title: Avulsion fracture of the coracoid process in a patient with chronic anterior shoulder instability treated with the Latarjet procedure: a case report.
abstract: BACKGROUND
  Shoulder dislocations can cause acute and chronic instabilities that need to be addressed in order to restore joint functioning. The transfer of the coracoid process has become a feasible surgical procedure in patients with shoulder instability. Several concomitant injuries after recurrent dislocations have been described.
  
  
  METHODS
  A 32-year-old German man presented to our department with a history of recurrent shoulder dislocations. He was diagnosed with an avulsion fracture of the coracoid process and dislocation of an osseous piece with attachment to the conjoined tendons during the surgical transfer of the coracoid process. Therefore, we performed an open Latarjet procedure and reattached the bony piece with the conjoined tendons to the glenoid rim. Three months after the operation the patient presented with a satisfying range of motion and without instabilities or pain. He was able to return to his job.
  
  
  CONCLUSIONS
  Patients suffering from anterior shoulder dislocation might develop accompanying lesions after numerous dislocations that are not present upon first visit. Different techniques for the reconstruction of the glenoid rim and the restoration of shoulder joint stability have been described in the literature. We opted for a coracoid transfer and achieved an optimal reconstruction, as shown on the postoperative computed tomography scan. An avulsion fracture of the coracoid process with dislocation of the conjoined tendons can not only be found in patients suffering a direct trauma as pointed out in the literature, but also in patients with anterior shoulder instability with recurrent anterior shoulder dislocation.
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Sports Medicine, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str, 200, D-51109 Cologne, Germany. marco.schneider@orthopia.com.
authors.forename: Marco Michael
authors.initials: MM
authors.lastname: Schneider
authors.forename: Maurice
authors.initials: M
authors.lastname: Balke
authors.forename: Paola
authors.initials: P
authors.lastname: Koenen
authors.forename: Bertil
authors.initials: B
authors.lastname: Bouillon
authors.forename: Marc
authors.initials: M
authors.lastname: Banerjee
mesh_terms: D000328:Adult; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods; D016059:Range of Motion, Articular; D012540:Scapula / Q000293:injuries* / Q000601:surgery; D012783:Shoulder Dislocation / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery; D013710:Tendons / Q000601:surgery