Gupta Prateek Kumar, Acharya Ashis, Mourya Amit
Department of Orthopaedics, Sir Ganga Ram Hospital, Rajendra Nagar, New Delhi, India.
J Orthop Case Rep. 2016 Nov-Dec;6(5):81-84. doi: 10.13107/jocr.2250-0685.644.
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.
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.
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.
喙突骨折常被漏诊，因为在肩部常规前后位片上看不到骨折，且未安排特殊视图检查。肩关节脱位很常见，但伴有喙突骨折的脱位很少见。本文的目的是介绍一名单侧肩关节前不稳定患者罕见地发生双侧喙突骨折，采用拉塔热手术使用同一骨折的喙突碎片进行治疗的情况。
我们报告一例48岁男性患者，因左肩复发性脱位前来就诊。他5年前曾频繁发作强直阵挛性癫痫。他被诊断患有脑囊尾蚴病，并已成功接受治疗。此后他未再发作癫痫，但仅左侧仍反复出现脱位。检查其左肩时，活动范围正常。发现他即使在活动范围中部也非常担忧。这使我们怀疑存在肩胛盂骨质流失，因此对左肩进行了磁共振成像和三维计算机断层扫描（CT）。CT扫描显示双侧喙突骨折以及肩胛盂骨质流失。在诊断性关节镜检查后，计划进行包括髂嵴骨移植的开放性骨手术，同时考虑到由于喙突骨折可能无法进行拉塔热手术。手术中，我们发现喙突碎片足够大，可以进行拉塔热手术，而不是进行髂嵴骨移植。这本身通过提供一个骨块，在外展和外旋时为肩关节提供了稳定性，无需对希尔-萨克斯损伤进行任何进一步手术。
癫痫患者应接受CT扫描评估，以确定肩胛盂骨质流失、巨大的希尔-萨克斯损伤并排除喙突骨折，从而规划骨稳定手术。由于我们在拉塔热手术中使用了同一骨折的喙突碎片并取得成功，这为骨科界增添了知识。
