Saragaglia D, Picard F, Gérard P, Tourne Y, Leroy J M
Service de Chirurgie Orthopédique et de Traumatologie du Sport, CHU de Grenoble, Hôpital Sud, Echirolles.
Rev Chir Orthop Reparatrice Appar Mot. 1994;80(7):651-55.
The aim of this paper is to present an unusual lesion associating anterior instability of the shoulder with a fracture of the horizontal part of the coracoid process. It emphasizes surgical treatment using the Latarjet procedure.
Three cases are presented: One case was a recurrent anterior dislocation of the shoulder associated with a fracture of the horizontal part of the coracoid process; an other case was a painful shoulder associated with pseudarthrosis of the coracoid process and a fracture of the anterior and inferior edge of the glenoid. In the last case there was a recurrent dislocation of the shoulder associated with a pseudarthrosis of the coracoid process detected intra-operatively. All the patients were operated on using the Latarjet's procedure using the fractured coracoid process.
The three cases had a good result.
The association of an anterior dislocation of the shoulder and a fracture of the coracoid process is very unusual. It is often unrecognized because of poor knowledge of this lesion or a poor quality of the radiograms performed in the emergency room. The most likely mechanism is a direct impact of the humeral head against the coracoid process during the dislocation. The fracture is located (as in our 3 cases) at the horizontal part of the coracoid process near its elbow and they are often associated lesions at the anterior and inferior edge of the glenoid. The diagnosis requires good quality radiograms and a Garth's view systematically performed after reducing the dislocation. When the shoulder is painful or unstable, surgical treatment is performed and the Latarjet's procedure takes care of the pseudarthrosis and the instability of the shoulder.
Isolated fractures of the coracoid process are probably uncommon. When there is a fracture of the horizontal part of the coracoid process anterior instability of the shoulder should be suspected. This is the case when the shoulder has never been dislocated and when the standard radiograms are "normal" without "crossing lesions" at the anterior and inferior edge of the glenoid or at the humeral head (Hill-Sach lesion).
本文旨在介绍一种罕见的病变，即肩关节前向不稳定合并喙突水平部骨折。重点阐述采用Latarjet手术的外科治疗方法。
报告3例病例：1例为复发性肩关节前脱位合并喙突水平部骨折；另1例为疼痛性肩关节合并喙突假关节形成及肩胛盂前下缘骨折。最后1例为术中发现的复发性肩关节脱位合并喙突假关节形成。所有患者均采用Latarjet手术，利用骨折的喙突进行治疗。
3例患者均取得良好疗效。
肩关节前脱位与喙突骨折同时存在的情况非常罕见。由于对此类病变认识不足或急诊室X线片质量不佳，这种情况常未被识别。最可能的机制是脱位时肱骨头直接撞击喙突。骨折部位（如我们的3例病例）位于喙突靠近肘部的水平部，且常合并肩胛盂前下缘的相关病变。诊断需要高质量的X线片，复位脱位后应常规拍摄Garth位片。当肩关节疼痛或不稳定时，应进行手术治疗，Latarjet手术可解决假关节问题及肩关节不稳定。
孤立性喙突骨折可能并不常见。当喙突水平部骨折时，应怀疑存在肩关节前向不稳定。当肩关节从未脱位且标准X线片“正常”，肩胛盂前下缘或肱骨头无“交叉病变”（Hill-Sach损伤）时，即为此种情况。
