Recurrent Anterior Shoulder Dislocation After Trauma with Coracoid Apophysis Fracture - A Rare Association / Luxação anterior recorrente do ombro após traumatismo com fratura apófise coracoide - Uma associação rara

Abstract Anterior dislocations represent about 96% of total shoulder dislocations, with recurrence/instability being more common in young patients. Injury of other shoulder structures is frequent, namely bony Bankart lesion. However, the association with coracoid apophysis fracture is very rare. The present article describes the clinical case of a 67-year-old man who presented to the emergency department with complaints of persistent omalgia, with acute episodes, beginning after a fall from his own height. The patient also presented history of shoulder trauma 3 months earlier, which was evaluated at another hospital. Shoulder anterior dislocation was observed radiographically, and the computed tomography (CT) confirmed bone erosion of the anteroinferior part of the glenoid (bone loss of about 50% of the anteroposterior diameter in the lower region of the glenoid), with almost complete resorption of the bony Bankart lesion (apparent in later analysis of the radiography of the initial traumatic episode). Connectedly, a transverse fracture of the coracoid apophysis (type II in the Ogawa classification) was diagnosed. The patient was submitted to surgical treatment, with anterior bone stop confection using the remnant of the fractured fragment of the coracoid supplemented by tricortical autologous iliac graft, fixed with cannulated screws (according to the Bristow-Latarjet and Eden-Hybinett techniques). In the postoperative follow-up, a good functional result was observed, with no new episodes of dislocation and no significant pain complaints. A rare association of shoulder lesions is described, and the challenge of their treatment is highlighted, given the late diagnosis, as in the case presented.

Resumo As luxações anteriores representam cerca de 96% do total de luxações do ombro, sendo a recidiva/instabilidade mais comum em pacientes jovens. A lesão de outras estruturas do ombro é frequente, nomeadamente a lesão óssea de Bankart. Contudo, a associação com a fratura da apófise coracoide é muito rara. Este artigo descreve o caso clínico de um homem de 67 anos que recorreu ao serviço de urgência com queixas de omalgia persistente, com episódios de agudização, iniciados após queda da própria altura. O paciente apresentava ainda histórico de trauma do ombro 3 meses antes, avaliado em outro hospital. A luxação anterior do ombro foi constatada radiograficamente, e a tomografia computorizada (TC) do ombro confirmou erosão óssea da vertente anteroinferior da glenoide (perda óssea de cerca de 50% do diâmetro anteroposterior na região inferior da glenoide), com reabsorção quase completa de lesão óssea de Bankart (aparente em análise a posteriori da radiografia do episódio traumático inicial). Associadamente, foi diagnosticada uma fratura transversa da apófise coracoide (tipo II da classificação de Ogawa). O paciente foi submetido ao tratamento cirúrgico, com confecção do batente ósseo anterior utilizando remanescente do fragmento fraturado do coracoide suplementado por enxerto autólogo tricortical do ilíaco, fixados com parafusos canulados (de acordo com as técnicas de Bristow-Latarjet e Eden-Hybinett). No seguimento pós-operatório, foi observado um bom resultado funcional, sem novos episódios de luxação e sem queixas álgicas significativas. Descreve-se uma associação rara de lesões do ombro, e salienta-se o desafio do tratamento das mesmas dado o seu diagnóstico tardio, como no caso apresentado.

Morphological classification and clinical significance of the coracoid process based on CT three-dimensional reconstruction / 解剖学报

Objective To provide anatomical basis for clinical treatment of acromioclavicular joint dislocation by studying the morphology of coracoid process of human scapula. Methods A total of 500 patients with shoulder injury were selected from the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University in Sichuan Province, and 300 patients were selected as subjects, including 159 cases of right shoulder and 141 cases of left shoulder. CT scan images and 3D reconstruction results of scapula of the subjects were collected. The basic morphological characteristics of coracoid process CT images of the subjects were observed, and the relevant parameters were measured, including the longest horizontal distance of the coracoid process tip and the thickness of the midpoint (cd, pp’), the distance from the upper part of the coracoid process scapula to the base and the thickness of the midpoint (mn, kk’). The distance from the apex of the coracoid process to the base of the coracoid process (ab), the longest horizontal distance of the recursion part of the coracoid process (ef), the distance of as (point s was the intersection of point a perpendicular to mn), the distance of hj (point h and j were the intersection of the base of the coracoid process and the recursion part respectively), and ik (point i was the intersection of point k perpendicular to mn and the coracoid process retraction). Results According to the morphological characteristics of coracoid process, they were divided into five types, including peanut 29. 7%; Short rod type accounted for 27. 4%; Melon seed type accounted for 12. 6%; Rod type accounted for 17. 0%; Wedge type accounted for 13. 3%. Through data comparison, it was found that the distance ef and distance hj on the left were larger than those on the right, P<0. 05. All types had statistical difference in comparison distance cd, P<0. 05. The melon seed type showed statistical differences with peanut type, wedge type, long stick type and short stick type in thickness pp’, distance ab and as of point p, P<0. 05. In the comparison of point K thickness kk’, there was statistical difference between melon seed type and other four types, P<0. 05. In the distance ab comparison, there was statistical difference between the short bar type and the other four types, P < 0. 05. Conclusion The study on the morphology of coracoid process can provide anatomical basis for clinical reconstruction of coracoid ligament to treat acromioclavicular joint dislocation.

Research progress of bone graft resorption after Latarjet procedure for treatment of recurrent anterior shoulder dislocation / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of bone graft resorption after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation, and provide a guide for further research on bone graft resorption.@*METHODS@#The relevant literature in recent years was extensively reviewed. The pathogenesis, classification, risk factors, clinical function impact, and management of bone graft resorption after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation were summarized.@*RESULTS@#Bone graft resorption is the common complication after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation. Stress shielding and poor blood supply may contribute to the occurrence of bone graft resorption. The absence of significant preoperative glenoid bone loss, open procedure, earlier graft healing may to be the risk factors for bone graft resorption. Various assessment methods and classification systems are used to evaluate the region and severity of bone graft resorption. Partial resorption may be considered as a natural glenoid remodeling process after the surgery, but severe and complete resorption is proved to be one of the reasons for failed procedures and there is no effective measure to prevent it, except for accepting revision surgery.@*CONCLUSION@#The pathogenesis, risk factors, clinical function impact of bone graft resorption after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation has not been fully elucidated and there is a lack of effective management strategies, so further clinical and basic researches are needed.

Treatment of recurrent anterior shoulder dislocation with bristow-latarjet procedure / Tratamento da luxação anterior recidivante do ombro pela técnica de bristow-latarjet

ABSTRACT Objectives: To describe the clinical and radiographic results of patients with traumatic recurrent anterior shoulder dislocation treated with the Bristow-Latarjet procedure. Methods: Retrospective case series including 44 patients (45 shoulders) who underwent the Bristow-Latarjet procedure. The graft was fixed "standing" in 84% of the shoulders, and "lying" in 16%. Results: The follow-up was 19.25 ± 10.24 months. We obtained 96% of good results, with 2 recurrences presented as subluxation. Graft healing occurred in 62% of cases. The graft was positioned below the glenoid equator in 84% of the cases, and less than 10 mm from its edge in 98%. The external rotation had a limitation of 20.7º ± 15.9º, while the internal rotation was limited in 4.0º ± 9.6º. The limitation of rotation and the position of the graft ("standing" or "lying") did not correlate with graft healing (p>0.05). Bicortical fixation was positively correlated with healing (p <0.001). Conclusion: The Bristow-Latarjet technique is indicated for the treatment of recurrent anterior dislocations and subluxations of the shoulder. It is a safe treatment method, which can be used in people with intense physical activity. Limiting shoulder mobility does not prevent patients from returning to their usual occupations. Level of Evidence IV, Case series.

RESUMO Objetivos: Descrever os resultados clínicos e radiográficos do tratamento da luxação anterior recidivante traumática do ombro pela técnica de Bristow-Latarjet. Métodos: Série de casos retrospectiva, incluindo 44 pacientes (45 ombros) submetidos à técnica de Bristow-Latarjet. O enxerto foi fixado "em pé" em 84% dos ombros, e "deitado" em 16%, utilizando 1 parafuso metálico. Resultados: O seguimento foi de 19,25 ± 10,24 meses. Obtivemos 96% de bons resultados, sendo 2 recidivas sob a forma de subluxação. A consolidação ocorreu em 62% dos casos. O enxerto foi posicionado abaixo do equador da glenoide em 84% das vezes, e a menos de 10 mm da sua borda em 98%. A rotação externa apresentou limitação de 20,7º ± 15,9º, enquanto a rotação interna 4,0º ± 9,6º. A limitação das rotações e a posição do enxerto ("em pé" ou 'deitado") não se correlacionaram com a consolidação do enxerto. A fixação bicortical correlacionou-se positivamente com a consolidação. Conclusões: A técnica de Bristow-Latarjet está indicada para o tratamento da instabilidade anterior recidivante do ombro. É um método de tratamento seguro, que pode ser utilizado em pessoas com atividade física intensa. A limitação da mobilidade do ombro não impede os pacientes de voltarem às suas ocupações habituais. Nível de Evidência IV, Série de casos.

Functional Outcome of Open Latarjet Procedure in NonAthletic Middle-Aged Patie

@#Introduction: The movement and steadiness of the shoulder joint is due to both the dynamic and static stabilisers. Recurrent anterior shoulder instability is common due to the Bankart lesion or the Hill Sachs lesion. The bone loss and soft tissue failure due to these lesions causing instability is well compensated by Latarjet procedure which acts by triple blocking effect of the bone graft, the sling effect of the conjoint tendon of subscapularis and the ligament of the coracoacromial ligament stump. Materials and methods: Middle-aged patients with recurrent anterior shoulder dislocation and a mid-range instability on clinical assessment with an isolated glenoid bone loss of 20% or Bankart lesion with engaging Hill Sachs lesion were selected for the study. The surgical procedure included a subscapularis split to expose the glenoid. The coracoid graft harvested was prefixed with Kirschner wires and placed flush over the glenoid ensuring no medial or lateral overhang and fixed with 4.0mm cancellous screws with the washer. The functional outcome was measured with the ROWE score and ASES score and the movements were evaluated. Results: A total of 24 patients fulfilled the inclusion criteria. Post-operatively at final follow-up, the mean ROWE score was 97.08 ±8.45 and the mean ASES score was 94.4±9.10. One patient had screw breakage as a complication and another had restriction of movement which was managed with physiotherapy. Conclusion: Open Latarjet is an effective procedure for recurrent anterior shoulder instability in non-athletic middleaged patients as a excellent functional outcome was achieved with this technique. We therefore recommend open Latarjet as an alternative to arthroscopic treatment in developing countries where patient affordability and the availability of the resources are the issues.

The axillary arch inserted to the coracoid process compressing the brachial plexus / El arco axilar insertado en el proceso coracoideo comprimiendo el plexo braquial

The axillary arch is a variant slip extending between the latissimus dorsi muscle and the pectoralis major. During educational dissection, a variant muscle was found in left arm of 70-year-old female cadaver. A slip muscle originated from the lateral margin of the latissimus dorsi and crossed the axilla obliquely. Therefore, we defined this muscular variation as axillary arch. It ran anterior (superficial) to the medial and lateral cords of the brachial plexus, and then it inserted to coracoid process. We reported this variant muscle and discussed its clinical significances.

El arco axilar es una variante que se extiende entre el músculo dorsal ancho y el pectoral mayor. Durante la disección educativa, se encontró una variante muscular en el brazo izquierdo de un cadáver de una mujer de 70 años. El músculo deslizante se originó en el borde lateral del dorsal ancho y cruzó la axila oblicuamente. Por lo tanto, definimos esta variación muscular como el arco axilar. Se extendió anterior (superficial) a los cordones medial y lateral del plexo braquial, y luego se insertó en el proceso coracoideo. Reportamos esta variante muscular y discutimos sus significados clínicas.

Acromion, coracoid and glenoid processes of scapula: an anatomical study

Background: Acromion morphology has an important role in impingement syndrome and pathogenesis of rotator cuff diseases. Coracoid process is involved in many surgical procedures of shoulder joint. Dimensions of glenoid process are essential in designing glenoid components for total shoulder replacement. Aim of the study was to measure the various dimensions and note the morphology of acromion, coracoid and glenoid processes of scapula.Methods: Fourty two scapulae (24 right, 18 left) were used and the dimensions of the three processes were measured with digital Vernier calipers.Results: The findings were as follows- length of acromion- 43.57±5.13 mm; width of acromion- 25.03±3.57 mm; acromio-coracoid distance- 33.09±7.02 mm; acromio-glenoid distance- 25.24±4.05 mm; height of coraco-acromial arch- 15.17±3.8 mm; length of coracoid- 38.73±3.72 mm; width of coracoid- 14.28±2.36 mm; tip thickness of coracoid- 8.61±1.89 mm; height of base coracoid- 12.91±2.88 mm; width of base of coracoid- 22.31±3.54 mm; height of glenoid- 34.18±3.53 mm; superior antero-posterior glenoid length- 15.35±2.35 mm and inferior antero-posterior glenoid length- 23.9±2.52 mm.Conclusions: The results will be highly relevant in orthopaedic surgery and manufacturing shoulder prosthesis.

Morphometry Of Acromion Process Of Human Scapulae

Background: The acromion process plays an important role in formation of the shoulder joint and providesstability to the shoulder joint. Acromion process resection is done in case of shoulder impingement syndrome.Materials and Methods: About 100 dry human scapulae were measured for parameters such as length, breadthof acromion process of scapula. The acromio coracoids distance and acromio glenoid distance was measuredusing vernier callipers.Observation: It was observed that the curved type of acromion process was the commonest type. Flat type is leastcommon type. The mean length of acromion process on right side is longer significantly than the left side. Thelength of acromion process on right side is significantly longer than the left side. All the other parameters(Breadth of acromion process, Acromio glenoid distance, acromio clavicular distance on right and left side wasnot significant.Conclusion: The present study provides useful data of dimensions of acromion which may help the orthopaediciansduring surgical repair around the shoulder joint. It will of interest to anthropologists when studying about theevolution of the bipedal gate

Prominent Hardware Post Latarjet Mimicking Shoulder Instability Symptoms

@#A 29-year-old man, who was a medical intern presented with history of recurrent shoulder dislocation. Radiographs and computed tomography imaging revealed a bony bankart lesion with glenoid bone loss of 25% with moderate Hill- Sachs lesion. Latarjet surgery was performed. At post-operative 8 months, the patient experienced pain and clicking in the left shoulder while performing cardiopulmonary resuscitation. At post-operative 1 year, magnetic resonance arthrography showed a united coracoid graft and intact posterior labrum. Left shoulder diagnostic arthroscopy and removal of Latarjet screws through a limited anterior deltopectoral approach were performed. The symptoms pain, clicking and instability sense was caused by either the prominent distal screw or the remnant suture material from the anchor which resulted in impingement of the infraspinatus muscle. We recommend the use of image intensifier to check on the position and length of the screw at the end of the surgery to avoid this complication.

Open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex with coracoid process fracture / 中国修复重建外科杂志

Objective: To investigate the effectiveness of open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex (SSSC) with coracoid process fracture. Methods: Between January 2014 and October 2018, 22 patients with multiple injuries of SSSC with coracoid process fracture were treated by open reduction and internal fixation. There were 16 males and 6 females, aged from 24 to 72 years with an average age of 36.6 years. There were 10 cases of falling injury, 5 cases of traffic accident injury, and 7 cases of falling from height injury. All of them were fresh closed injuries. The time from injury to operation ranged from 2 to 17 days with an average of 6.9 days. Both X-ray film and CT showed the coracoid process fracture complicated with clavicular fracture in 14 cases, acromioclavicular joint dislocation in 12 cases, and acromioclavicular fracture in 5 cases. There were 14 cases of two places of SSSC, 7 cases of three places of SSSC, and 1 case of four places of SSSC. Results: All incisions healed in primary stage after operation. All patients were followed up 10-24 months with an average of 14.1 months. X-ray films showed that all fractures healed and the acromioclavicular joint was normal. The healing time ranged from 6 to 12 months, with an average of 6.2 months. No complications such as internal fixation failure and nonunion occurred. According to University of California Los Angeles (UCLA) shoulder scoring system, the shoulder joint function was rated as excellent in 15 cases, good in 5 cases, and poor in 2 cases at last follow-up. The excellent and good rate was 90.9%. Conclusion: Open reduction and internal fixation for treatment of multiple injuries of SSSC with coracoid process fracture is firm and reliable. Combined with active postoperative rehabilitation program intervention, it can accelerate the recovery of shoulder joint function and achieve satisfactory effectiveness.

Application of supraclavicular fossa puncture in coracoid approach brachial plexus block guided by ultrasound / 临床麻醉学杂志

Objective To evaluate the clinical effect of supraclavicular fossa puncture in coracoid approach brachial plexus block under ultrasonic guidance.Methods Sixty patients scheduled for distal upper extremity surgery, male 33 and female 27, BMI 18.5-28.0 kg/m2, aged 18-60 years old, falling into ASA physical statusⅠ-Ⅲ, were randomly divided into groups A and B, 30 cases in each.Coracoid approach brachial plexus block was carried out under ultrasonic guidance.The puncturing point was located in infraclavicula (group A) or supraclavicular fossa (group B), and 0.5％ropivacaine 20 ml was injected around axillary artery for each patient.The procedure time and the number of needle adjustment were recorded as primary outcome, and the onset time, sensory block score at 15 min after injection, the success rate of block and the incidence of complications were noted also.Results Compared with group A, the procedure time was shorter in group B (P<0.05).There was no significant difference in the number of needle adjustment, onset time, sensory block score at 15 min, the success rate of block and incidence of complications between the two groups.Conclusion Puncturing through supraclavicular fossa can shorten the procedure time of coracoid approach brachial plexus block guided by ultrasound.It is effective and safe, and does not increase the complications.

Functional anatomy and vertical biomechanics of the acromioclavicular joint / 中华创伤骨科杂志

Objective To determine the role of acromioclavicular ligament in maintaining the stability of acromioclavicular joint.Methods In 12 cadaveric specimens of normal shoulder joint which had been routinely treated by formalin,the coracoclavicular ligaments (trapezium and conical ligaments) were dissected and exposed after soft tissue was removed from the surface.The distribution of the insertion and starting points,appearance and attachment area of the trapezium and conical ligaments were observed.The lengths of the 2 ligaments,the coronal and sagittal lengths of the clavicular attachment area,the distances from the most lateral point to the distal end of the clavicle,and the angles at the coronal and sagittal positions of the 2 ligaments were measured.Subsequently,the 12 cadaveric specimens were randomly divided into 4 groups (n =3).Group A retained the intact acromioclavicular ligament,group B the intact coracoclavicular ligament,group C the intact trapezium ligament and group D the intact conical ligament.In an electronic machine for versatile mechanical tests,a 100 mm/min load speed was applied for destructive static stretching of the ligament specimens in the vertical direction.The load-displacement curves were recorded and drawn by a computer in connection with the biomechanical testing machine.The rupture strengths of the 4 ligaments were recorded.Results The average lengths of the conical and trapezium ligaments were 10.6 mm and 12.5 mm,respectively.The coronal and sagittal lengths of the clavicular attachment area of the conical ligament averaged 13.4 mm and 5.8 mm,respectively.The coronal and sagittal lengths of the clavicular attachment area of the trapezium ligament averaged 14.2 mm and 8.7 mm,respectively.The distances from the most lateral points of the conical and trapezium ligaments to the distal clavicle averaged 35.5 mm and 23.6 mm,respectively.The average angles at the coronal and sagittal positions were 6.2° and 11.3° for the conical ligament and 38.7°and 6.9° for the trapezium ligament,respectively.The average tensile force was 201.3 ± 1.9 N for the acromioclavicular ligament rupture,374.6 ± 1.4 N for the coracoclavicular ligament rupture,192.3 ±4.3 N for the trapezium ligament rupture,and 345.7 ± 1.1 N for the conical ligament rupture.Conclusions The roles and contributions of the conical,trapezium and acromioclavicular ligaments are different in maintaining the stability of the acromioclavicular joint.In anatomical reconstruction of the acromioclavicular joint,it is more important to reconstruct the conical ligament and to repair the acromioclavicular ligament simultaneously as much as possible.

Functional anatomy and vertical biomechanics of the acromioclavicular joint / 中华创伤骨科杂志

Objective@#To determine the role of acromioclavicular ligament in maintaining the stability of acromioclavicular joint.@*Methods@#In 12 cadaveric specimens of normal shoulder joint which had been routinely treated by formalin, the coracoclavicular ligaments (trapezium and conical ligaments) were dissected and exposed after soft tissue was removed from the surface. The distribution of the insertion and starting points, appearance and attachment area of the trapezium and conical ligaments were observed. The lengths of the 2 ligaments, the coronal and sagittal lengths of the clavicular attachment area, the distances from the most lateral point to the distal end of the clavicle, and the angles at the coronal and sagittal positions of the 2 ligaments were measured. Subsequently, the 12 cadaveric specimens were randomly divided into 4 groups (n=3). Group A retained the intact acromioclavicular ligament, group B the intact coracoclavicular ligament, group C the intact trapezium ligament and group D the intact conical ligament. In an electronic machine for versatile mechanical tests, a 100 mm/min load speed was applied for destructive static stretching of the ligament specimens in the vertical direction. The load-displacement curves were recorded and drawn by a computer in connection with the biomechanical testing machine. The rupture strengths of the 4 ligaments were recorded.@*Results@#The average lengths of the conical and trapezium ligaments were 10.6 mm and 12.5 mm, respectively. The coronal and sagittal lengths of the clavicular attachment area of the conical ligament averaged 13.4 mm and 5.8 mm, respectively. The coronal and sagittal lengths of the clavicular attachment area of the trapezium ligament averaged 14.2 mm and 8.7 mm, respectively. The distances from the most lateral points of the conical and trapezium ligaments to the distal clavicle averaged 35.5 mm and 23.6 mm, respectively. The average angles at the coronal and sagittal positions were 6.2° and 11.3° for the conical ligament and 38.7°and 6.9° for the trapezium ligament, respectively. The average tensile force was 201.3±1.9 N for the acromioclavicular ligament rupture, 374.6±1.4 N for the coracoclavicular ligament rupture, 192.3±4.3 N for the trapezium ligament rupture, and 345.7±1.1 N for the conical ligament rupture.@*Conclusions@#The roles and contributions of the conical, trapezium and acromioclavicular ligaments are different in maintaining the stability of the acromioclavicular joint. In anatomical reconstruction of the acromioclavicular joint, it is more important to reconstruct the conical ligament and to repair the acromioclavicular ligament simultaneously as much as possible.

Análisis morfométrico de la apófisis coracoides mediante tomografía computarizada en Chile / Morphometric coracoid process analysis by computed tomography in Chile

OBJETIVO: Determinar la morfometría de la apófisis coracoides (Cor) mediante tomografía computarizada de hombro (TC hombro) en población chilena. MÉTODO: 162 TC hombro (90 género femenino y 72 masculino), edad promedio 55,9 20,2 años, fueron analizadas mediante sistema computacional IMPAX. RESULTADOS: Largo total Cor promedio de 41,0 2,5 mm. Largo promedio del pilar superior de 20,5 2 mm. Altura media pilar superior de 9,2 1,2 mm. Ancho promedio pilar superior de 10,3 1,5 mm. Altura media de la base de 13,4 1,8 mm. CONCLUSIÓN: En nuestra población el pilar superior es más ancho que alto y el largo total de Cor es aproximadamente el doble del largo del pilar superior. Todas las dimensiones de Cor son mayores en el género masculino versus femenino. Al comparar la morfometría de Cor, nuestra población es similar a otros grupos étnicos según lo descrito en la literatura. Nivel de evidencia: III.

PURPOSE: Define the morphometric measurements of the coracoid process (Cor) in Chilean population through the analysis of shoulder computed tomography (shoulder CT) METHOD: 162 shoulder TC (90 females and 72 males), average age 55.9 20.2 years, were analyzed by IMPAX software. RESULTS: The mean total Cor length was of 41.0 2.5 mm. Average upper pillar length was 20.5 2 mm. The mean upper pillar height was 9.2 1.2 mm. The mean upper pillar width was 10.3 1.5 mm. Average base height was 13.4 1.8 mm. CONCLUSIONS: In our population, upper pillar is wider than high and the total Cor length is approximately twice than upper pillar length. All Cor dimensions are greater in males versus females. The Cor morphometric measurements in our population is similar to other ethnic groups as described in the literature. Level of evidence: III.

Variations Of Origin And Distance Of Axillary Nerve: A Descriptive Study

Background–Axillary nerve, one of the terminal branches of posterior cord of brachial plexus is more prone for inju-ries. Lack of proper anatomical knowledge and variations of axillary nerve leads to risk of nerve injuries. The present study describes the origin of axillary nerve, its distance of origin from tip of coracoids process. Method: Thirty brachi-al plexuses from fifteen formalin fixed human cadavers of both the sexes were studied by dissection method. Origin and branching pattern of axillary nerve and its distance of origin from the anteromedial aspect of tip of coracoid pro-cess & posterolateral aspect of acromion process was recorded. Results:Out of the 30 specimens studied, axillary nerve was originating from the posterior cord of brachial plexus in 90% of specimens, remaining 10% specimens showed a common trunk of origin of axillary nerve from posterior cord of brachial plexus. The mean distance of origin of axillary nerve from the anteromedial aspect of tip of coracoid process and posterolateral aspect of acromion process is 3.98cm & 6.30cm respectively. The axillary nerve terminated into anterior and posterior branch within quadrangular space in 29 specimens. In one specimen articular branch for shoulder joint was not directly arising from axillary nerve instead it is arising from anterior branch of axillary nerve. Conclusion: In studied population Axil-lary nerves display variations in the origin and distance of origin. Knowledge of this variation in axillary nerve is very important to clinicians, anaesthetists and orthopaedic surgeons during surgical exploration of neck, axilla and upper arm, shoulder dislocation, infraclavicular brachial plexus block and fracture of surgical neck of humerus.

Anatomic Study Of The Coracoid Process: Safety Margin For Osteotomy For Shoulder Surgery

Background: Surgical procedures as coracoid osteotomy, transfer, and fixation are used for management ofrecurrent anterior shoulder instability. However, the peculiar anatomy of bony and soft tissue footprints of thecoracoid, as they relate to these surgical procedures, need further detailed studies owing to its clinical importance.Aim of the work: to obtain safety margin for osteotomy of the coracoid process.Materials and methods: The material of this work included twenty upper limbs of formalin preserved specimensobtained from the dissecting room of anatomy department, faculty of medicine, Alexandria University. Dimensionsof the coracoid process were recorded. Anatomical measurements between the tip of the coracoid process to theanterior and posterior margins of the tendon of pectoralis minor were recorded. Distances between the tip of thecoracoid process and the anterior and posterior margins of coracoacromial ligament, coracohumeral ligament,and the most distal point of conoid and trapezoid ligaments were recorded.Results: The mean length, width, and height of the coracoid were 4.25, 1.4, 1.16 cm respectively. The meandistance between the tip of the coracoid process to the anterior and posterior margins of pectoralis minor were1.07 and 2.04 cm respectively. The mean distance between tip of coracoid process and coracoacromial ligament(anterior and posterior margins), coracohumeral, conoid and trapezoid ligaments were 1.32, 2.19, 1.11, 3.70and 2.73 cm respectively.Conclusion: A safety margin of 2.35 cm from the tip of the coracoid process is recommended to avoid injury ofcoracoclavicular ligament. This distance was correlated with the distance between the tip and the posteriormargin of pectoralis minor muscle.

Morphological Variations Of The Coraco-acromial Ligament: A Cadaveric Study

Introduction: The coraco-acromial ligament forms coraco-acromial arch along with acromion and coracoidprocess of scapula which prevent the superior humeral head displacement. It plays a key role in the pathoetiology of sub-acromial impingement syndrome when there are no significant bony abnormalities.Material and Methods: In the present study we have studied 120 formalin preserved upper limbs (right: 60; left:60) of unknown age and sex. Each shoulder was dissected carefully to see coraco-acromial ligament. The CALwas identified with careful blunt dissection to prevent overlooking any thinner bands. We observed the numberof bands present and shape of the ligament. Photographs were taken.Results: Different morphological subtypes of coraco-acromial ligament were observed and classified accordingto Kesmezacar et al. Type II (28.33 %) was the most common then type I (25 %), type IV (17.5 %), type V (15 %), typeIII (11.66%). Anterolateral band of ligament extended antero-laterally to form coracoacromial falx in 51%.Discussion: Coraco-acromial ligament shows different morphological variations in Indian population. Knowledgeof morphological variations of coraco-acromial ligament will be helpful for orthopedic surgeon for clinical andintraoperative decision while dealing with sub-acromial impingement syndrome.

A retrospective study on mandibular coracoid fractures / 华西口腔医学杂志

OBJECTIVE@#This study aimed to analyze the treatment for mandibular coracoid fractures retrospectively.@*METHODS@#A retrospective study on 37 patients with mandibular coracoid fractures treated at Department of Traumatic and Plastic Surgery, West China Hospital of Stomatology, Sichuan University from January 2010 to December 2015 was conducted. Eleven patients were treated conservatively, and 26 patients underwent surgical restoration and internal fixation. Mouth opening and pain degree were used as indicators to analyze treatment results.@*RESULTS@#The 37 cases of coracoid fractures accounted for 3.18% of the total mandibular fractures. The average age of patients was 38.05 years. Satisfactory results were obtained in both treatments. A considerable change in the degree of mouth opening before and after 6 months was found in the two groups. The pain degree before treatment and 1 day after operation, 1 day and 4 weeks after operation, and 4 weeks and 6 months after operation indicated that the two groups did not significantly differ. However, substantial changes between the two groups were found before treatment and 6 months after operation.@*CONCLUSIONS@#Conservative treatment is recommended for patients with linear, temporalis muscle-located, and non-displaced coracoid fractures. Surgical treatment is recommended for patients with large fractures and those with accompanying zygomatic arch and mandible fractures.

Comparison of the anesthetic effects between ultrasound-guided brachial plexus block via costoclavicular approach and ultrasound-guided infraclavicular brachial plexus block via coracoid approach in operations of forearm and hand / 临床麻醉学杂志

Objective To compare the effectiveness between ultrasound-guided brachial plexus block via costoclavicular approach and ultrasound-guided infraclavicular brachial plexus block via cora-coid approach.Methods Fifty-eight patients scheduled for forearm or hand surgery,33 males and 25 females,aged 18-70 years,ASA physical status Ⅰ-Ⅲ,were selected in this study.The patients were equally randomized into two groups:the group of brachial plexus block via costoclavicular approach (group A)and group of infraclavicular brachial plexus block via coracoid approach (group B).0.5 % ropivacaine 20 ml was used for local anesthetic.The anatomic depth of brachial plexus nerve,nerve block operation time,sensory and motor blockade situation were recorded.Results Ultrasonic ima-ging showed the brachial plexus was shallower in group A (2.0±1.2)cm than in group B (3.5± 1.8)cm (P<0.05).Nerve block operation time in group A (2.0±1.5)min was less than that in group B (4.0 ± 1.5 )min (P <0.05 ).After 5 minutes and 10 minutes of the local anesthetic inj ection,the sensory blockade rate of the median nerve,the ulnar nerve,the radial nerve and the muscle cutaneous nerve in group A was higher than in group B (P<0.05).After 10 minutes of the inj ection,the motor blockade rate for the ulnar nerve,the radial nerve and the muscle cutaneous nerve was higher in group A than in group B (P<0.05).There were no dyspnea,nausea,vomiting,tinni-tus and other adverse reactions in the two groups.Conclusion The ultrasound-guided costoclaviculari brachial plexus block is more shallower than the subclavicular plexus block in the anatomic depth,and the nerve-blocked-operating time is shorter;at the same time,the former’s sensory and motor block effects is faster than the later.

Coracoid Process Morphology using 3D-CT Imaging in a Malaysian Population

Introduction: The aims of this study are to define the coracoid process anatomy in a Malaysian population, carried out on patients in Hospital Serdang with specific emphasis on the dimension of the base of coracoid process which is important in coraco-acromial (CC) ligament reconstruction, to define the average amount of bone available for use in coracoid transfer, and to compare the size of coracoid process based on gender and race, and with findings in previous studies. Materials and Methods: Fifteen pairs of computed tomography (CT) based 3-dimensional models of shoulders of patients aged between 20 to 60 years old were examined. The mean dimensions of coracoid were measured and compared with regards to gender and race. The data were also compared to previously published studies. Results: The mean length of the coracoid process was 37.94 ± 4.30 mm. Male subjects were found to have larger-sized coracoids in all dimensions as compared to female subjects. The mean tip of coracoid dimension overall was 19.99 + 1.93mm length x 10.03 + 1.48mm height x 11.63 + 2.12mm width. The mean base of coracoid dimension was 18.96 + 3.71mm length x 13.84 + 1.76mm width. No significant differences were observed with regards to racial denomination. The overall coracoid size measurements were found to be smaller compared to previous studies done on the Western population. Conclusion: This study may suggest that Malaysians have smaller coracoid dimension compared to Caucasians. The findings further suggest that the incidence of coracoid fracture and implants pull out in Malaysian subjects may be higher.