Ye Chun-Xiao, Guo Ying-Bin
Upper Extremity Service, Quanzhou Orthopedic-Traumatological Hospital, Quanzhou 362000, Fujian, China.
Zhongguo Gu Shang. 2024 Oct 25;37(10):1030-4. doi: 10.12200/j.issn.1003-0034.20221196.
To observe the computerized tomography (CT) imaging manifestations of coracoid process fractures associated with acromioclavicular(AC) joint dislocation and make classification and summary, and explore a new classification of coracoid process fracture combined with acromioclavicular joint dislocation.
The medical records of patients with the acute traumatic coracoid process fractures associated with AC joint dislocation who had undergone surgical management with clavicular hook plate fixation between May 2012 and June 2021 were retrospectively reviewed. Patients with fractures or dislocations of other parts of the ipsilateral upper limb, which affect the treatment and prognosis, or with chronic shoulder diseases on the affected side, which affect the function of the shoulder joint, were excluded. Eighteen patients were enrolled, including 10 males and 8 females, aged from 16 to 54 years old at the time of injury. The causes of injury were fall in 15 cases, traffic accident in 2 cases, and high fall in 1 case. The time from injury to operation ranged from 1 to 7 days. The morphology of coracoid process fracture and its corresponding relationship with scapula were observed on CT three-dimensional reconstruction images, and the reduction of coracoid process fracture was observed. The results were classified according to different manifestations and outcomes.
A total of 18 patients with 18 shoulders were included according to the Inclusion and exclusion criteria. Three manifestations of coracoid process fracture associated with acromioclavicular joint dislocation were observed on CT three-dimensional reconstruction images. One case was typeⅠ(avulsion fracture, coracoid process shape remained general intact), and the coracoid process fracture failed to self-reduction after AC joint reduction and fixation;Fifteen patients with type Ⅱ(hinged fracture, in which one side of the coracoid process fracture remained attached to the scapula or was less displaced than the other side of the fracture) had spontaneous reduction after AC joint reduction and fixation, even 7 of them had coracoid process fracture anatomical reduction;In 2 cases of type Ⅲ (translational fracture, coracoid process fracture with approximately parallel profile), coracoid process fracture failed to self-reduce after AC joint reduction and fixation.
The new type of coracoid process fractures associated with acromioclavicular dislocation on CT three-dimensional reconstruction provides an overview of the injury involvement of coracoid process fracture associated with AC joint dislocation, better understand of the nature of the disease, and a reference for clinical diagnosis, treatment and prognosis to the surgeon. Based on the fact that most coracoid fractures especially hinged fractures have spontaneous reduction after AC joint reduction and fixation, we believe that simple fixation of the AC joint is feasible and satisfactory for coracoid process fractures with acromioclavicular joint dislocation, and no surgical intervention is required for coracoid process fractures.
观察喙突骨折合并肩锁关节脱位的计算机断层扫描（CT）影像表现并进行分类总结，探索喙突骨折合并肩锁关节脱位的新分类方法。
回顾性分析2012年5月至2021年6月期间因急性创伤性喙突骨折合并肩锁关节脱位行锁骨钩钢板固定手术治疗的患者病历。排除同侧上肢其他部位骨折或脱位影响治疗及预后，或患侧存在影响肩关节功能的慢性肩部疾病的患者。纳入18例患者，其中男性10例，女性8例，受伤时年龄16至54岁。受伤原因：跌倒15例，交通事故2例，高处坠落1例。受伤至手术时间为1至7天。在CT三维重建图像上观察喙突骨折的形态及其与肩胛骨的对应关系，并观察喙突骨折的复位情况。根据不同表现及结果进行分类。
根据纳入和排除标准，共纳入18例患者18个肩部。在CT三维重建图像上观察到喙突骨折合并肩锁关节脱位有三种表现。Ⅰ型（撕脱骨折，喙突形态基本完整）1例，肩锁关节复位固定后喙突骨折未能自行复位；Ⅱ型（铰链骨折，喙突骨折一侧仍与肩胛骨相连或移位小于骨折另一侧）15例，肩锁关节复位固定后自行复位，其中7例喙突骨折解剖复位；Ⅲ型（平移骨折，喙突骨折形态近似平行）2例，肩锁关节复位固定后喙突骨折未能自行复位。
CT三维重建显示的与肩锁关节脱位相关的新型喙突骨折，为喙突骨折合并肩锁关节脱位的损伤累及情况提供了全面认识，有助于更好地了解疾病本质，为外科医生的临床诊断、治疗及预后提供参考。基于大多数喙突骨折尤其是铰链骨折在肩锁关节复位固定后可自行复位这一事实，我们认为对于肩锁关节脱位合并喙突骨折，单纯固定肩锁关节对喙突骨折是可行且满意的，喙突骨折无需手术干预。
