ANTERIOR INSTABILITY OF THE SHOULDER ASSO CIATED WITH A FRACTURE OF THE CORACOID PROCESS

Purpose of the study The aim of this paper is to present an unusual le sion 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. Material and methods Three ca ses are presented: One case was a recurrent anterior dislocation of th e shoulder associated with a fracture of the horizontal part of the co racoid process; an other case was a painful shoulder associated with p seudarthrosis of the coracoid process and a fracture of the anterior a nd inferior edge of the glenoid. In the last case there was a recurren t dislocation of the shoulder associated with a pseudarthrosis of the coracoid process detected intra-operatively. All the paients were oper ated on using the Latarjet's procedure using the fractured coracoid pr ocess. Results The three cases had a good result. Discussion The assoc iation of an anterior dislocation of the shoulder and a fracture of th e coracoid process is very unusual. It is often unrecognized because o f poor knowledge of this lesion or a poor quality of the radiograms pe rformed in the emergency room. The most likely mecanism is a direct im pact of the humeral head against the coracoid process during the dislo cation. The fracture is located (as in our 3 cases) at the horizontal part of the coracoid process near its elbow and they are often associa ted lesions at the anterior and inferior edge of the glenoid. The diag nosis requires good quality radiograms and a Garth's view systematical ly performed after reducing the dislocation. When the shoulder is pain ful or unstable, surgical treatment is performed and the Latarjet's pr ocedure takes care of the pseudarthrosis and the instability of the sh oulder. Conclusion Isolated fractures of the coracoid process are prob ably uncommon. When there is a fracture of the horizontal part of the coracoid process anterior instability of the shoulder should be suspec ted. 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).