited studies have compared graft-glenoid apposition and glenoid augmentation area between the Latarjet procedure and distal clavicle graft in glenohumeral stabilization. Additionally, preoperative planning is typically performed using computed tomography (CT), and few studies have used 3-dimensional (3D) magnetic resonance imaging (MRI) reformations to assess graft dimensions. Purpose: The purpose of this study was 2-fold: (1) to compare bony apposition, glenoid augmentation, and graft width among coracoid and distal clavicle bony augmentation techniques and (2) to determine the viability of 3D MRI to assess bone graft dimensions. Study Design: Controlled laboratory study. Methods: A total of 24 patients with recurrent glenohumeral instability and bone loss were included in this study. 3D CT and 3D MRI reformations were utilized to measure pertinent dimensions for 5 orientations of coracoid and distal clavicle autografts: (1) standard Latarjet procedure (SLJ), (2) congruent arc Latarjet procedure (CLJ), (3) distal clavicle attached by its posterior surface (DCP), (4) distal clavicle attached by its inferior surface (DCI), and (5) distal clavicle attached by its resected end (DCR). Glenoid augmentation was defined as the graft surface area contributing to the glenoid. Bone-on-bone apposition was defined as the graft-glenoid contact area for bone healing potential, and graft width was pertinent for fixation technique. Glenoid bone loss ranged from 0% to 34%. Paired t tests were used to compare graft sizes between patients and compare 3D CT versus 3D MRI measurements. Results: The CLJ had the largest graft surface area (mean, 318.41 ± 74.44 mm2), while the SLJ displayed the most bone-on-bone apposition (mean, 318.41 ± 74.44 mm2). The DCI had the largest graft width (mean, 20.62 ± 3.93 mm). Paired t tests revealed no significant differences between the Latarjet techniques, whereas distal clavicle grafts varied significantly with orientation. All 3D CT and 3D MRI measurements were within 1 mm of each other, and only 2 demonstrated a statistically significant difference (coracoid width: 13.03 vs 13.98 mm, respectively [P = .010]; distal clavicle thickness: 9.69 vs 10.77 mm, respectively [P = .002]). 3D CT and 3D MRI measurements demonstrated a strong positive correlation (r > 0.6 and P < .001 for all dimensions). Conclusion: Glenoid augmentation, bony apposition, and graft width varied with coracoid or distal clavicle graft type and orientation. Differences between 3D CT and 3D MRI were small and likely not clinically significant. Clinical Relevance: 3D MRI is a viable method for preoperative planning and graft selection in glenoid bone loss.

Radiographic Reference Intervals for Cardiac Size in Common Mynahs (Acridotheres tristis).

Cardiovascular diseases in the common mynah (Acridotheres tristis) often go undiagnosed due to limitations with the physical examination and common concurrent illnesses. The aim of this study was to establish accurate reference intervals for cardiac size based on radiographs for this species. All birds were considered healthy based on physical examination. High-quality ventrodorsal radiographic images were obtained from 34 healthy common mynah birds. The cardiac width (CW), thoracic width, distance between third and fourth ribs, synsacral width, coracoid width, and distance between clavicular bones were evaluated on the ventrodorsal radiographic images. Additionally, the ratio between the CW and these anatomical indices were measured. In order to evaluate the correlation between CW and the radiographic indices, a linear regression model was used. The mean ± SD for CW in the 34 birds was 16.1 ± 0.9 mm (95% confidence interval: 14.1-18 mm). Significant moderate correlation was found for CW with thoracic width (R2 = 0.37; P < 0.001), coracoid width (R2 = 0.25; P = 0.002), and the distance between the third and fourth ribs (R2 = 0.34; P < 0.001). The radiographic reference intervals calculated in this study can be used to evaluate cardiac size in the common mynah bird.

Poster 151: Latarjet Treatment of Anterior Shoulder Instability: The Effect of Pre-Operative MRI Coracoid Dimensions on Post-Operative Outcomes

Objectives:While pre-operative coracoid dimensions have been previously evaluated utilizing CT, no studies have utilized MRI to evaluate coracoid dimensions before Latarjet surgery. Also, no studies have evaluated post-operative outcomes based on pre-operative coracoid dimensions in Latarjet patients. Therefore, the purpose is to determine the effect of coracoid length and width as measured on pre-operative imaging (MRI) on outcomes following Latarjet treatment of anterior shoulder instability. We hypothesized that patients with longer and wider coracoid dimensions would have improved post-operative outcomes after Latarjet treatment for anterior shoulder instability.Methods:Patients who underwent primary Latarjet surgery between 2009-2019 were identified. Inclusion criteria were an available pre-operative MRI and minimum of 2-year post-operative follow-up. Longitudinal coracoid length was measured on axial MRI sequences as the distance from the coracoclavicular ligament insertion to the distal tip. Width measurements were obtained perpendicular to length at three locations – the coracoid base, midpoint and tip – and then averaged. Inter-rater reliability was good for measuring both coracoid length (ICC=0.75) and coracoid width (ICC=0.76). The primary outcomes of interest were recurrent instability, re-operation, complications, rate of and time until return-to-sport (RTS), and American Shoulder and Elbow Surgeons (ASES) score. Comparisons were made between shorter vs. longer coracoid length, narrower vs. wider coracoid width, and male vs. female coracoid dimensions.Results:56 patients were included with an average age of 28.4 years and 16% were female. There were no statistically significant demographic differences between coracoid length and coracoid width groups. Coracoid length averaged 21.6 ± 2.4 mm (range: 16.7-26.9 mm), coracoid width 10.0 ± 1.0 mm (range: 8.3-13.2 mm), and glenoid bone loss 13.7% ± 8.2% (range: 0.0%-32.4%). There were 41 patients (73.2%) with harvestable coracoid length ≥ 20 mm. 55 patients received two coracoid screws for fixation, and only one patient was limited to one screw. Patients with a smaller coracoid length (<22 mm, n=30) had similar rate of recurrent instability (smaller length 6.7% vs. longer length 3.8%), complication (10.0% vs. 15.4%), re-operation (3.3% vs. 7.7%), rate of RTS (76.5% vs. 58.8%), and post-operative ASES scores (85.0 vs. 81.6) (all p>0.05), relative to patients with a larger coracoid length (>22 mm, n=26). Likewise, patients with a smaller coracoid width (<10 mm, n=29) had similar prevalence of recurrent instability (smaller width 6.9% vs. larger width 3.7%), complication (17.2% vs. 7.4%), re-operation (3.5% vs. 7.4%), rate of RTS (66.7% vs. 68.4%), and post-operative ASES scores (87.1 vs. 80.0) (all p>0.05), relative to patients with a larger coracoid length (>10 mm, n=27). Finally, male patients had a larger average coracoid width (10.1 ± 1.0 mm) than female patients (9.3 ± 0.5 mm) (p=0.001).Conclusions:This MRI protocol closely accounts for the specific landmarks utilized during the Latarjet osteotomy by focusing on identification of the CC ligament insertion. A minimum pre-operative coracoid length of 25 mm is not needed as previously stated, as anterior shoulder instability patients experience favorable post-operative outcomes after Latarjet surgery regardless of pre-operative coracoid dimensions based on our findings. Surgeons who are treating patients with significant glenoid bone loss may utilize this MRI protocol if they are concerned about the anatomy of the coracoid pre-operatively.Figure 1.Demonstration of coracoid width measurements. (Figure 2A) First, on the coronal T1 weighted oblique sequence the coracoclavicular ligaments were identified (between the red arrows), outlined by fat, including the more medial trapezoid ligament and lateral conoid ligament. (Figure 2B) Using scout localizers, the insertion of the coracoclavicular ligaments on the fluid sensitive axial sequence was identified (red arrow). A line from this point to the anterior margin of the glenoid was drawn (yellow dotted line) denoting the width of the coracoid base. Coracoid width measurements were then collected at three locations: 5 mm anteriorly from the coracoid base, midpoint, and 5 mm posteriorly from the coracoid tip. A straight line from the midpoint of the base to tip (not shown) was drawn to approximate coracoid length.Figure 2.Difference between mean pre-operative coracoid length (on left) and width (on right) between female (dark) and male (not dark) patients as measured on MRI. UPLOAD-https://planion-client-files.s3.amazonaws.com/AOSSM/blobs/d06d5b2e-8ec8-40b2-a9b0-fd58358533b7/1/Table_2_Coracoid_Dimensions.doc Table 1.Comparison of post-operative complications, recurrent instability, and re-operation between smaller (<22 mm) and larger (≥22 mm) coracoid length, and between smaller (<10 mm) and larger (≥10 mm) coracoid width. Categorical data presented as n (%), continuous data presented as mean ± standard deviation.Table 2.Comparison of post-operative American Shoulder and Elbow Surgeons (ASES) scores, return to play (RTP) rates, and RTP time between smaller (<22 mm) and larger (≥22 mm) coracoid length, and between smaller (<10 mm) and larger (≥10 mm) coracoid width. Categorical data presented as n (%), continuous data presented as mean ± standard deviation.

Anatomy of the coracoid process in Thais: Cadaveric study and clinical implications

IntroductionThe aim of this study was to investigate the morphology of the coracoid process and its relationship to body height in Thai cadavers. Materials and methodsThirty-four shoulders were dissected, and the coracoid processes were measured for their length, width, thickness, and coracohumeral distance. The association between measured values and body height was analyzed. ResultsThe mean dimension of the coracoid process was 13.1 ± 2.3 mm in width (range 9.6–19.3 mm), 23.7 ± 4.8 mm in length (range 14.4–33.3 mm), and 8.9 ± 1.4 mm in thickness (range 6.7–12.5 mm). The mean coracohumeral distance (CHD) was 9.3 ± 2.1 mm (range 5.6–14.1 mm). Pearson's correlation showed a positive correlation between body height and coracoid width (r = 0.36, p < 0.05) and coracoid thickness (r = 0.50, p < 0.01). Male cadavers showed significantly thicker (p < 0.001) and wider (p < 0.003) coracoids compared to those of females, but not length or CHD. The mean coracoid width for male was 14.6 ± 2.2 mm (range 11.1–19.3 mm) and female was 12.1 ± 1.8 mm (range 11.3–13.1 mm). The mean coracoid thickness for male was 9.8 ± 1.6 mm (range 6.7–12.5 mm) and female was 8.4 ± 1.0 mm (6.7–10.4 mm). ConclusionsThe morphology of the coracoid is influenced by sex and body height. The coracoid thickness and width of the cadavers correlate with body height, but not length or CHD. These findings may help predict the size of the coracoid when surgery involves coracoid size determination.

Radiographic evaluation of cardiac size in the white stork (Ciconia ciconia)

Physical examination of the cardiovascular system in birds is quite difficult compared to other animals. As in humans and mammalian animals, radiography is a reliable diagnostic tool to identify cardiovascular disorders in birds. However, cardiovascular radiography studies for birds are very limited and reference information is lacking. In this study the aim was to determine the reference values of cardiac radiographic measurements that can be used especially in the diagnosis of cardiomegaly in storks, which is a free-living bird species. For this purpose, 26 white storks without cardiovascular disorders were used in the study. Radiographs were taken in lateral and ventrodorsal projections. Five measurements: heart length (61.70 ± 6.69 mm), heart width (51.65 ± 4.84), carina length (139.80 ± 10.05), thoracic width (87.45 ± 6.58), and coracoid width (10.24 ± 1.20) were performed. The ratio of the heart width to thoracic width was 59.16%. The ratio of heart length to carina length was 44.28%. Heart width correlates significantly and positively with the thoracic width (R: 0.556, R2: 0.310, P: 0.003). The heart width can be estimated by using the thoracic width values with the regressionbased formula in the results of this study. Clinically, it can be determined whether an individual case falls between the minimum or maximum reference values for heart width or length. The results presented in this study may provide clinicians with reference information regarding cardiomegaly.

Radiographic Measurements of the Cardiac Silhouette and Comparison with Other Radiographic Landmarks in Wild Galahs (Eolophus roseicapilla).

Simple SummaryCardiac diseases are a common finding in captive parrots. In this retrospective study, the cardiac silhouette of 36 wild galahs was measured in the ventrodorsal and laterolateral projections using radiographic images. The aim of the study was to determine reference values of the width and the length of the heart of wild galahs in relation to other anatomic landmarks. The evaluated reference indicates that the width of the heart is 50–65% of the thoracic width and 570–743% of the coracoid width.Background: Part of the diagnostic workup for cardiac diseases is radiographic imaging. To determine an enlarged heart, species-specific reference values are necessary. Wild birds are rarely diagnosed with cardiac disease, and only a few studies have been done to investigate the cardiac silhouette in wild birds. Methods: In this retrospective study, the cardiac silhouette of 36 wild galahs, presented at the hospital, was investigated in relation to other anatomic landmarks like the thoracic width, clavicula width, synsacrum width, distance between the third and fourth rib, distance of the clavicula, and length and height of the sternum using a digital DICOM viewer. Results: The cardiac width was significant compared to the thoracic width with a minimum to maximum of 50 to 65%. The cardiac width compared with the coracoid width also showed significant results with a minimum to maximum range of 570 to 743%. A significant correlation was found between the weight and the cardiac width and length. Conclusion: The cardiac silhouette in wild galahs is easily measured in both radiographic views, and the heart size can be compared to other anatomical landmarks.

Cadaveric coracoid dimensions in Indian populations for its implications in shoulder instability

Objective: Anterior shoulder instability with glenoid bone loss is a common clinical entity, particularly among young athletic patient population. Nonoperative management and arthroscopic treatment of glenohumeral instability have been associated with high rates of recurrence. Significant bone loss is commonly managed with the bony augmentation mainly Latarjet procedure. However, the bony anatomy of the coracoid in coracoid transfer has not yet been defined in Indian populations. The aims of this study were to describe the coracoid anatomy and average bone dimension of coracoid available for transfer in Indian populations.Methods: We dissected 20 fresh frozen shoulders, exposing the coracoid process and then measured the bony dimensions of the coracoid.Results: The mean coracoid length was 26.03mm (SD, 1.98mm), mean coracoid width was 16.16mm (SD, 1.53mm), mean coracoid height was 9.66mm (SD, 0.82mm). The mean subscapularis vertical dimension at the level of coracoid graft insertion (sling mechanism) was 35.35mm (SD, 4.51mm), mean vertical dimension at subscapularis footprint was 24.82 (SD, 3.28mm) and mean anteroposterior dimension at footprint was 15.98mm (SD, 1.31mm). The mean Coracoacromial ligament length was 2.46mm (SD, 0.24mm)Conclusion: The coracoid dimensionally available for transfer in Indian population are slight less than American populations. Thus facing difficulty in inserting two screws for Latarjet procedure by standard Gillie Walch technique.

A gender-based comparison of coracoid and glenoid anatomy: CT analysis and discussion of potential impact on the Latarjet procedure

The success of the modified Latarjet procedure depends on proper sizing of the coracoid graft. There is no information available regarding the morphometric relationship between the glenoid cavity and the coracoid process for the South African population. This study aims at measuring the relationship between the glenoid and coracoid morphometries and investigates their gender-related differences. Glenohumeral computerized tomography scans of 100 consecutive patients were considered for this study. Morphometric measurements were performed after aligning the coracoid and glenoid in their optimum orientation. These measurements were performed by 2 independent observers. The ratio between glenoid and coracoid measurements was calculated and statistically compared using the Mann-Whitney U test. Intraclass correlation coefficients were calculated to analyze interobserver reliability. All the statistical tests were performed in SPSS v.26, and power calculations in G∗Power v.3.1. An average intraclass correlation coefficient value of 0.79 suggested that the interobserver reliability was good. Except for coracoid length, statistically significant (P < .05) gender differences were observed for all the other morphometries. The coracoid width (16.5 ± 1.4 mm vs. 14.7 ± 1.4 mm) and height (13.6 ± 1.6 mm vs. 10.5 ± 1.5 mm) differed between genders by 1.8 and 3.1 mm, respectively. The glenoid anteroposterior (AP) (25.3 ± 2.9 mm vs. 23.2 ± 2.4 mm) and superioinferior (36.9 ± 1.9 mm vs. 33.7 ± 2.6 mm) measurements differed by 2.1 and 3.3 mm, respectively, between the males and the females. The ratio between the AP width of the glenoid and the coracoid height was also found to be significantly different (P < .05) between the gender groups. These morphometric ratios for the coracoid width (0.66 ± 0.09 mm vs. 0.64 ± 0.08 mm) and the coracoid height (0.55 ± 0.09 mm vs. 0.46 ± 0.07 mm) differed between genders by 0.02 and 0.09, respectively. Measurements taken from computerized tomography scans showed significant differences between genders in absolute measurements and in the ratio of the coracoid height to the glenoid AP distance. This could have implications on the ability of the Latarjet procedure to compensate for bone loss in female patients.

Radiographic Reference Intervals of the Cardiac Silhouette Width in the Bald Eagle (Haliaeetus leucocephalus).

Radiograph imaging is an important diagnostic tool for assessing cardiac size in avian patients. The bald eagle (Haliaeetus leucocephalis), once on the United States Federal List of Endangered and Threatened Wildlife and Plants, is now a thriving species in the United States. However, there is surprisingly little information regarding bald eagle cardiac reference values obtained through radiographic imaging for use in assessment of cardiac disease in this species. This study was performed to establish reference values of cardiac size in the bald eagle. Ventrodorsal radiographic images were taken from 9 healthy birds obtained from a raptor rehabilitation facility. Cardiac silhouette width to thorax width, cardiac silhouette width to sternum width, cardiac silhouette width to hepatic silhouette width, and cardiac silhouette width to coracoid width were obtained. Ratios were calculated between the respective areas measured. The results showed that the cardiac silhouette averages 44%-52% of the thoracic width, 71%-86% of the sternal width, 94%-117% of the width of the hepatic silhouette, and 500%-920% of the coracoid width. In the individuals studied there was a strong correlation between cardiac silhouette width to thoracic and sternal width whereas cardiac width with hepatic and coracoid widths had a moderate to weak correlation respectively. The values obtained in this study can be used to radiographically assess the cardiac size of bald eagles, thus aiding in the diagnosis of cardiomegaly in this species.

A cadaveric morphometric analysis of coracoid process with reference to the Latarjet procedure using the "congruent arc technique".

Congruent arc Latarjet procedure involves rotating the coracoid process so that its inferior surface is flush with the glenoid face, owing to their matching radius of curvature (ROC). However, there has been no cadaveric study to actually measure and compare the ROC of coracoid with glenoid, especially in Indian population. 44 shoulders were dissected in 24 cadavers to measure usable length of coracoid process, width, height, ROC of coracoid and glenoid as well as ulnar length (as proxy of cadaver height). Critical coracoid height and length were estimated based on screw sizes of 2.7mm, 3.5mm, 4mm and 4.5mm, and pair concordance between height and length calculated. ROC of coracoid and glenoid were compared to measure extent of congruency. The mean usable length of coracoid process, width and height at mid-point were 21.8mm, 13.7mm and 8.6mm, respectively. Out of the different screw sizes, 2.7mm screws were found safe in 82% shoulders. 24 coracoid-glenoid pairs fulfilled the operational definition (≤ 5mm) of congruency while rest 20 were seemingly incongruent chiefly due to coracoid variations, with mean ROC difference 4.13mm (95% CI 1.51-6.74mm). The ulnar length was significantly smaller in the incongruent ROC group (p = 0.0002). The available length as well as height of the transferred coracoid must be considered when deciding optimum diameter fixation screws in Latarjet procedure. Owing to smaller anatomic dimensions of coracoid in Indian population, 2.7-mm screws provide the safest fixation option. Also, the ROC of coracoid and glenoid does not match in substantial proportion of the cadavers. Pre-operative planning should include a CT-based assessment of glenoid and coracoid dimensions to decide the technique of Latarjet procedure and the optimum diameter fixation screws required.

Analysis of the coracoid morphology with multiplanar 2D CT and its effects on the graft size in the Latarjet procedure.

In this study, we aimed to reveal the individual differences regarding the size of the coracoid and their effects on the classical and modified Latarjet procedures. Computed tomography images of 120 patients (mean age: 41.18 ± 12.01 years) without shoulder complaints or shoulder instability were evaluated retrospectively. The glenoid width, the surgical graft length, and the coracoid total length, width, and thickness were measured using the multiplanar reconstruction method on the Sectra Picture Archiving and Communications System (PACS) system. Age, gender, side, the dominant hand, and the height of the patients were recorded and the correlations between them were investigated. On the created hypothetical model, the current size of the coracoid was evaluated to determine what size of glenoid defects it could repair by employing the classical and the modified Latarjet techniques. There was no significant difference between the right-hand-dominant group and the left-hand-dominant group in terms of coracoid measurement results (p > 0.05). Again, there was no statistically significant difference between the right and the left side regarding the coracoid size (p > 0.05). A positive correlation could be detected only between age and the coracoid width and thickness (p < 0.05). A positive correlation was also found between the glenoid width and the coracoid width and thickness in both shoulders (p < 0.001). Coracoid thickness could fill in the defects that amounted to 40% of the glenoid width, while the coracoid width could fill in for the defects that were 50% of the glenoid width in both genders. Our study showed that hand dominance and side were not effective on the coracoid dimensions. In addition, it has been shown that the coracoid dimensions did not have a significant effect in the choice of Latarjet technique in terms of defect repair and that repair rates of up to 40% could be achieved in glenoid defects with both techniques.

Best implant choice for coracoid graft fixation during the Latarjet procedure depends on patients\u2019 morphometric considerations

PurposeTo assess the anthropometric dimensions of the coracoid process and the glenoid articular surface and to determine possible implications with the different commercially available Latarjet fixation techniques.MethodsIn a total of 101 skeletal scapulae the glenoid length (GL), the glenoid width (GW), the coracoid length (CL), the coracoid width (CW) and the coracoid thickness (CTh) were measured. In order to assess the ability of the transferred coracoid to restore the glenoid anatomy we created a hypothetical model of 10%, 15%, 20%, 25% and 30% glenoid bone loss. We analyzed four common surgical fixation techniques for the Latarjet procedure (4.5 mm screws, 3.75 mm screws, 3.5 mm screws, and 2.8 mm button). The distances from the superior-inferior and medio-lateral limits of the coracoid using the four different fixation methods were calculated. We hypothesized that the “safe distance” between the implant and the coracoid osteotomy should be at least equal to the diameter of the implant.ResultsThe intra and inter-observer reliability tests were almost perfect for all measurements. The mean GH was 36.8 ± 2.5 mm, the GW 26.4 ± 2.2 mm, the CL 23.9 ± 3 mm, the CW 13.6 ± 2.mm, and the mean CTh was 8.7 ± 1.3 mm. The CL was < 25 mm in 46% of the cases. In cases with 25% and 30% bone loss, the coracoid graft restored the glenoid anatomy in 96% and 79.2% of the cases. With the use of the 4.5 mm screws the “safe distance” was present in 56% of the cases, with the 3.75 mm screws in 85%, with the 3.5 mm screws in 87%, and with the 2.8 mm button in 98% of the cases. The distance from the medio-lateral limit of the coracoid could be significantly increased (up to 9 mm) when smaller-button implants are used.ConclusionsThe coracoid graft could not always restore glenoid defects of 30%. Larger implants could be positioned too close to the osteotomy and the “medio-lateral offset” of the coracoid could be increased with smaller implants.

Radiological study of the Asian coracoid process and clavicle: Implications for coracoclavicular ligament reconstruction

PurposeIatrogenic coracoid and clavicle fracture is a known complication of drilling bone tunnels during anatomic coracoclavicular ligament reconstruction (ACCR). This study aims to measure the dimensions of coracoid process and clavicle in an Asian population to evaluate the suitability of drilling coracoid and clavicle tunnels for ACCR in Asians. MethodsWidth measurements of 196 coracoids and 189 clavicles were obtained after reviewing all computed tomography (CT) scans of the shoulder performed over a 6 years period. Coracoid measurements were made on the CT slice which showed the maximum cross sectional width of the coracoid base. Medial to lateral measurements of the coracoid width were taken on an axial view, 4 mm above the identified junction of the coracoid base and glenoid base. Antero-posterior clavicle width was measured through a point directly above the midpoint of the coracoid and perpendicular to the long axis of the clavicle. ResultsThe overall mean coracoid width was 14.8 mm ± 2.54 mm (range 9.2–23.3 mm) and clavicle width was 17.1 mm ± 2.72 mm (range 11.1–25.3 mm). ConclusionThe Asian coracoid process is smaller than its Western equivalent. More research is required to validate this conclusion as no cadaveric studies with equivalent measurement techniques have been performed on Asians. Given the potentially narrower dimensions of the Asian coracoid process, extra precautions are required to minimize the risk of iatrogenic coracoid and clavicle fractures.

Radiographic Reference Values for the Cardiac Silhouette in Bonelli's Eagle (Aquila fasciata).

Radiographs are an important diagnostic tool available in wildlife hospitals to evaluate the size of the avian heart. Despite the large variety wild birds in the Iberian peninsula, clinical studies addressing these species are lacking. To establish reference values for cardiac size in the Bonelli's eagle (Aquila fasciata), ventrodorsal radiographs of 20 healthy birds were obtained, and the width of the cardiac silhouette, sternum, thorax, coracoid, and hepatic silhouette were measured. The ratios between cardiac width and other mentioned indices were calculated. Results showed that cardiac silhouette width should occupy 81%-93% of sternal width, 48%-57% of thoracic width, and 506%-673% of coracoid width. The cardiac silhouette width was strongly correlated with sternal and thoracic widths. A moderate correlation was found between the width of the heart and the width of the coracoid. No significant correlation was found between width of the cardiac silhouette and the hepatic silhouette. These results support that sternal and thoracic widths should be used preferentially when evaluating the width of the cardiac silhouette in this species. The values obtained in this study can be used as a reference for normal cardiac size when evaluating radiographs of Bonelli's eagles.

Differences in Coracoid and Glenoid Dimensions Based on Sex, Race, and Age: Implications for Use of the Latarjet Technique in Glenoid Reconstruction.

The Latarjet procedure restores shoulder stability through reconstruction of the glenoid arc. Prior investigations of glenoid and coracoid dimensions have been underpowered to detect differences based on sex and race. We sought to establish normative values for glenoid width and coracoid dimensions based on sex, race, and age. In addition, we assessed the restoration of glenoid dimensions using the classic and modified Latarjet techniques (classic technique: placing lateral surface of the coracoid to the glenoid; modified technique: placing inferior surface of the coracoid to the glenoid). A total of 993 cadaveric specimens (n = 1986 scapulae) from people over 18 years of age at the time of death were analyzed. Measurements of maximal glenoid width, coracoid width, thickness, and length were recorded. Statistical analysis was performed to detect differences based on sex and race, while univariable linear regression was used to determine the association of increasing age on measured dimensions. All dimensions of specimens were significantly larger in males than in females. Caucasians possessed larger mean glenoid width, coracoid width, and coracoid length, while coracoid thickness was significantly larger in African Americans. Linear regression analysis found that increasing age was associated with increased glenoid width and coracoid dimensions. Coracoid positioning restored glenoid width in defects measuring 20% of glenoid width using both classic and modified Latarjet techniques, while defects measuring up to 25% were more accurately reproduced using the modified technique. Dimensions were significantly larger in males and in Caucasians, aside from coracoid thickness. Mean dimensions increased with advancing age. Coracoid positioning using classic or modified Latarjet techniques restored glenoid width defects measuring 20% of the glenoid width, while the modified technique allowed for restoration of larger defects.

Anthropometric and Radiologic Measurements of Coracoid Dimensions and Clinical Implications in an Indian Population.

Background:Recurrent shoulder dislocation and anterior instability are most commonly attributed to pathology of the capsulolabral complex with the presence of bony loss at the humeral and glenoid surfaces. Unassessed bone loss has been a cause of failure of primary soft tissue procedures or recurrence of symptoms, despite adequate address of soft tissue pathology.Purpose:To study the anthropometric and radiologic dimensions of the coracoid in relation to glenoid bone loss, its adequacy in filling glenoid defects in an Indian population, and whether the choice of surgical technique (congruent arc vs classical) and graft positioning alters the surgical results. This study also intended to establish whether computed tomography measurements correlate with actual anthropometric measurements.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 64 participants with 108 healthy shoulders were included in this study. Additionally, 100 skeletally mature bone specimens of the scapula were measured to assess glenoid diameter as well as coracoid width and length in 2 perpendicular planes with a humeral subtraction 3-dimensional en face glenoid view.Results:Specimen and participant measurements proved that the congruent arc technique was able to fill up to 50% more glenoid bone loss than the classical technique in an Indian population (mean ± SD, 13.45 ± 6.97 vs 7.96 ± 4.89 mm, respectively), with computed tomography being the best and most accurate modality to study it. The mean difference in the bone block length restoration of the glenoid bony arc was 5.41 ± 2.08 mm. Radii of curvature were congruent in populations of the Indian subcontinent.Conclusion:The congruent arc technique can be performed in an Indian population but with caution and careful presurgical assessment of bone loss. However, adequate coracoid dimension to accommodate the implant for fixation without failure must be ensured, as anthropometry suggests the existence of a subset of the population in whom the graft may have compromised width for accommodating standard implants for fixation.