Verma Nikhil, Chahar Deepak, Chawla Ankit, Sreenivasan Ravi, Pankaj Amite
Department of Orthopedics, University College of Medical Sciences, (University of Delhi) and GTB Hospital, Delhi, India.
J Clin Orthop Trauma. 2016 Oct-Dec;7(Suppl 1):99-102. doi: 10.1016/j.jcot.2016.05.009. Epub 2016 Aug 28.
Recurrent anterior shoulder instability following shoulder dislocation has an incidence as high as 68% among the younger population, however its association with coracoid fracture is extremely rare. Majority of coracoid fractures reported earlier have been shown to be associated with seizure disorder. We report a case of displaced coracoid fracture associated with recurrent anterior instability in a patient with no history of seizure disorder and its implications in causation as well as management are discussed. A 28 year old male, paramedic by profession, presented with complaints of multiple episodes of shoulder dislocation of right dominant extremity for last ten months. Pre-operative CT scan showed Hill-Sach's lesion associated with coracoid process fracture. In view of significant engaging Hill-Sach's lesion, bony reconstruction of glenoid to increase the articular arc was planned. However in view of the small coracoid fragment occurred due to fracture, Latarjet's procedure could not be planned and iliac crest bone graft (ICBG) was planned instead. Till date only 10 cases of coracoid fracture with anterior shoulder instability have been reported in English literature. Of the ten cases, six cases had history of seizure disorder while four cases had only traumatic association. In our case as coracoid fragment was small, it could not be used for Latarjet's procedure and instead was fixed to its proximal stump with suture anchors. This case highlight's rare injury pattern and emphasises on good clinico-radiological examination supplemented by high index of suspicion needed to diagnose this unusual presentation.
肩关节脱位后复发性前肩不稳在年轻人群中的发生率高达68%，然而其与喙突骨折的关联极为罕见。早期报道的大多数喙突骨折已被证明与癫痫发作障碍有关。我们报告一例无癫痫发作障碍病史的患者发生的移位性喙突骨折伴复发性前不稳，并讨论其在病因及治疗方面的意义。一名28岁男性，职业为护理人员，因右优势上肢近十个月来多次肩关节脱位前来就诊。术前CT扫描显示Hill-Sach损伤伴喙突骨折。鉴于存在明显的嵌顿性Hill-Sach损伤，计划对肩胛盂进行骨重建以增加关节弧。然而，鉴于骨折导致的喙突小碎片，无法计划进行Latarjet手术，而是计划采用髂嵴骨移植（ICBG）。迄今为止，英文文献中仅报道了10例喙突骨折伴前肩不稳的病例。在这10例病例中，6例有癫痫发作障碍病史，4例仅有创伤性关联。在我们的病例中，由于喙突碎片较小，无法用于Latarjet手术，而是用缝线锚钉将其固定于近端残端。该病例突出了这种罕见的损伤模式，并强调了良好的临床放射学检查以及高度的怀疑指数对于诊断这种不寻常表现的必要性。
