Erosion of the Coracoid Process After Distal Clavicle Fracture Plate Fixation. An Unreported Complication
Article Sidebar
Published:
Apr 18, 2022
Keywords:
Coracoid erosion, clavicle fracture, complications, reduction, osteosynthesis
Main Article Content
Abstract
Background: Several surgical techniques have been developed to reduce nonunion rates and improve functional outcomes after displaced distal clavicle fractures, including the use of a tension band, the modified Weaver-Dunn procedure, coracoclavicular screw fixation, or locking plates. None of these techniques have been universally accepted, and each one has its own complications. NTo our knowledge, there are no previous publications describing osteolysis of the coracoid process caused by the tip of a cortical screw of a distal LCP plate.
Case summary: We present the case of a 29-year-old male patient who had been treated with an anatomic pre-contoured plate for a distal clavicle fracture. Six months later, he presented to our institution with limiting shoulder pain and tenderness upon the right coracoid process. Standard radiographs of the shoulder showed that the tip of a cortical screw was eroding the coracoid process. Surgery with hardware removal was then performed. One month after surgery, the patient was painless and with a full active shoulder ROM.
Conclusion: Erosion of the coracoid process with plate screw fixation has never been described before. We suggest that extreme precaution should be taken in drilling and measuring the length of screws to avoidpotential complications.
Case summary: We present the case of a 29-year-old male patient who had been treated with an anatomic pre-contoured plate for a distal clavicle fracture. Six months later, he presented to our institution with limiting shoulder pain and tenderness upon the right coracoid process. Standard radiographs of the shoulder showed that the tip of a cortical screw was eroding the coracoid process. Surgery with hardware removal was then performed. One month after surgery, the patient was painless and with a full active shoulder ROM.
Conclusion: Erosion of the coracoid process with plate screw fixation has never been described before. We suggest that extreme precaution should be taken in drilling and measuring the length of screws to avoidpotential complications.
Downloads
Download data is not yet available.
Metrics
Metrics Loading ...
Article Details
How to Cite
García Bistolfi, M., Brandariz, R. N., Montenegro Puigdengolas, N., Rossi, L. A., Tanoira, I., & Ranalletta, M. (2022). Erosion of the Coracoid Process After Distal Clavicle Fracture Plate Fixation. An Unreported Complication. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(2), 253-258. https://doi.org/10.15417/issn.1852-7434.2022.87.2.1452
Section
Case Presentations
Copyright (c) 2022 Revista de la Asociación Argentina de Ortopedia y Traumatología
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
References
1. Ropars M, Thomazeau H, Huten D. Clavicle fractures. Orthop Traumatol Surg Res 2017;103(1S):S53-9.
https://doi.org/10.1016/j.otsr.2016.11.007
2. Luo TD, Ashraf A, Larson AN, Stans AA, Shaughnessy WJ, McIntosh AL. Complications in the treatment of
adolescent clavicle fractures. Orthopedics 2015;38(4):e287-91. https://doi.org/10.3928/01477447-20150402-56
3. Wijdicks FJ, Van der Meijden OA, Millett PJ, Verleisdonk EJ, Houwert RM. Systematic review of the complications
of plate fixation of clavicle fractures. Arch Orthop Trauma Surg 2012;132(5):617-25. https://doi.org/10.1007/s00402-011-1456-5
4. Singh A, Schultzel M, Fleming JF, Navarro RA. Complications after surgical treatment of distal clavicle fractures.
Orthop Traumatol Surg Res 2019;105(5):853-9. https://doi.org/10.1016/j.otsr.2019.03.012
5. Neer CS 2nd. Fractures of the distal third of the clavicle. Clin Orthop Relat Res 1968;58:43-50. PMID: 5666866
6. Oh JH, Kim SH, Lee JH, Shin SH, Gong HS. Treatment of distal clavicle fracture: a systematic review of treatment
modalities in 425 fractures. Arch Orthop Trauma Surg 2011;131(4):525-33. https://doi.org/10.1007/s00402-010-1196-y
7. Van der Meijden OA, Gaskill TR, Millett PJ. Treatment of clavicle fractures: current concepts review. J Shoulder
Elbow Surg 2012;21(3):423-9. https://doi.org/10.1016/j.jse.2011.08.053
8. Shackford SR, Connolly JF. Taming of the screw: a case report and literature review of limb-threatening
complications after plate osteosynthesis of a clavicular nonunion. J Trauma 2003;55(5):840-3; discussion 843.
https://doi.org/10.1097/01.TA.0000085862.32648.05
9. Qin D, Zhang Q, Zhang YZ, Pan JS, Chen W. Safe drilling angles and depths for plate-screw fixation of the clavicle: avoidance of inadvertent iatrogenic subclavian neurovascular bundle injury. J Trauma 2010;69(1):162-8.
https://doi.org/10.1097/TA.0b013e3181bbd617
10. Zaidenberg EE, Voor M, Pereira E, Rossi LA, Zaidenberg CR. Bicortical versus unicortical fixation of plated clavicular fractures: A biomechanical study. Shoulder Elbow 2021;13(4):426-32. https://doi.org/10.1177/1758573220914217
11. Looft JM, Corrêa L, Patel M, Rawlings M, Ackland DC. Unicortical and bicortical plating in the fixation of comminuted fractures of the clavicle: a biomechanical study. ANZ J Surg 2017;87(11):915-20. https://doi.org/10.1111/ans.14139
12. Fazal MA, Saksena J, Haddad FS. Temporary coracoclavicular screw fixation for displaced distal clavicle fractures. J Orthop Surg (Hong Kong) 2007;15(1):9-11. https://doi.org/10.1177/230949900701500103
13. Macheras G, Kateros KT, Savvidou OD, Sofianos J, Fawzy EA, Papagelopoulos PJ. Coracoclavicular screw fixation for unstable distal clavicle fractures. Orthopedics 2005;28(7):693-6. https://doi.org/10.3928/0147-7447-20050701-18
14. Kim DW, Kim DH, Kim BS, Cho CH. Current concepts for classification and treatment of distal clavicle fractures. Clin Orthop Surg 2020;12(2):135-44. https://doi.org/10.4055/cios20010
15. Ockert B, Wiedemann E, Haasters F. Laterale Klavikulafraktur. Klassifikationen und Therapieoptionen [Distal
clavicle fractures. Classifications and management]. Unfallchirurg 2015;118(5):397-406. https://doi.org/10.1007/s00113-015-0003-1
16. Xu Y, Guo X, Peng H, Dai H, Huang Z, Zhao J. Different internal fixation methods for unstable distal clavicle
fractures in adults: a systematic review and network meta-analysis. J Orthop Surg Res 2022;17(1):43.
https://doi.org/10.1186/s13018-021-02904-6
17. Boonard M, Sumanont S, Arirachakaran A, Sikarinkul E, Ratanapongpean P, Kanchanatawan W, et al. Fixation
method for treatment of unstable distal clavicle fracture: systematic review and network meta-analysis. Eur J
Orthop Surg Traumatol 2018;28(6):1065-78. https://doi.org/10.1007/s00590-018-2187-x
https://doi.org/10.1016/j.otsr.2016.11.007
2. Luo TD, Ashraf A, Larson AN, Stans AA, Shaughnessy WJ, McIntosh AL. Complications in the treatment of
adolescent clavicle fractures. Orthopedics 2015;38(4):e287-91. https://doi.org/10.3928/01477447-20150402-56
3. Wijdicks FJ, Van der Meijden OA, Millett PJ, Verleisdonk EJ, Houwert RM. Systematic review of the complications
of plate fixation of clavicle fractures. Arch Orthop Trauma Surg 2012;132(5):617-25. https://doi.org/10.1007/s00402-011-1456-5
4. Singh A, Schultzel M, Fleming JF, Navarro RA. Complications after surgical treatment of distal clavicle fractures.
Orthop Traumatol Surg Res 2019;105(5):853-9. https://doi.org/10.1016/j.otsr.2019.03.012
5. Neer CS 2nd. Fractures of the distal third of the clavicle. Clin Orthop Relat Res 1968;58:43-50. PMID: 5666866
6. Oh JH, Kim SH, Lee JH, Shin SH, Gong HS. Treatment of distal clavicle fracture: a systematic review of treatment
modalities in 425 fractures. Arch Orthop Trauma Surg 2011;131(4):525-33. https://doi.org/10.1007/s00402-010-1196-y
7. Van der Meijden OA, Gaskill TR, Millett PJ. Treatment of clavicle fractures: current concepts review. J Shoulder
Elbow Surg 2012;21(3):423-9. https://doi.org/10.1016/j.jse.2011.08.053
8. Shackford SR, Connolly JF. Taming of the screw: a case report and literature review of limb-threatening
complications after plate osteosynthesis of a clavicular nonunion. J Trauma 2003;55(5):840-3; discussion 843.
https://doi.org/10.1097/01.TA.0000085862.32648.05
9. Qin D, Zhang Q, Zhang YZ, Pan JS, Chen W. Safe drilling angles and depths for plate-screw fixation of the clavicle: avoidance of inadvertent iatrogenic subclavian neurovascular bundle injury. J Trauma 2010;69(1):162-8.
https://doi.org/10.1097/TA.0b013e3181bbd617
10. Zaidenberg EE, Voor M, Pereira E, Rossi LA, Zaidenberg CR. Bicortical versus unicortical fixation of plated clavicular fractures: A biomechanical study. Shoulder Elbow 2021;13(4):426-32. https://doi.org/10.1177/1758573220914217
11. Looft JM, Corrêa L, Patel M, Rawlings M, Ackland DC. Unicortical and bicortical plating in the fixation of comminuted fractures of the clavicle: a biomechanical study. ANZ J Surg 2017;87(11):915-20. https://doi.org/10.1111/ans.14139
12. Fazal MA, Saksena J, Haddad FS. Temporary coracoclavicular screw fixation for displaced distal clavicle fractures. J Orthop Surg (Hong Kong) 2007;15(1):9-11. https://doi.org/10.1177/230949900701500103
13. Macheras G, Kateros KT, Savvidou OD, Sofianos J, Fawzy EA, Papagelopoulos PJ. Coracoclavicular screw fixation for unstable distal clavicle fractures. Orthopedics 2005;28(7):693-6. https://doi.org/10.3928/0147-7447-20050701-18
14. Kim DW, Kim DH, Kim BS, Cho CH. Current concepts for classification and treatment of distal clavicle fractures. Clin Orthop Surg 2020;12(2):135-44. https://doi.org/10.4055/cios20010
15. Ockert B, Wiedemann E, Haasters F. Laterale Klavikulafraktur. Klassifikationen und Therapieoptionen [Distal
clavicle fractures. Classifications and management]. Unfallchirurg 2015;118(5):397-406. https://doi.org/10.1007/s00113-015-0003-1
16. Xu Y, Guo X, Peng H, Dai H, Huang Z, Zhao J. Different internal fixation methods for unstable distal clavicle
fractures in adults: a systematic review and network meta-analysis. J Orthop Surg Res 2022;17(1):43.
https://doi.org/10.1186/s13018-021-02904-6
17. Boonard M, Sumanont S, Arirachakaran A, Sikarinkul E, Ratanapongpean P, Kanchanatawan W, et al. Fixation
method for treatment of unstable distal clavicle fracture: systematic review and network meta-analysis. Eur J
Orthop Surg Traumatol 2018;28(6):1065-78. https://doi.org/10.1007/s00590-018-2187-x